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November 22, 2022

NPACE Notes: November 2022

Table of Content

1. From the Director

2. 2023 Conferences

3. Black Friday Sale

4. Partners of NPACE

5. Monthly Article

6. Monthly Wisdom

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From the Director

By: Terri Schmitt, Executive Director

Gratitude, as defined by Merriam-Webster Dictionary, is the state of being grateful. Then, in all capital letters Merriam-Webster’s notes “THANKFULNESS”. Gratitude sums up how I feel today about being with NPACE and the work the organization has done in the last year. Last month, I had the honor of reviewing all of the ‘give-back’ in free continuing education, faculty seats, and student-centric products that NPACE provided thus far in 2022. This give-back I am thankful for and has enhanced my own NP practice.

This month I am grateful we completed the last of our 2022 conferences in Boston and opened registration for our first two conferences of 2023 in Savannah and Denver. The Boston event was one of the high points of the year for me, where NPACE got to celebrate both Veterans’ Day and NP Week with nurse practitioners from across the nation. We were able to read the Massachusetts governor’s proclamation of NP week with our board of directors President, Karen Windle. Continue reading
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2023 Conference Registration

Register for Savannah! Register for Denver!

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Black Friday Sale

NPACE is back again this year with another spectacular Black Friday sale!

Get 50% off your entire cart at the NPACE Learning Center! With a wide selection of more than 120+ individual courses and 20+ bundles, you can find the exact courses you need. Only on November 25th till 11:59 PM EST!

Use Code: BLACKFRIDAY22 at checkout to redeem this offer!

*Excludes NONPF Bundle

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Partners of NPACE

PCEC Free COPD Course

Earn 1.0 CE Credits when you complete this Free CE Course! Available until Nov 30^th– Click HERE TO REGISTER

IDD Healthcare Course (Intellectability)

NPACE has partnered with IntellectAbility to bring clinicians the fundamentals of IDD healthcare, providing learners with pertinent, practical information that can be used immediately in their practices to improve outcomes, reduce suffering, and prevent unnecessary death in their patients with intellectual and developmental disabilities. Use code NPACE22 for $200 off! Register NOW!

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Palliative Care: An idea whose time has come

By: Jackie P. Fournier NP, C. ACHPN

hirley lives with her husband and is constantly surrounded by her grandchildren. They give her joy. Despite ebbing energy, she insists on being surrounded by them. Shirley has been living with throat cancer for about a year. She has received all the established cancer treatments including surgery. Shirley can’t talk but she can express her needs, desires, and loves very easily. I am fortunate enough to care for her in outpatient oncology. I am a palliative care nurse practitioner. Read more

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Monthly Wisdom

CDC Releases 2021 Chronic Disease Statistics

On September 27^th, 2022, the Centers for Disease Control (CDC) released data from the Behavioral Risk Surveillance System (BRSS). This database provides critical information on trends about chronic disease and risk factors. Information from over 400,000 participants helps to track diseases and risk factors for development including depression, asthma, cancer, diabetes, and more. Information on the database release can be found here.

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As always, thank you for supporting NPACE! ____________________________________________________________________________________________________
November 21, 2022

Palliative care: An idea whose time has come

Palliative care: An idea whose time has come

By: Jackie P. Fournier NP, C. ACHPN

Shirley lives with her husband and is constantly surrounded by her grandchildren. They give her joy. Despite ebbing energy, she insists on being surrounded by them. Shirley has been living with throat cancer for about a year. She has received all the established cancer treatments including surgery. Shirley can’t talk but she can express her needs, desires, and loves very easily. I am fortunate enough to care for her in outpatient oncology. I am a palliative care nurse practitioner.

Frequently, palliative care teams are asked “what is palliative care”? Dr. Cicely Saunders and Dr. Balfour Mount are credited for establishing the foundation of palliative care. Dame Cicely Saunders, a nurse, social worker, and physician established the discipline and culture of palliative care. Dr. Mount, a Canadian urologic oncology surgeon coined the name, “Palliative care” to define a specialized healing approach for patients and families dealing with serious illnesses. Each explored the essence of caring through curative care or when a cure could not be attained. At any stage of an illness, palliative care (PC) provides relief of symptoms affecting QOL and offers an extra layer of support to patients, families, healthcare teams, and PC partners¹.

In the early 1980s, PC services for patients with cancer were acknowledged as a needed and essential health service². Serious illnesses with high mortality rates, like heart failure, prompted the American Heart Association to call for PC integration into routine heart failure management³. PC can improve patient-centered outcomes and reduce hospital costs and admission rates. Among patients with lung cancer, those with PC involved had fewer depressive symptoms, lower rates of aggressive treatment at end of life (EOL), and greater family and caregiver satisfaction⁴. In patients with COPD who had an unpredictable disease trajectory, early PC involvement and regular discussions reduced emotional angst, provided time to digest information, and an opportunity to understand the illness⁵. Despite research supporting the benefits of early utilization of PC services, misconceptions persist that PC is only to be used at EOL⁵.

So, the obvious question is, “why do delays in the utilization of PC services persist”? One barrier to the appropriate use of PC may be the name itself. The term PC evokes confusion and fear because of perceived links to active dying or hospice³. Another barrier may be the referrer’s lack of knowledge regarding what PC provides. Despite growing populous needs, the lack of PC providers may also be a barrier to PC referrals^{5, 6}. The PC model focuses on the biopsychosocial needs of those with serious, chronic illness and their families. Palliative care affords an extra layer of support across all healthcare settings that provides an opportunity to optimize care and clarify the goals of care.

(more…)
October 27, 2022

NPACE Notes: October 2022
Table of Content

1. From the Director

2. Bobbie Medical

3. 2022 Nurse Practitioner Week

4. Partners of NPACE

5. Save the Dates!

6. Monthly Wisdom

7. Needs Assessment

8. NOTEWorthy

9. Meet Our New NPACE Staff Members

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From the Director

By: Terri Schmitt, Executive Director

NPACE 2022 Give Back & 2023 Sneak Peek

As a non-profit, NPACE works hard in to give back to the NP community through excellent continuing education and opportunities. Without requiring membership we ensure our content is accessible to any NP. We are proud to note that in 2022 thus far we are able to provide significant giveback in our educational offerings! Below are just a few of the ways we are able to provide continuing education content:
- Thus far, we have provided partner courses each month to over 300 learners totaling over 2,100 registrants.
- Through our work with partner organizations we were able to provide two free continuing education webinars with partners to over 250 registrants. Read more
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Bobbie Medical

Supporting Combination Feeding: Navigating the Spectrum of Infant Supplementation

Join their discussion on Nov 4th, 2022 at 12:30pm EST on Zoom! Register here! Dietitians can claim 0.75 CPEU, and RN can claim 1.0 CE.

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2022 Nurse Practitioner Week: Nov 13 – 19

“NPACE is excited to celebrate Nurse Practitioner Week and thanks all nurse practitioners for what they do to improve healthcare in Massachusetts and the United States.” – Josh Plotkin, COO

Governor Charles D. Baker has proclaimed November 13th – 19th, 2022 as Nurse Practitioner Week with this year theme as: Rising to Meet the Needs of Patients. NPACE will read the proclamation on the 13th of November at our Boston Conference to celebrate NP week and thank all nurse practitioners in Massachusetts and the United States. In celebration of Nurse Practitioner Week, NPACE is also having a sale on our Learning Center.

Check out our Press Release for Nurse Practitioner Week!

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Partners of NPACE

PCEC

Register now for a new Free CE program, New Horizons in Asthma Care.This program is available between Oct 1 – Oct 31 and must be completed by October 31st to earn credit. Register here!

Janssen

Join the Janssen’s virtual discussion on Patient & Provider Perspectives on the Treatment-resistant Depression Journey November 3rd, 2022. The live broadcast will be discussing SPRAVATO, a different option for treating adult patients with treatment-resistant depression. Learn more.

Scynexis

You are invited to an educational event with Scynexis! Virtual Meeting: Women’s health topic on Vulvovaginal Candidiasis Multiple program dates to choose from depending on your state/region! Programs will be concluding in the next two weeks, be sure to check them out now! View Scynexis Program Opportunities!

IntellectAbility

NPACE has partnered with IntellectAbility to bring clinicians the fundamentals of IDD healthcare, providing learners with pertinent, practical information that can be used immediately in their practices to improve outcomes, reduce suffering, and prevent unnecessary death in their patients with intellectual and developmental disabilities. Use code NPACE22 for $200 off. Register NOW!

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Save the dates! 2023 Conference Registration Opening Soon!

NPACE is extremely excited to announce our 2023 conference locations. Registration for NPACE 2023 Conferences will open on our website soon! Follow our social media to stay updated! For NPACE On-Demand courses, check out the NPACE Learning Center!

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Monthly Wisdom

Inflammatory Breast Cancer

By: Mona Williams-Gregory, PhD, DNP, APRN

Inflammatory breast cancer is a rare, very aggressive cancer that accounts for up to 5% of all breast cancers in the US¹. At the time of diagnosis, inflammatory breast cancer is usually stage III or IV¹. As many as 30% of cases involve metastasis². Identifying inflammatory breast cancer can be challenging because symptoms emerge rapidly and may be mistaken for an acute inflammatory process like mastitis³. It is more common among African American women, women under 40, and women who are overweight or obese². Read more ______________________________________________________________________________________________________________________

Needs Assessment

NPACE Values Your Opinion!

NPACE is conducting a brief, 10-minute survey to better understand the learning environments and formats that Nurse Practitioners prefer when selecting their continuing education activities. As we develop our conference plans for 2023, we’d love to hear how we can best serve you at our live conferences and with online learning opportunities.

As a thank you, all survey respondents will receive 10% off any 2023 in-person conference upon completion. In addition, NPACE will also raffle 4 free conference seats to any 2023 in-person conference! Each person who completes the survey will be entered into the raffle to win a free registration to one 2023 in-person conference!

Thank you in advance for sharing your insights with us, and we look forward to seeing you at a future NPACE conference!

Take the survey HERE

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NOTEWorthy

CDC Releases 2021 Chronic Disease Statistics

On September 27^th, 2022, the Centers for Disease Control (CDC) released data from the Behavioral Risk Surveillance System (BRSS). This database provides critical information on trends pertaining to chronic disease and risk factors. Information from over 400,000 participants help to track diseases and risk factors for development including depression, asthma, cancer, diabetes and more. Information on the database release can be found here.

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Meet Our New NPACE Staff Members

Danielle Slavin – Administrative Assistant

I was born and raised in Foxboro, MA. I am now raising my two boys, Brayden and Antonio, in my hometown. I achieved my Bachelor of Science in Criminal Justice from Johnson & Wales University. I truly enjoy a challenge, meeting new people, and strive to learn something new every day. During my free time, I love spending quality time with my family. We enjoy attending Monster Trucks, especially when they come to Gillette.

Maya Nguyen – Public Relations, Communications, and Relationships Coordinator

I recently graduated from Bryant University with a Bachelor of Arts in Communications specialized in PR and Event Planning. I’m a big traveler and a music lover. In 2019, I traveled all the way to Thailand for a concert, and it is by far one of the best experiences I have had traveling. However, my favorite place still has to be Sydney, Australia. When I was 12, I did a study abroad program in Gold Coast and Sydney.It was my first time traveling without my parents. Experiencing a whole new country with my friends truly sparked my interest and love for traveling.

Catherine Frattasio – Event Planner

I began my career in NYC working in the medical education arena, planning pharmaceutical and biotech meetings. I moved back to Boston in 2002 and gained experience planning incentives, sales kick offs, and client events working internally for a technology firm. In 2010, I started my own event planning company in hopes of balancing my growing family and my busy travel schedule. I’m excited to join NPACE and help produce exceptional conferences. My favorite part of planning is seeing an event come to life. I love creating something with a purpose and have a keen understanding of the event goals. Outside of work, I’m a mom of three who keep me busy with their ever-growing sport schedules! I love to travel and spend time with my family and friends. My favorite spot, anytime of the year, is the beach at sunset!

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As always, thank you for supporting NPACE! ____________________________________________________________________________________________________
October 25, 2022

Inflammatory Breast Cancer
Inflammatory Breast Cancer

By: Mona Williams-Gregory, PhD, DNP, APRN

Inflammatory breast cancer is a rare, very aggressive cancer that accounts for up to 5% of all breast cancers in the US¹. At the time of diagnosis, inflammatory breast cancer is usually stage III or IV¹. As many as 30% of cases involve metastasis². Identifying inflammatory breast cancer can be challenging because symptoms emerge rapidly and may be mistaken for an acute inflammatory process like mastitis³. It is more common among African American women, women under 40, and women who are overweight or obese². As a result of lymphatic fluid buildup within the breast, clinical manifestations include bruising or redness, swelling, warmth, pain, itching, dimpling of the skin, or pulling of the nipple^1-3. Traditional mammography may not be useful in diagnosing inflammatory breast cancer. Most women with inflammatory breast cancer do not have a lump and their breast tissue is dense¹. These factors make mammography less definitive, but it can be useful in identifying lymph node involvement. An ultrasound, PET scan, CT scan, or bone scan can also be used to evaluate metastasis¹. A breast biopsy is used to definitively diagnose inflammatory breast cancer^1-3. The standard of care for nonmetastatic inflammatory breast cancer employs a trimodal approach of systemic chemotherapy followed by modified radical mastectomy and radiation^1-3. The survival rate for women with inflammatory breast cancer is lower than that of women with other types of breast cancer^1-4. But outcomes associated with this trimodal approach have favorable control rates⁴, which highlights the importance of early detection and prompt treatment of inflammatory breast cancer. Let’s use breast cancer awareness month as an opportunity to educate our patients about inflammatory breast cancer.

References
1. National Institute of Health (NIH). (2016, January). Inflammatory breast cancer. https://www.cancer.gov/types/breast/ibc-fact-sheet
2. American Cancer Society. (2022, March). Inflammatory breast cancer. https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer/inflammatory-breast-cancer.html
1. Susan G. Komen. (2022, May). Inflammatory breast cancer. https://www.komen.org/breast-cancer/treatment/by-diagnosis/inflammatory-breast-cancer/
1. Hester, R. H., Hortobagyi, G. N., Lim, B. (2021). Inflammatory breast cancer: Early recognition and diagnosis is critical. American Journal of Obstetrics & Gynecology, 4, 392-396. DOI: https://doi.org/10.1016/j.ajog.2021.04.217
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 26, 2022

Lynparza trial stopped at colorectal cancer
By: Maya Nguyen, Master’s in PRCC Candidate, Georgetown School for Continuing Studies.

Lynparza is a targeted therapy for patients with advanced ovarian cancer, metastatic prostate cancer, metastatic pancreatic cancer, and early metastatic breast cancer. Lynparza is an oral medication that works as PARP inhibitor. PARP is a protein that repairs DNA damage in cells, including cancer cells. Lynparza works to stop PARP from repairing the damaged cells, helping to kill cancer cells.

The medication is co-owned by Merck and AstraZeneca. The trial was conducted to determine whether or not the drugs can help patients who have stabilized or gone into remission following treatment with Avastin. Avastin is a medication used alongside with chemotherapy as an anti-angiogenic. It is often used to treat metastatic colorectal cancer.

Lynparza has had its success especially with breast cancer. It helps prevent breast cancer from returning by 42% and lowers the risk of death by 32% in early breast cancer. However, Lynparza has not found its success with colorectal cancer. The trial was stopped at phase 3. The drug was tested alone as well as alongside Avastin. The result of the trial showed that given alone or with Avastin, did not extend survival in patients with metastatic disease.

References
1. Becker, Z. (2022, July 19). In another Lynparza Flop, AstraZeneca, Merck pull the plug on a colorectal cancer trial. Fierce Pharma. Retrieved August 1, 2022, from https://www.fiercepharma.com/pharma/merck-astrazeneca-pull-plug-phase-3-lynparza-trial-colorectal-cancer#:~:text=As%20AstraZeneca%20and%20Merck%20try,was%20found%20unlikely%20to%20suceed
2. Gardner, J. (2022, July 19). Merck terminates Lynparza trial in colorectal cancer. BiopharmaDive. Retrieved July 22, 2022, from https://www.biopharmadive.com/news/lynparza-fail-colorectal-cancer-/627585/.
3. Lynparza® (OLAPARIB)- official patient website. (n.d.). Retrieved August 1, 2022, from https://www.lynparza.com/
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
August 24, 2022

Tobacco and Vaping
Madison Davis MPH Candidate, Brown University School of Public Health

Background

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.

Going all the way back to your biochemistry class you took years ago, we are going to dive into the specific physiological effects of nicotine on the developing brain. The nicotinic acetylcholine receptors (nAChRs) are ligand-gated ion channels found throughout the brain². These channels are responsible for regulating agonist affinity, ion selectivity, desensitization, and downstream signaling². Given its versatile function, nAChRs plays a vital role in the central and peripheral nervous system². However, these receptors have a high affinity for (or really enjoy binding to) nicotine which causes desensitization in the brain of a smoker². There are other subtypes of the receptor that experience similar effects in the caudal brain region which plays an important role in the nicotine addiction pathway². The activation of regions involved with the nicotine addiction pathway (that have high concentrations of nAChR receptors) causes nicotine-induced firing and activity of dopamine neurons in the brain². This process occurs in many different brain regions affecting a variety of systems². Nicotine also plays a similar and important role in the ascending serotonin system³.

All of this means that the limbic system, which controls cognition, emotion, and drug reward, is very vulnerable to developmental issues when exposed to nicotine particularly during adolescence². This sensitivity to nicotine suggests that smoking is not only associated with mood disorders, but may also be the cause⁴.

Not only are there severe effects on the brain and nervous system, but also there can be major damage to the lungs of those who smoke. A 2019 study looked at the vaping-associated lung injuries in individuals who using vapes/e-cigerettes⁵. The presence of diacetyl in vapes is known to cause lung injuries⁵. The warning signs for providers is discussed further below.

Health Law

In 2009, the Tobacco Control Act and “Deeming Rule” were passed to allow the FDA to establish regulations on cigarettes and new tobacco products including e-cigarettes⁶. More recently, in 2019, the federal government increased the age requirement to purchase e-cigarettes from 18 to 21 years of age⁶. In 2020, they went a step further to halt the sale of flavored cartridges and prevent the online sale of e-cigarettes in order to dissuade younger people from purchasing them⁶. Future law directions include a proposed regulation on the amount of nicotine that can be present in an e-cigarettes⁶.

Details for Providers

Individuals who begin smoking during their adolescent life are more likely to use other drugs, engage in high-risk sexual behavior, and develop psychiatric disorders when compared to nonsmoking adolescents^7,8. Given the clear developmental impact that nicotine has on the emotional, cognitive, and addiction pathways of the brain, this is where providers may see deficits in their patients who smoke².

For patients with vaping-associated lung injuries, they may present with mild respiratory symptoms including persistent cough, shortness of breath, or chest pain⁵. However, there is not a clear clinic guideline for this type of illness. Instead, as a provider, you can make the diagnosis by establishing a temporal relationship between vaping and symptoms, rule-out other potential causes for symptoms, and determine if there is improvement with the cessation of smoking⁵. In regard to radiological findings, a hypersensitive pneumonitis pattern that was improved with cessation of smoking has been reported⁵. Additionally, diffuse alveolar hemorrhage, which presents with cough, fever, difficulty breathing, and sometimes coughing up blood, has been found as well⁵. Other conditions include acute lung injury, acute eosinophilic pneumonia organizing pneumonia, lipoid pneumonia, and giant cell interstitial pneumonia⁷.

As a provider it is important to screen patients for smoking history and advise on the potential dangers of vaping particularly between the ages of 12 and 18 years. Furthermore, the cessation of smoking has been found to help improve associated symptoms and may be a valuable first step in treatment⁷.

References
1. Miech R, Johnston L, O’Malley PM, Bachman JG, Patrick ME. Trends in adolescent vaping, 2017–2019. New England Journal of Medicine. 2019;381(15):1490-1491.
2. Yuan M, Cross SJ, Loughlin SE, Leslie FM. Nicotine and the adolescent brain. The Journal of physiology. 2015;593(16):3397-3412.
3. Bang SJ, Commons KG. Age-dependent effects of initial exposure to nicotine on serotonin neurons. 2011;179:1-8.
4. John U, Meyer C, Rumpf H-J, Hapke U. Smoking, nicotine dependence and psychiatric comorbidity—a population-based study including smoking cessation after three years. Drug and alcohol dependence. 2004;76(3):287-295.
5. Henry TS, Kligerman SJ, Raptis CA, Mann H, Sechrist JW, Kanne JP. Imaging findings of vaping-associated lung injury. AJR Am J Roentgenol. 2020;214(3):498-505.
6. Laura Summers M. Curbing the Youth Vaping Pandemic: A Review of How Utah’s Laws and Policies Compare Nationally and to Other States. 2021.
7. Lai S, Lai H, Page JB, McCoy CB. The association between cigarette smoking and drug abuse in the United States. Journal of addictive diseases. 2000;19(4):11-24.
8. Rashad I, Kaestner R. Teenage sex, drugs and alcohol use: problems identifying the cause of risky behaviors. Journal of health economics. 2004;23(3):493-503.

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