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December 22, 2022

NPACE Notes: December 2022
Table of Content

1. From the Director

2. End-of-Year Sale

3. Bobbie Medical

4. 2023 Conference Registrations

5. Partners of NPACE

6. Free CE Opportunity – Become NPACE Content Expert

7. Monthly Article

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From the Director

A year in review

By: Terri Schmitt, Executive Director

Nothing brings reflection for me like the end of the year. It is a time to laugh, cry, embrace the best, and look for opportunities to be better. In reflection, the last 12 months at NPACE have been incredible in many ways. Some of my most fond memories of this past year include
- Being terrified that returning to in-person conferences was not going to work, especially after the January & February Omicron outbreaks and airline staffing shortages.
- Sitting in the front row in Orlando, the first in-person conference in 2 years, to hear Wendy Wright and Sally Miller inspire and provide some of the best in-person education. Continue reading
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End-of-Year Sale

Save 20% off your ENTIRE CART on The NPACE Learning Center

Use code YEAREND22 to redeem
Sale dates: 12/16/22 – 12/31/22

*End of Year Sale Excludes NONPF Bundle

THERE’S MORE

We have added two new FREE courses by Kathy Baldridge, DNP, APRN, FNP-BC, FAANP, FAIPM. Both are available now each with 1.0 CE Credit included!

Alzheimer’s Dementia: The Hippo in the Room

Alzheimer’s disease is the most common cause of dementia. The etiology is unknown and there is no known cure for this devastating progressive neurodegenerative disease. The hippocampus is affected and prevents the patient from forming new memories.

Parkinson’s Back to the Future

Parkinson’s Disease is a common neurologic disorder. Early recognition and treatment are key to slowing the progressive disability that occurs as a result of decreased dopamine. Primary care providers are key to recognizing signs and symptoms of Parkinson’s Disease early.

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Bobbie Medical

Take the Feeding Friendly Pledge

Join the new generation of Feeding Friendly healthcare professionals who are dedicated to improving infant feeding clinical care so that no parent ever feels shame or guilt for how they feed their babies! utm_source=email&utm_content=NPACEdec”>Join here!

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JOIN NPACE IN 2023

In-Person Conferences

Register for Savannah! Register for Denver!

Virtual Conferences

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Partners of NPACE

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!

NONPF

National Organization of Nurse Practitioner Faculties (NONPF) and NursePractitioner Associates for Continuing Education (NPACE) have partnered to offer a 28-credit continuing education program specific to the learning needs of new nurse practitioner (NP) educators.
- Foundations and Theoretical Frameworks of Education
- Curriculum Design
- Student Assessment
- Clinical Education and Evaluation
- Technology and Learning Best PracticesRegister NOW!
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Free CE Opportunity – Become NPACE Content Expert

NPACE appreciates your experience and expertise! We are looking for content experts. As a content expert, you would be asked to review CE courses on our LMS. Your input as a content expert helps NPACE decide if the content is relevant, unbiased, and clinically appropriate. In return for volunteering to review CE content, you will receive all the CE for the content that you review for free. NPACE publishes a monthly newsletter. You may also have an opportunity to write a 500-word article for our newsletter, too. Thank you for your service to our NP community!!!

Please use the link to apply to become an NPACE Content Expert!

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Full Practice Authority

What Does This Mean for our Patients?

By: Mona Williams-Gregory, Ph.D., DNP, APRN

In 1965, the role of the NP was created by Loretta Ford. In this fledgling role, she functioned as a pediatric NP in collaboration with a pediatrician. For several years, the role of the NP remained relatively unchanged and ill-defined with physicians acting in supervisory capacities. In 1971, Idaho was the first state to formally recognize the role and the expansive scope of NPs¹. Increasingly since then, the contributions made by NPs have been well documented and are rich in the literature. By 1994, five states had adopted full practice authority for NPs. Since then, full practice authority has been sweeping the US and has been adopted by 26 states, DC, and two US territories¹. Continue reading

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As always, thank you for supporting NPACE! ____________________________________________________________________________________________________
December 15, 2022

Full Practice Authority: What does this mean for our patients?
Full Practice Authority

What Does This Mean for our Patients?

By: Mona Williams-Gregory, Ph.D., DNP, APRN

In 1965, the role of the NP was created by Loretta Ford. In this fledgling role, she functioned as a pediatric NP in collaboration with a pediatrician. For several years, the role of the NP remained relatively unchanged and ill-defined with physicians acting in supervisory capacities. In 1971, Idaho was the first state to formally recognize the role and the expansive scope of NPs¹. Increasingly since then, the contributions made by NPs have been well documented and are rich in the literature. By 1994, five states had adopted full practice authority for NPs. Since then, full practice authority has been sweeping the US and has been adopted by 26 states, DC, and two US territories¹.

What does full practice authority mean for our patients? Head-to-head studies have compared clinical and quality outcomes of patients cared for by NPs with patients cared for by physicians. Patients cared for by NPs have equivalent, positive clinical outcomes when compared to similar patients cared for by physicians^2,3,4,5,6. When caring for patients, the clinical safety among NPs is equivalent to that of physicians⁶. Care provided by an NP has demonstrated improvement in several clinical indicators. Inpatients cared for by NPs have lower mortality rates³. Outpatients cared for by NPs have fewer ED visits⁵ and fewer hospitalizations^2,5. Overall, the care provided by NPs is associated with lower total healthcare expenditures⁵. Patients cared for by NPs consistently report greater patient satisfaction than when cared for by other health care practitioners⁶. NPs provide superior education and more counseling than any other healthcare provider^4,6. Full practice authority means reduced costs and improved access to quality healthcare services^5,7.

References:
1. Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. J Am Assoc Nurse Pract, 30(3), 120-130.doi: 1-.1097/JXX.000000000000023
1. Liu, C-F., Hebert, P. L., Douglas, J. H., Neely, E. L., Sulc, C. A., Reddy, A., Sales, A. E., & Wong, E. S. (2020). Outcomes in primary care delivery by nurse practitioners: Utilization, cost and quality of care. Health Services Research, 55(2),1 78-189. doi: 10.1111/1475-6773.13246
2. Gupta, S., Balachandran, M., Bolton, G., Pratt, N., Molloy, J., Paul, E., & Tiruvoipati, R. (2021). Comparison of clinical outcomes between nurse practitioner and registrar-led medical emergency teams: a propensity-matched analysis. Critical Care, 25(117). https://doi.org/10.1186/s13054-021-03534-4
3. Kurtzman, E. T., & Barnow, B. S. (2017). A comparison of nurse practitioners, physician assistants, and primary care physicians’ patterns of practice and quality of care in health centers. Med Care, 55(66), 615-622. doi: 10.1097/MLR.0000000000000689
4. Morgan. P. A., Smith, V. A., Berkowitz, T, Edelman, D., Van Houtven, C., Woolson, S. L., Hendrix, C. C., Everett, C. M., White, B. S., & Jackson, G. L. (2019). Impact of physicians, nurse practitioners, and physician assistants on utilization and costs for complex patients. Health Affairs, 38(6). https://doi.org/10.1377/hlthaff.2019.00014
5. Carranza, A. N., Munoz, P., & Nash, A. J. (2020). Comparing quality of care in medical specialties between nurse practitioners and physicians. J Am Assoc Nurse Pract, 33(3), 184-193. doi: 10.1097/JXX.0000000000000394
6. Dillon, D., & Gary, F. A. (2017). Full practice authority for nurse practitioners. Nursing Administration Quarterly, 41(1), 86-93. https://www.researchgate.net/publication/312009196
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.

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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.

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