TSchmitt@npace.org

September 30, 2022

NPACE Notes September 2022
From The Director: Partnership with NONPF now Launched

By: Terri Schmitt, Executive Director

Partnership with NONPF Now Launched!

NPACE is proud to announce the launch of its partnership with the National Organization of Nurse Practitioner Faculty (NONPF). We have been working closely together for nearly 2 years to design and launch a product to help meet the learning needs about the nuances of educating nurse practitioner students. Having been an NP educator for years, I remember the stress that came with not knowing certain documents, how to navigate clinical, how to write exam questions and run exam test statistics, and then how to best teach with technology.

This 28-credit on-demand continuing education program covers topics unique to the learning needs of novice NP educators. In addition, these modules cover complex yet unique aspects of NP education, created exclusively for faculty who are new educators.

The project is broken into five easily navigable modules with learning activities and more! Modules include:
- Foundations and Theoretical Frameworks of Education
- Curriculum Design and Development
- Student Assessment and Test Construction
- Clinical Education and Evaluation
- Technology and Learning Best Practices
If you are a new NP faculty, or are looking to learn more so that you can explore teaching NP students, this educational opportunity is for you! A big thank you to the entire NONPF team for their dedication and time in building the project, the faculty who worked and presented content, and the NPACE staff who spent many hours putting together the final pieces!

For more information check out our learning center page here.

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Upcoming 2022 conferences and 2023 registration coming soon!

In Boston, MA you can shop for the holidays, see pieces of history, or eat great Italian food! You can also join us for free workshops on radiology reading, EKG interpretation, women’s health and more.

If you cannot join us this year, then be looking to 2023, where we are going to new places, changing up our schedule to offer you more down time with more benefits and CE, and making wellness for you a priority. Join us in Savanah at the end of February, Denver in April, Cape Cod in June or October, SanDiego in August, or Phoenix in November! We are also providing full pharmacology conferences in 2023 at some locations! Registration will be open in mid October! Be watching for updates.

Finally, as always NPACE wants to hear from you. What do you need for wellness, continuing education, community with other professionals? We want to start more conversation. Follow us on Instagram, Twitter, LinkedIn or Facebook.

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On Demand: 2022 Conference Packages on Sale!

If you missed joining us in person this year, you still have the opportunity to purchase one of the amazing conferences on demand. Check out the great conferences here. If you have not visited the NPACE Learning Center at learn.npace.org, then you should. Engaging and expert content you need, pharmacology credits, and important topics.

September Wisdom: RAAS

by: Danielle Hebert, DNP, ANP-BC

What does one do with the RAAS inhibitor when a patient experiences hyperkalemia? This has been a question by many providers as well as researchers. There is an incline to stop the RAAS inhibitor and prevent the recurrence of hyperkalemia. A recent study by Leon et al. (2022) found that the discontinuation of RAAS inhibitors resulted in a “higher risk of CV mortality, all-cause mortality, fatal and nonfatal CV events, and dialysis initiation.” As these findings are important in our treatment selection, this is not a ‘one size fits all’ solution. To learn more about the findings from this study and how you may apply them to the care of your patients, please read:

Leon, S. J., Whitlock, R., Rigatto, C., Komenda, P., Bohm, C., Sucha, E., Bota, S. E., Tuna, M., Collister, D., Sood, M., & Tangri, N. (2022). Hyperkalemia-related discontinuation of renin-angiotensin-aldosterone system inhibitors and clinical outcomes in CKD: A population-based Cohort Study. American Journal of Kidney Diseases, 80(2). https://doi.org/10.1053/j.ajkd.2022.01.002

VULVAR CANCER

BY: Suzanne Garcia, CRNP, BSN, Johns Hopkins School of Medicine & Baltimore City Health Department

Vulvar cancer includes cancer of the mons pubis, labia majora, labia minora, clitoris, vestibular bulb, and greater vestibular glands. Geographically, it’s most common in Europe, North and South America, and Oceania.¹

Read more…
September 30, 2022

Vulvar Cancer
Vulvar Cancer

By: Suzanne Garcia, CRNP, BSN

Johns Hopkins School of Medicine & Baltimore City Health Department

        Vulvar cancer includes cancer of the mons pubis, labia majora, labia minora, clitoris, vestibular bulb, and greater vestibular glands. Geographically, it’s most common in Europe, North and South America, and Oceania.¹ Women between the ages of 60 and 80 years old are more likely to develop vulvar cancer; however, it may occur in younger women as well.

     The etiology of the disease process is different in these two groups. In younger women, especially those who smoke, have a history of sexually transmitted infections, are immunodeficient, or have a low socioeconomic status are more like to have HPV associated vulvar cancer.¹These women experience the precursor lesion, vulvar intraepithelial neoplasia (VIN) that is HPV dependent and seldom progresses to squamous cell carcinoma (SCC).²Women over 60 years old typically develop VIN that is HPV independent and progresses to warty/basaloid SCC.² HPV independent vulvar SCC arises from lichen sclerosus, lichen planus, or another form of chronic dermatitis.³ From inflammation, to cellular atypia with advancement to VIN and squamous cell carcinoma¹, SCC is usually diagnosed early and may present as a mass, scaly patch, plaque, pruritis, or ulcer.³

     Although women between 60-80 years old typically develop HPV independent neoplasia, recommendations for examination and diagnosis include vaginal and cervical colposcopy³because HPV is present in 86% of precancerous changes in the vulva.¹ Cystoscopy and/or proctoscopy may be indicated for invasive disease.³

     Surgery is the mainstay of treatment for early stage disease.³ Evaluation of lymph nodes is necessary if the lesion is >1mm deep, or ≥2 cm from vulvar midline. Furthermore, biopsy of the sentinel node is warranted according to Wohlmuth and Wohlmuth-Wieser (2019) “. . . if the tumor is unifocal, has a diameter of less than 4 cm, and the lymph nodes are clinically negative.”^3(p1260)

    Nodal disease is a predictor of outcome. If the sentinel node is positive, treatment with external beam radiation therapy (EBRT), and possibly chemotherapy with dissection of the inguinal node is preferred.³ Although these patients are less likely to have progressive disease, involvement of at least one node drops the 3-year overall survival rate to 56.2% from the 90% of negative nodal disease per the retrospective AGO-CaRE-1-multi center study. Additionally, the five-year recurrence rate is 37% treatment completion.⁴

     Vulvar cancer is often diagnosed in women over 60, but some younger women may be affected. HPV is a factor in this group, while it typically arises from prolonged inflammation later in life. However, colposcopy is a mainstay of diagnosis in both groups. Nodal involvement forecasts outcomes.

References
1. Merlo, S. (2020). Modern treatment of vulvar cancer. Radiol Oncol, 54(4), 371-376. doi: 2478/raon-2020-0053
2. van der Avoort, I. A. M., Shirango, H., Hoevenaars, B. M., et al. (2006). Vulvar squamous cell carcinoma is a multifactorial disease following two separate and independent pathways. Int J Gynecol Pathol, 25(1), 22-29. doi: 10.1097/01.pgp.0000177646.38266.6a
3. Wohlmuth, C., & Wohlmuth-Wieser, I. (2019). Vulvar malignancies: An interdisciplinary perspective. Journal der Deutschen Dermatologischen Gesellschaft, 1257-1273. doi: 10.1111/ddg.13995
4. Te Grootenhuis, N. C., van der Zee, A. G. J., van Doorn, H. C., et al. (2016). Sentinal nodes in vulvar cancer: Long-term follow-up of the Groningen International. Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I. Gynecol Oncol, 140(1). 8-14. doi: 10.1016/j.ygyno.2015.09.077
August 25, 2022

NPACE Notes August 2022

From The Director

By: Terri Schmitt, Executive Director

Happy almost Fall! This time of year, the back to school, changes in schedules, thinking about preparation for fall is a great time. It’s a time to get outside, reorganize the schedule, consider new professional or personal routines, begin preparing for family and friends. Here at NPACE we are doing the same. We are preparing for the final quarter, reviewing the year thus far, and looking ahead to what we want 2023 to be like. I have to say that 2022 return to in person conferences has been such a fantastic thing to experience. Connecting with some amazing attendees, partners, and speakers has been the highlight of this work! We aren’t done yet this year!

In Boston, MA you can shop for the holidays, see pieces of history, or eat great Italian food! You can also join us for free workshops on radiology reading, EKG interpretation, or women’s health.

If you need a virtual option, besides on demand, we have a $50 1 day event coming Oct, 4th!

If you cannot join us this year, then be looking to 2023, where we are going to new places, changing up our schedule to offer you more down time with more benefits and CE, and making wellness for you a priority. Our registration will be out this fall!

Finally, as always NPACE wants to hear from you. What do you need for wellness, continuing education, community with other professionals? We want to start more conversation. Follow us on Instagram, Twitter, LinkedIn or Facebook.

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On Demand: Upcoming Labor Day Sale

If you have not visited the NPACE Learning Center at learn.npace.org, then you should. Engaging and expert content you need, pharmacology credits, and important topics. Be looking for more information on our big upcoming Labor Day sale!

August Wisdom: Monkey Pox

by: Danielle Hebert, DNP, ANP-BC

Monkeypox-yet another outbreak creating concern and worry amongst our patients. As of August 3, 2022, there was 6,617 confirmed cases in the United States, with higher concentration of cases noted in New York, California, Texas, Florida, Georgia, and Illinois (CDC, 2022). Cases are continuing to climb, emphasizing the need for providers to be familiar with presenting signs and symptoms, at-risk populations, prevention, and treatment. To learn more or to monitor this evolving situation, please go to https://www.cdc.gov/poxvirus/monkeypox/index.html

LUNG CANCER SCREENING: A MAJOR ROLE IN PREVENTATIVE CARE

BY: Jolene Cannaday DNP, AGPCNP-C

On August 1^st we observed World Lung Cancer Day, a day of observance that started in 2012 to help raise awareness and promote overall lung health. Many NPs work in primary care where preventative screening plays a major role. The importance of lung cancer screening is part of this preventative mindset. The United States Preventative Services Taskforce (USPSTF) currently has a Grade B recommendation for lung cancer screening via low-dose computed tomography (LDCT) for 50 – 80-year-old adults who have a 20 pack-year smoking history, currently smoke, or have quit smoking within the past 15 years¹.

Read more…

Tobacco and Vaping

By: Madison Davis MPH Candidate, Brown University School of Public Health

Vaping is an ongoing, dangerous, trend among adolescents. The increase in harmful side effects associated with vaping has led to concern among providers and public health officials. A vape, or an e-cigarette, allows individuals inhale a heated aerosol that usually contains nicotine¹. A monitoring study in 2019 concluded that the prevalence of vaping increased two-fold among eighth grade, tenth grade, and twelfth grade students between 2017 and 2019¹. It is important to observe the increase in vaping among young individuals because of the detrimental effects nicotine has on developing teenagers². During the adolescent period, generally defined as between 12 and 18 years of age, there are critical changes in cognitive and executive function, working memory, reward processing, emotional regulation, and motivated behavior².

Read more…
August 24, 2022

Lung Cancer Screening
LUNG CANCER SCREENING: A MAJOR ROLE IN PREVENTATIVE CARE

By: Jolene Cannaday DNP, AGPCNP-C



On August 1^st we observed World Lung Cancer Day, a day of observance that started in 2012 to help raise awareness and promote overall lung health. Many NPs work in primary care where preventative screening plays a major role. The importance of lung cancer screening is part of this preventative mindset. The United States Preventative Services Taskforce (USPSTF) currently has a Grade B recommendation for lung cancer screening via low-dose computed tomography (LDCT) for 50 – 80-year-old adults who have a 20 pack-year smoking history, currently smoke, or have quit smoking within the past 15 years¹. The USPSTF recommends that screening be discontinued if a patient has not smoked for 15 years, or if they have health issues that greatly limit life expectancy or limit their ability to have lifesaving surgery or treatments¹. When screening a patient’s smoking history remember that one pack-year is the equivalent of smoking an average of 1 pack, 20 cigarettes, every day for one year. On average when calculating this, I ask patients to think about the greatest number of cigarettes they have smoked daily for the longest period of time, because at times a patient’s smoking history may be varied.

            Lung cancer was the second most common cancer and the leading cause of cancer-related death among men and women in the United States in 2020². Screening is an important preventative measure in lung cancer, as many patients with lung cancer presented with metastatic or later disease². Lung cancer has 2 main categories of classification. The first classification is non-small cell lung cancer (NSCLC) which includes adenocarcinoma, squamous cell, and large cell cancers. The second classification is small cell lung cancer which is considered the more aggressive of the two major categories and has lower survival rates. Approximately 80% to 85% of lung cancers are in the NSCLC category³. Risk factors for lung cancer include smoking, which accounts for 90% of all lung cancers, and radiation therapy, environmental exposures, family history, race/ethnicity, and other lung diseases⁴.

            Therefore, lung cancer screening is a pertinent discussion to have with your higher risk patients. Ensure that each patient is screened for smoking history, which will help determine which patients to further discuss this key element of preventative care. During the month of August promote lung cancer awareness and discuss lung cancer screening with other colleagues in your practice. Create an atmosphere of prevention and guideline-based care.

References
1. S Preventative Services Task Force. Lung Cancer Screening. Published March 2021.Accessed July 10, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program: Cancer Stat Facts: lung and bronchus cancer. Accessed July 24, 2022. https://seer.cancer.gov/statfacts/html/lungb.html
2. American Cancer Society. Key statistics for lung cancer. Published 2017. Accessed July 10, 2022. http://www.cancer.org/cancer/lung-cancer/about/key-statistics.html
3. American Cancer Society. What is lung cancer? Published 2019. Accessed July 10, 2022. http://www.cancer.org/cancer/lung-cancer/about/what-is.html

July 21, 2022

NPACE Notes July 2022

July Table of Contents

From The Director

July Splash Sale!

Content Experts Needed

COVID Wisdom

Celebrating HIV Awareness Month with Updates on PrEP

Accidental Drownings

NONPF September Faculty Workshop

From The Director

By: Terri Schmitt, Executive Director

I must admit this summer has been somewhat difficult for me professionally, as I am sure it has for many. Changing state healthcare laws, surges in infectious disease, and limited access to specialists has made my professional practice much more challenging.

The things I am trying to remember…We are literally all in this together.
We all still need to commune together.
We all still need continuing education.

We all still need to fill our own cup, which is easier said than done, but critical ultimately to enhancing our ability to care for others.

Join us and do all of this at our remaining 2022 events.

In Dana Point, CA you can get out on the water, take a morning stroll, join us for yoga, or whale watch! You can also learn in person from Dr. Sally Miller, Dr. Patsy Sulak, and Dr. Josh Hamilton.

In Boston, MA you can shop for the holidays, see pieces of history, or eat great Italian food! You can also join us for free workshops on radiology reading, EKG interpretation, or women’s health.

If you need a virtual option, besides on demand, we have a $50 1 day event coming Oct, 4th!

If you cannot join us this year, then be looking to 2023, where we are going to new places, changing up our schedule to offer you more down time with more benefits and CE, and making wellness for you a priority. Our registration will be out this fall!

Finally, as always NPACE wants to hear from you. What do you need for wellness, continuing education, community with other professionals? We want to start more conversation. Follow us on Instagram, Twitter, LinkedIn or Facebook.

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On Demand in July: Splash Sale!

Get your CE credit poolside this summer! July 5th – 26th, save big on select bundles with 20% off. Take a deep dive into Pediatric/Adolescent Health, Dermatology, and more. Below is the full list of bundles you can save on today and register before these savings are gone! (No code needed)

What’s On Sale?

Dermatology Extras: Acne, Hair, and Injectables Bundle
Women’s Health
Pediatric/Adolescent Health
Hot Topics in Primary Care Bundle Vol 2
2021 Mental Health
2021 Infectious Disease

Content Experts Needed

NPACE appreciates your knowledge and expertise! As a content expert, you are asked to review CE and provide feedback. In return for volunteering to review CE, you receive all of the CE for the content that you review for free. Content Experts may also have an opportunity to write a 500-word article for the NPACE newsletter.

Please use this link to apply to become an NPACE Content Expert: https://airtable.com/shrAmGaJstVnOSXRU

July Wisdom: Paxlovid

by: Danielle Hebert, DNP, ANP-BC
Why do some patients experience a rebound COVID-19 infection and others do not? This is the question that is being asked by many. In May, the CDC issued a Health Advisory informing us about rebound infections occurring after treatment with Paxlovid. However, there have been others who have experienced the same rebound infection phenomenon without having received the treatment. Those who have received Paxlovid may experience a recurrence of symptoms or a positive test 2-8 days after their recovery (CDC, 2022). These occurrences do not preclude the use of Paxlovid as it is very effective in preventing hospital stays associated with COVID-19 infections. This remains to be a fluid situation with more research and literature being published—stay tuned!

CDC Health Advisory https://emergency.cdc.gov/han/2022/pdf/CDC_HAN_467.pdf

Rubin, R. (2022). From positive to negative to positive Again—The mystery of why COVID-19 rebounds in some patients who take Paxlovid. JAMA, 327 (24), 2380-2382. doi: 10.1001/jama.2022.9925.

Celebrating HIV Awareness Month with Clinical Practice Updates on PrEP

Ellen Smith, MSN, MPH, NP-C, WHNP-BC, CIC, CPH

Given the COVID-19 pandemic over the past two years, many nurse practitioners may be unfamiliar with recent clinical practice updates and treatment options in other corners of the infection control field. As we celebrate the month of July as HIV Awareness Month, we turn our attention to developments in the field of HIV prevention, namely HIV PrEP (Pre-exposure prophylaxis). Pre-exposure prophylaxis consists of medications that are prescribed to people at risk for HIV acquisition (such as people who use IV drugs or have high-risk sex)¹.

Join NONPF for their virtual September Faculty Workshop September 15-16!

Click here for more information.

January 4, 2022

NPACE COVID-19 Latest Information

NPACE continues to monitor the rapidly evolving situation related to COVID-19, including CDC recommendations and stay-at-home orders, mandatory self-quarantines for travelers, and other regulations issued at Federal, State, and Local levels.

As a result of ongoing restrictions, the following NPACE conference has been converted to a virtual live event from an in-person event:

NPACE Primary Care & Pharmacology Conference – Nashville (February 6-9)

Registrants of our canceled conference have been notified by email and received guidance on canceling travel arrangements.

As of this time, all other future NPACE conferences are still proceeding as scheduled. We appreciate your patience as we work through this rapidly developing situation nationwide and will provide continuous updates here as needed.

Travel Guidance:

Given the fluidity of the situation, NPACE highly recommends that conference registrants research airline cancellation and rebooking policies before making travel arrangements, and book refundable airfare whenever possible. Registrants should also consider purchasing travel insurance, but we recommend checking with the provider to ensure that it will cover cancellations due to COVID-19. Please read all of the NPACE in-person conference policies here.

Please continue to monitor your email, the NPACE web site, and our social media channels for the latest updates. Any additional questions or concerns may be sent to us at npace@npace.org.
February 13, 2020

AA Women and Heart Disease: More than Half of African-American Women in the United States has Heart Disease

It’s a startling statistic but it’s one that has persisted for several years. African-American women have one of the highest risks for heart disease. Cardiovascular disease claims the lives of more black women than all forms of cancer, accidents, assaults and Alzheimer’s Disease combined, according to the American Heart Association.

As we know, February is American Heart Month, and through education, lifestyle modification, and programmatic support, we can turn the tide on these statistics for our most vulnerable patients. Share this story with your patients of a young African-American woman from Chicago who turned her health around after being diagnosed with hypertension during pregnancy.

According to Target: BP^TM, a national initiative formed by the American Heart Association and the American Medical Association, nearly half of American adults have high blood pressure and many don’t even know they have it. Target: BP helps health care organizations and care teams, at no cost, improve BP control rates through an evidence-based quality improvement program and recognizes organizations committed to improving BP control. Consider joining Target: BP today.
February 5, 2020

National Wear Red Day and American Heart Month

Join NPACE in celebrating American Heart Month. The National Heart, Lung, and Blood Institute (NHLBI) and The Heart Truth® are promoting awareness about heart health and inspiring people to prevent heart disease. This year’s theme, “#OurHearts are Healthier Together,” emphasizes the importance of people working together to make heart healthy lifestyle changes.

Kick off the month by celebrating National Wear Red Day tomorrow, Friday, February 7th to bring greater attention to heart disease as the leading cause of death in the U.S. Use the Wear Red Day resources to help spread the word and get others to join you. Post photos of your events and other community activities, as well as your family, friends, and colleagues wearing red on social media using #OurHearts.

Research shows that strong social support makes getting regular physical activity, eating healthier, reaching and maintaining a healthy weight, and quitting smoking, easier. Heart health also improves when we manage stress and get 7-8 hours of quality sleep each night. Visit the American Heart Month web page to find additional resources to use throughout the month.
January 30, 2020

Year of the Nurse – Celebrating Nurses and Midwives

The World Health Organization (WHO) has designated 2020 the “Year of the Nurse and Midwife” in honor of the 200th birth anniversary of Florence Nightingale. The yearlong campaign will celebrate the central role that nurses and midwives play in health care services around the world.

Part of the campaign is to recognize the achievements of nurses around the world, especially in conflict zones and other hardship areas. Nurses and midwives face many challenges in their day-to-day work, including the increasing need for healthcare services, the increasing cost of services, the prevalence of communicable diseases, access to sanitation and supplies, and differing levels of autonomy, to name a few. Adding to these challenges is the fact that the world needs 9 million more nurses and midwives if it is to achieve universal health coverage by 2030.

To face these challenges, WHO is taking and encouraging action by investing in education of the global medical workforce. This investment involves improving working conditions, advocating for decent pay and involving youth, the next generation of health care workers.

This year, and every year, we should celebrate and recognize the incredibly important role that nurses play in our health care systems and our societies.

Thank YOU!
January 16, 2020

FOLLOWING FARATO – WHEN GOOD WORLDS COLLIDE

In December, we celebrated the upcoming holiday season with the heartwarming story of Karen Windle, RNC, MS, WHNP-BC, long-standing NPACE board member who was about to venture to Farato, a small village in The Gambia, to render care and education. This is both a preamble and a follow-up to that story in which multiple worlds collide in a network of care.

NPACE Executive Director Shelley Yeager, MA LCSW served for many years as Senior Faculty for the International Diabetes Federation’s Young Leaders in Diabetes (YLD) Program. This program trained young adults around the world to educate communities about diabetes and to distribute donated supplies. Lamin, a Young Leader from The Gambia, would take a YLD leadership position, become close to Shelley, and call her “Auntie.” Thus, when Shelley became the Executive Director at NPACE and learned of Karen Windle’s 2017 trip to The Gambia, she reached out to Lamin, hoping he could help Karen in Farato. Shelley wasn’t sure where Lamin was located within the large country and had not been in touch with Lamin for over a year. Still, she messaged him through a commonly-used application. Almost instantly, he replied, “Auntie Shelley, Farato is the village where I was born! I will meet Karen there and do what I can to help her.” And thus, Karen’s world, Shelley’s world, Lamin’s world and the tiny village of Farato collided, and the magic of NPACE friendships began. Now Lamin calls Karen “Auntie.”

Since then, Shelley has worked with local Lions Clubs to gather medical supplies to assist Future for Farato, the small nonprofit which manages the efforts of volunteers and amasses support for education and health care.

Karen Windle is currently in Farato, bestowing her magic. On the very first day, she delivered a healthy baby and instructed village midwives in proper procedures. Along with a volunteer doctor from Domenica she treated a young girl’s leg ulcer, allowing the girl to return to school. She hung donated bed nets to prevent malaria, distributed donated shoes to prevent further injury and infection and educated teenagers about their bodies and the right to say “no.” She made the long trek to the city, Banjul, to see Dr. Gaye, the only diabetes doctor in the region. Here, she gave Dr. Gaye donated meters and strips to allow blood glucose monitoring in the most fragile of patients. She worked hard, celebrated with her village families and made a world of difference.

As we look at a world where bad things happen, let’s take time to celebrate the collision of good work and good worlds – and let’s pay it forward even further. If you are interested in getting involved in volunteering worldwide, please send us a message at syeager@npace.org.