News

Low-risk pregnancies may result in fewer interventions with midwives

A new study from Obstetrics & Gynecology indicates that women with low-risk pregnancies, who delivered in a hospital setting with a midwife, may need fewer interventions and cesarean sections (C-sections) than women who saw obstetricians. However, these results may reveal more questions than answers.

Continue reading »

2018 NPWH Women’s Health Nurse Practitioner Workforce Demographics and Compensation Survey: Highlights Report

The National Association of Nurse Practitioners in Women’s Health (NPWH), in collaboration with the National Certification Corporation (NCC), completed its Women’s Health Nurse Practitioner (WHNP) Workforce Demographics and Compensation Survey in fall 2018. Major objectives of the survey were (1) to obtain detailed demographic information to understand who today’s WHNPs are, where they work, what they do, and which populations they serve, (2) to identify trends in employment compensation specific to WHNPs, (3) to ascertain associations among WHNP education, experience, practice characteristics, and compensation, (4) to identify associations among experience, practice characteristics, and employment/role satisfaction, and (5) to explore trends and attitudes regarding the preceptor role.

Continue reading »

Message from the CEO

As the New Year continues to un- fold, I am excited about all that lies ahead. First, we welcome four new board members:

  • Heidi Fantasia, PhD, RN, WHNP-BC, Assistant Professor at the University of Massachusetts in Lowell
  • Rachel Gorham, MSN, WHNP-BC, AGN-BC, women’s health nurse practitioner at Physicians Medical Center in the State of Washington
  • Shawana Moore, DNP, MSN, CRNP, WHNP, Assistant Professor/WHNP and Program Director at Thomas Jefferson University College of Nursing in Philadelphia, Pennsylvania
  • Sandi Tenfelde, PhD, RN, APN, WHNP-BC, Associate Professor and Director of the Women’s Health Nurse Practitioner program at Loyola University Chicago, Marcella Niehoff School of Nursing, in Illinois.

 

Gay Johnson, CEO

We look forward to working with these WHNPs as part of our team.

Some of you had a sneak peek at our H.E.R. Hub (Health, Education, Resources for Her) while attending the NPWH conference in San Antonio this past October. If you haven’t seen it, check out this link on our website. This portal, which we plan to launch soon, will offer helpful information for you to share with your patients.

2019 marks the sixth year that NPWH is offering the Women’s Sexual Health Course for NPs. This year, the course will be held in Orlando, Florida, from May 30 through June 2. We look forward to welcoming new NPs to the course and are always delighted to see NPs who have attended in the past. This is the only program specifically designed for NPs regarding female sexual dysfunction (FSD). The knowledge and skill-building provided

by this course will help prepare NPs to initiate sensitive discussions with their patients and increase their ability to evaluate, diagnose, and manage FSD. The faculty members for the course are highly trained and sought after for their expertise in the field of sexual medicine. The course schedule appears on the following pages. We look forward to seeing you in Orlando!

– Gay Johnson Chief Executive Officer, NPWH

 

Please download the PDF 1Q March 2019_WH-p19-23
for more information on this course.

NPWH news & updates


Gay Johnson, CEO

Message from the CEO

For almost 23 years, I have had the joy of working for the National Association of Nurse Practitioners in Women’s Health (NPWH). For the past 8 years, I have had the privilege of representing all of you as your Chief Executive Officer (CEO). And now, it is time for me to shift my focus and energy to my family members, who require more time than I have to give. For that reason, I will be retiring as of January 3, 2020.

This decision to retire has not been an easy one for me because serving as CEO of NPWH is not just a job, but a passion. I have truly enjoyed supporting all of you, and I am immensely proud of all that we have been able to accomplish together to advance the profession of women’s health nurse practitioners and other advanced practice nurses who care for women. I have seen NPWH grow and change over the years, and I feel honored to have played a part in seeing this association emerge as a leader in women’s health. We are now sought after as an organizational leader in women’s health by industry and other advocacy groups, and we are highly respected among our fellow healthcare associations. Our opinion matters.

For me, it’s not just about NPWH, the association. It’s also about knowing and working with so many esteemed NPs during my time at NPWH. To this day, I am still in awe of the tireless and compassionate work you do each day to care for women. I extend my heartfelt thanks to each and every one of you for your friendship and support over the years.

– Gay Johnson Chief Executive Officer, NPWH

Editor-in-Chief’s Message | September 2019

beth kelsey editor chief

Dear Colleagues,

In July 2019, the NPWH Board of Directors approved a position statement entitled Eliminating Preventable Maternal Deaths. Readers can find the position statement in this issue of the journal. Within this position statement, NPWH makes a commitment to provide members with continuing education (CE) programs and evidence-based resources regarding causes, contributing factors, and strategies to eliminate preventable pregnancy-related deaths.

This year’s 22nd Annual NPWH Premier Women’s Healthcare Conference provides numerous sessions in various formats that inform NPs about how we can lead in the elimination of preventable pregnancy-related deaths. The preconference day includes a 4-hour panel format presentation, Maternal Mortality: Beyond the Hospital Walls, that focuses on quality improvement (QI) efforts and how to implement relevant Alliance for Innovation on Maternal Health safety bundles in clinical settings. A breakout session, The Heart of the Matter: What Every Obstetrical Provider Must Know About Pregnancy-Related Hypertensive Disorders and Peripartum Cardiomyopathy in 2020, provides important information on these two leading causes of preventable pregnancy-related death. To address growing evidence that mental health disorders and substance abuse are major contributors to maternal mortality—most apparent in the first year postpartum—the conference includes a breakout session, Maternal Mental Health: A Comprehensive Pathway, and a 4-hour American Society of Addiction Medicine (ASAM) Treatment of Opioid Use Disorders Course. The ASAM course, combined with 4 hours of online content, meets the required education to obtain a waiver to prescribe medication-assisted treatment for opioid use disorder. I strongly recommend attending at least one of these sessions.

The journal itself is an excellent avenue for CE and for sharing of evidence-based resources. To that purpose, I am putting out a special call for submission of journal manuscripts on topics related to:
• risk factors that can be identified prior to a pregnancy and mitigated by care individualized to each woman’s needs (See Box 3 of the position statement);
• leading causes of maternal mortality during the pregnancy-through-postpartum continuum (See Box 1 of the position statement);
• strategies for action to address contributing factors for
• pregnancy-related deaths at community, health facility, patient/family, and/or provider levels (See the Table in the position statement);
• racial/ethnic disparities in maternal mortality; and
• addressing implicit bias at provider, health facility, and health system levels.

If you wish to respond to this call for manuscripts, you can access our Guidelines for Authors hereA. If you wish to discuss a potential manuscript topic, please contact me at bkelsey@npwomenshealthcare.com.

Nurse practitioners who provide healthcare for women before, during, and in between pregnancies must heed the call to lead or be part of the collaborative effort needed to make a difference. As you read the position statement, I hope you take to heart and implement at least some of the recommendations. I hope that you get involved in planning and implementing evidence-based maternal mortality prevention strategies not just at provider and patient levels but also at community and health facility levels. You can lead and/or participate in research and QI projects addressing preventable maternal mortality. You can educate your state and federal legislators so they understand and embrace the imperatives to reduce racial and ethnic disparities in pregnancy-related mortality and to ensure access to quality care for all reproductive-aged women.

In a country as rich in resources as the United States, the maternal mortality rate should not be higher than that in other countries with similar resources. But it is. If three in five pregnancy-related deaths in the U.S. are preventable, then they should be prevented.1 Please join with NPWH in our commitment to make a difference.

 

 

 

Reference

1. Petersen EE, Davis NL, Goodman D, et al. Vital signs: pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 States, 2013-2017. MMWR. 2019;68(18):423-429. cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm

Web resource

A. npwomenshealthcare.com/wp-content/uploads/2019/04/WH-Guidelines-for-Authors-04-8-19.pdf

NPWH news & updates | June 2019

Message from the CEO

One of my favorite tasks as CEO of NPWH is to present two special awards during our annual conference. The first is the Fran Way Legacy Award, which we established in 2018. This award recognizes a women’s health nurse practitioner (WHNP) who has demonstrated a commitment to women’s health through practice, education, and advocacy. Last year, we honored Fran herself; you can read about Fran’s contribution to our profession here.

The second award is our longstanding Inspiration in Women’s Health Award, which recognizes outstanding WHNPs who animate and uplift us, who exemplify the WHNP role as innovative educators and researchers, and who have made contributions to policy work in women’s health and/or contributions to clinical practice in women’s health.

Both of these distinguished awards give us the opportunity to acknowledge extraordinary WHNPs. It will be my honor to present these awards to deserving WHNPs at this year’s 22nd Annual NPWH Premier Women’s Healthcare Conference, which will take place in Savannah, Georgia, on October 16-19.

On that note, this edition of Women’s Healthcare is accompanied by our Annual Conference Program Guide. Once again, our planning committee members have outdone themselves in creating content that is current, relevant, and evidence based, and that will enable conference attendees to provide up-to-date, high-quality healthcare to women. I encourage you to seize this opportunity to enhance your knowledge base and, just as important, to network with your colleagues.

I look forward to welcoming you in Savannah in October! Please join us!

– Gay Johnson Chief Executive Officer, NPWH

Editor-in-chief’s message

beth kelsey editor chiefDear Colleagues,

June is Men’s Health Awareness Month. Whether or not you provide direct care for men, you can play an important role in one aspect of men’s health: working to eliminate HPV-associated cancers. According to the CDC, about 15,800 men in the United States are diagnosed each year with HPV-associated cancers.1 Eighty percent of these men are found to have oropharyngeal cancer (base of tongue, tonsils, pharynx) and 20% are found to have penile, rectal, or anal cancer.

These cancers typically develop slowly over several years or even decades after HPV infection occurs. According to the CDC, with respect to HPV-associated cancers in men, the median age at diagnosis was 61 years for oropharyngeal cancer, 69 years for penile cancer, and 59 years for anal cancer.2 Most men with recently diagnosed HPV-associated cancers did not have the HPV vaccine (approved for use in males in 2009) available to them to prevent infection when they first became sexually active as adolescents or young adults.

Today we have an HPV vaccine approved for males and females that prevents infection by all seven of the high-risk HPV types associated with cancer, as well as the two low-risk types of HPV responsible for genital warts. Although HPV vaccination rates are improving, those in males continue to lag behind those in females: According to 2017 CDC data, 53.1% of girls aged 13-17 were up to date with the recommended HPV vaccination series, as compared with 44.3% of boys aged 13-17.3

Current recommendations for males include routine vaccination at age 11 or 12.4 Catch-up vaccination is recommended for males aged 13-21 who have not completed the vaccine series. In addition, vaccination is recommended through age 26 for males not adequately vaccinated previously who fall into any of these categories: men who have sex with men, individuals who are transgender, and individuals who have certain immunocompromising conditions.

A call for action: If you see adolescent and/or young adult males in your practice, ask them if they have completed the HPV vaccination series. If not, and when indicated, urge them to get vaccinated at that time. Because young males are not as likely as young females to seek regular reproductive/sexual healthcare, we must advocate for HPV vaccination for both males and females at every opportunity. When providing the vaccine to females, let them know why young males should get vaccinated too. When performing cervical cancer screening or discussing cervical cancer screening recommendations with female patients, let them know that the HPV vaccine that prevents cervical cancer also prevents several types of cancer in males. Offer your patients written information such as the CDC’s HPV and Men – Fact Sheet. With a concerted effort to get all preteen, adolescent, and young adult males HPV vaccinated, when these individuals reach age 40 and beyond, the cancer statistics for men should look much different than they do today.

 

 

 

 

Beth Kelsey, EdD, APRN, WHNP-BC, FAANP

References

1. Viens LJ, Henley SJ, Watson M, et al. Human papillo-mavirus-associated cancers – United States, 2008-2012. MMWR Morb Mortal Wkly Rep. 2016;65(26):661-666.

2. CDC. HPV and Cancer. HPV-Associated Cancer Diagnosis by Age. Page last reviewed August 16, 2018. cdc.gov/cancer/hpv/statistics/age.htm

3. Walker TY, Elam-Evans LD, Yankey D, et al. National, regional, state, and selected local area vaccination coverage among adolescents ages 13-17 years – United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(33):909-917.

4. CDC. Vaccines and Preventable Diseases. HPV Vaccination Recommendations. Page last reviewed December 28, 2016. cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html

Editor-in-chief’s message

Dear Colleagues,

I hope the start of 2019 has been a good one for everyone. We have much to anticipate in the coming year with the journal and NPWH. For now, though, I want to take a look back at 2018, recognize the many individuals who helped us have an excellent year, and celebrate all we have accomplished for the journal.

I’ll start by thanking all the authors of articles published in the 2018 issues of the journal. They brought us high-quality, interesting, and clinically useful information for our everyday practice. The wide variety of content provides something for every reader. As special recognition, we asked readers to choose their Women’s Healthcare 2018 Favorite Articles. Congratulations to these winners:

Feature Articles

First place: The ABCDs of bacterial vaginosis: Abnormal flora, Bothersome symptoms, Chronicity, and the Differential diagnosis, by Alisa Pascale, DNP, WHNP-BC (December 2018)

Second place (tie):
Dense breasts: Cancer risk and supplemental imaging modalities, by Mary Ellen Egger, APN, WHNP, CBPN and Diana L. Lam, MD (March 2018)

Caring for women with disabilities during the perinatal period, by Lorraine Byrnes, PhD, FNP-BC, PMHNP-BC, CNM, FAANP; Mary Hickey, EdD, WHNP-BC, FNP; Jin Young Seo, PhD, WHNP-BC; and Lorie Goshin, PhD, RN (December 2018)

Department Articles

First Place: Policy & practice points: Cultivating your inner Wonder Woman: Policy advocacy, by Diana M. Drake, DNP, MSN, APRN, WHNP-BC (March 2018)

Second Place: Commentary: WHNPs in specialty programs: My experience in breast surgical oncology, by Caitlyn E. Hull, MS, APRN-CNP, WHNP-BC and Randee L. Masciola, DNP, APRN-CNP, WHNP-BC (September 2018)

I also extend a special thank-you to all the individuals who peer-reviewed manuscripts for us in 2018: 

We rely on their thoughtful and expert feedback to ensure that the articles we publish are the very best.

Our editorial advisory board (EAB) members continue to provide guidance on potential topics and format for the journal. They do this by reviewing feedback from readers on what they want to know more about, staying abreast of contemporary issues, and participating in a yearly meeting. Some of our EAB members also contribute by peer-reviewing manuscripts and submitting manuscripts of their own. I am pleased to welcome Lorraine Byrnes as our newest member of the board.

The HealthCom Media publishing team is outstanding. They bring together diverse talents that keep us moving forward and looking our best. Their commitment to publishing a journal we can be proud of is apparent in all they do. It continues to by my honor and delight to work in partnership with Dory Greene, our journal’s managing editor, as we share a passion in what we do. I appreciate beyond words her expertise, dedication, professionalism, and kindness.

Our Women’s Healthcare journal team includes editors, authors, peer reviewers, EAB members, publisher and publishing staff, and NPWH staff, board of directors (BOD), and CEO Gay Johnson. We all look forward to continuing to provide you with a variety of high-quality, interesting, and clinically relevant articles in 2019.

Beyond the journal, I want to recognize individuals who have participated on writing groups that create NPWH position statements. These individuals bring expertise and dedication to a process that takes time, discussion, and an ability to interact in a meaningful way to create a product that reflects the NPWH mission and values. In 2018, the NPWH BOD approved four new position statements:

Cervical Cancer Screening

Men with Breast Conditions: The Role of the WHNP Specializing in Breast Care

Male Sexual and Reproductive Health: The Role of WHNPs

Brain Health is Women’s Health

The writing group members for these position statements are:

Reviewers and individuals who provide feedback through public comment strengthen our position statements. I want to thank all who participated in this process.

We expect 2019 to be another busy year as NPWH continues to grow and provide the services and products we hear that our members want. We look forward to seeing you at NPWH events and hearing from you throughout the year!

 

 

 

Message from the CEO

As CEO of NPWH, I am fortunate throughout the year to meet and work with so many wonderful NPs. One of my greatest joys each year is calling the winners of the Inspiration in Women’s Health Award to tell them the good news. Most of them respond with surprise, disbelief, and tears of joy!

message ceo post

Inspiration in Women’s Health Award winners (L-R): Allyssa Harris, Anne Moore, Marcia Clevesy, and Nalo Hamilton

During our annual conference in San Antonio, Texas, this year, we recognized four outstanding WHNPs in front of more than 700 of their colleagues. Each of these WHNPs represented one of four diff erent categories: Practice, Research, Policy, or Education. We congratulate all of these winners:

  • Marcia Clevesy, DNP, WHNP-BC (Practice): Marcia is Associate Professor at the University of Nevada, Las Vegas, and volunteers weekly at the Nevada Obstetrical Charity Clinic, a nonprofit organization providing obstetric and gynecologic care services at reduced fees for uninsured women and underserved minority females. She recently implemented a QI project that improved postpartum depression screening and detection rates in several clinics.
  • Nalo Hamilton, PhD, MSN, APRN-BC (Research): Nalo is both a biological researcher and a practicing WHNP. Her unique background in biochemistry and molecular biology, combined with her clinical expertise as a WHNP, enables her to investigate questions related to women’s health. Her current research focuses on the identifi cation of biological markers for screening and therapeutic treatment of triple-negative breast cancer.
  • Allyssa Harris, PhD, RN, WHNP-BC (Policy): Allyssa is the WHNP program director at Boston College. She is also a mentor for Boston College’s Keys to Inclusive Leadership Program, which helps prepare nurses from disadvantaged backgrounds, including members of racial and ethnic minority groups, to enter the nursing workforce as leaders with the inherent capacity to make a diff erence in local communities and women’s health.
  • Anne Moore, DNP, WHNP, ANP, FAANP (Education): Anne developed the WHNP program at Vanderbilt University, serving a total of 22 years as both instructor and program director. She trained NPs all over the country in managing contraception and STDs with the National Family Planning Training Center. She has also educated and trained indigenous providers on LARC for ACOG and has been published more than 100 times. She is currently a Senior Medical Science Liaison for AMAG Pharmaceuticals.
message ceo Fran Way Gay Johnson

Fran Way and Gay Johnson

This year, for the first time, we honored and recognized a pioneer for WHNPs: Fran Way, RNC-E, WHNP, MS. Fran’s career in reproductive healthcare began in 1960 and spanned 32 years with Planned Parenthood Affi liates in Iowa and Wisconsin. In 1972, she founded one of the country’s first WHNP programs, which was also the first to be funded by Title X. In 1980, Fran was one of 20 NPs who met to discuss starting a national organization for NPs working in family planning and reproductive health settings. The organization was initially called the National Association of Nurse Practitioners in Family Planning. The term Family Planning was then broadened to Reproductive Health, which was then expanded, finally, to Women’s Health. With regard to her involvement with the National Association of Nurse Practitioners in Women’s Health (NPWH), Fran served as a member of the organizational committee, then on the Board of Directors (BOD), and then as Chair of the BOD from 1988 to 1992.

In 1994, Fran assisted in establishing NPWH’s popular continuing education approval program. In 1997, Fran represented NPWH in a new national coalition of nursing education credentialing organizations. Over the next 10 years, Fran continued to represent NPWH and the interests of WHNPs on a variety of task forces of nursing organizations that worked to develop consensus on role defi nition, accreditation, certifications, and licensure of advanced practice registered nurses. If it weren’t for Fran, digging in her heels and standing up for the role definition of WHNPs, there would be no WHNP specialty.

Because of Fran Way’s role as a founder of NPWH and as a facilitator in guiding the growth and success of NPWH, along with her extraordinary vision, passionate advocacy, and outstanding commitment to the WHNP role, I was deeply honored to present her with the first Fran Way Legacy Award on October 11, 2018.

What a privilege it is to work among such talented and dedicated WHNPs!

– Gay Johnson
Chief Executive Officer, NPWH

 

Editor-in-chief ’s message

Dear Colleagues,

The National Association of Nurse Practitioners in Women’s Health (NPWH) strives to continuously improve the accessibility and quality of healthcare for women. This improvement is accomplished by promoting innovation and excellence in continuing education and professional development; leadership in policy, practice, and research areas; and support and services for our members. Achieving all these goals is our organization’s vision. Continue reading »

Editor-in-Chief’s message

Dear Colleagues,

As we wrap up 2018, I am pleased to report on some of our fourth-quarter accomplishments and to introduce member opportunities for 2019. First, I am happy to share that our 21st Annual NPWH Premier Women’s Healthcare Conference in San Antonio, Texas, was spectacular, with more than 700 attendees! The success of the conference is the result of extraordinary teamwork by the Planning Committee, Education Committee, Research Committee, Membership Committee, NPWH Board of Directors, staff members, CEO Gay Johnson, and RSG Consulting.

editor chiefs message 7 postI always love the opportunity to meet newcomers and to reconnect with colleagues I have met over the years. As usual, the presentations and posters provided cutting-edge, evidence-based information relevant to providing healthcare for women. If you attended the conference, you may have faced the same difficulty I did in terms of choosing among the breakout sessions. Fortunately, these sessions were recorded and are available free to conference attendees on the NPWH website E-Learning Portal. If you were unable to attend the conference, you can purchase individual sessions and obtain CE credit. Please plan to join us for the 22nd Annual NPWH Premier Women’s Healthcare Conference in Savannah, Georgia, on October 16-19, 2019.

Second, on behalf of NPWH, I extend a sincere thank you to everyone who completed the 2018 NPWH WHNP Workforce Demographics and Compensation Survey. The survey invitation was sent to 11,319 certified WHNPs. We received 2,374 completed surveys, for a response rate of 21%. A summary report will be available at the NPWH website in January 2019. An article in the journal will follow soon after with a more extensive survey report and description of how NPWH plans to use the survey data to support and advocate for WHNPs.

As editor-in-chief of Women’s Healthcare and NPWH director of publications, I hope we are reaching all 11,319 WHNPs who received the survey. NPWH is the national organization for WHNPs. If you are a WHNP who has chosen to focus your expertise and passion on providing healthcare for women and are not a member of NPWH, please join us. If you are a member, please consider becoming active in the organization. You have much to offer NPWH and all of its members.

Here are some ideas for becoming involved in NPWH in the coming year. We offer opportunities for new WHNP graduates as well as seasoned WHNPs, and for those who are involved in clinical practice, academe, research, administration, policy, or some combination thereof.

Submit a manuscript for publication consideration. See our Guidelines for Authors for the different formats you might consider and the submission process.

Apply to be a peer reviewer for the journal. We need content experts, practice experts, and research methodology experts. Click on our peer reviewer application form.

Participate in writing or reviewing position statements.

Explore information on the work of NPWH committees and become involved.

Apply for a board position.

Submit an abstract to present your research or quality improvement project at the next conference.

Take a look at the NPWH blog, Women’s Health Wisdom. Contact Julia Knox at NPWH (jknox@npwh. org) if you have a topic you’d like to see on the blog or if you would like to contribute to the blog.

View a full list of articles and vote for your top two favorites at SurveyMonkey

Past 2018 issues (i.e., March, June, and September) are available at journal website archives

Now is the time to choose your favorite articles from our four 2018 issues: March, June, September, and December. This is a great way to recognize the articles (and their authors) that you found the most interesting and informative. You can view a full list of articles and vote for your top two favorites at SurveyMonkey. If you need to refresh your memory about the articles you read in the March, June, and September issues, you can find them in our journal website archives. Please submit your choices by January 11, 2019. We will announce the winners in the next issue of the journal. I wish all of you happy holidays shared with family and friends!

 

 

 

 

Beth Kelsey, EdD, APRN, WHNP-BC, FAANP

WHNP1218_EIC Message

Detecting women’s cancer with cell phones

Researchers at Louisiana State University are working to turn cell phones into medical diagnostic tools for breast cancer. In the future, this new technology could help women screen for the BRCA gene and mutations at an affordable cost, all from the convenience of their local clinic, without having to travel to a specialist. Continue reading »

Editor-in-chief’s message

Dear Colleagues,

What a wonderful time of the year—spring is in full swing, and many of us are planning for summertime events. As we move into summer, I invite you to take a few minutes to reflect on nurse practitioners (NPs) in the world of women’s health who have been an inspiration to you and others. With its Inspiration in Women’s Health Awards, NPWH gives us an opportunity to recognize and celebrate NPs who have inspired us. These awards will be presented at our 21st Annual NPWH PremierWomen’s Healthcare Conference, which will take place in San Antonio, Texas, on October 10-13, 2018. Continue reading »

Editor-in-chief’s message: Reflection on 2017 and the year ahead

Dear Colleagues,

I hope the start of 2018 has been a good one for everyone. I imagine that all of you, like me, are looking forward to spring; it is just around the corner!

For now, though, I want to look back at 2017 to celebrate what we have accomplished for the journal, as well as recognize the many individuals who helped us have an excellent year. I’ll start off by announcing the winners of our Women’s Healthcare 2017 Favorite Article Contest: Continue reading »

New evidence-based guideline for accurate HPV testing in head and neck cancers

The College of American Pathologists has released its newest evidence-based practice guideline, “Human Papillomavirus Testing in Head and Neck Carcinomas,” now available in Archives of Pathology and Laboratory Medicine. The guideline recommends accurate assessments of a patient’s high-risk HPV status, directly or by surrogate markers. Read more.

Message from the CEO

I am proud to announce that the 20th Annual NPWH Premier Women’s Healthcare to date! We had more than 750 attendees, and the viewed our excellent poster presentations. I received comments about the conference that included the following: Inspiring! Great content! Excellent faculty! Fun to be with colleagues in this learning environment. I extend a special thanks to the 2017 Planning Committee, the NPWH Board of Directors, RSG Consulting, and our incredible NPWH staff for making this truly our best conference yet! Continue reading »

Editor-in-chief’s message

Dear Colleagues,

I have a few updates and opportunities regarding the journal that I’d like to share with you. First, there is an erratum in our September 2017 issue’s Focus on Sexual Health article, “Persistent genital arousal disorder: The uninvited guest (Part 2),” by Brooke M. Faught. The first paragraph and a portion of the second paragraph of the article were inadvertently omitted in the print version of the journal. The article is published in its entirety in the online version of the September 2017 issue. Continue reading »

Message from the CEO

gary johnson ceo nurse practitioner womens healthcareHappy September and  the beginning of the new fall season!

As you may remember, NPWH was founded in 1980 as a national organization for nurse practitioners (NPs) who were focused on family planning and reproductive health. As the years have progressed, so have we. NPWH now represents all women’s health NPs (WHNPs), as well as family NPs and adult NPs who are providing healthcare to women. In addition, NPWH represents individuals in academia who are educating these women’s health-focused NPs. We have defined ourselves as the premier organization that works tirelessly to develop and produce the absolute best in educational opportunities, as well as new programs, initiatives, and resources that provide expert, up-to-date content in all areas of women’s health. Continue reading »

Editor-in-chief’s message: Women’s Healthcare: A Clinical Journal for NPs (WH) reader survey

Dear Colleagues,

Thank you to everyone who completed our recent Women’s Healthcare: A Clinical Journal for NPs (WH) reader survey. We received 481 responses. The information you provided is very helpful to us as we continue to strive to bring you articles on topics of the utmost importance and interest. As a team, the WH editing and publishing staff, the WH editorial advisory board, NPWH CEO Gay Johnson, and I do listen to what you, our readers, tell us as we plan content and format.  Continue reading »

Laparoscopic vs. Robotic Surgery for Endometriosis

Outcomes can be equally good with either procedure

Contrary to the common expectation that robotic assistance can improve the outcomes of endometriosis surgery, a study found no evidence it is either superior or inferior to traditional laparoscopic technique.

“Both robotic and laparoscopic surgery improve quality of life and relieve pain when the procedures are done by experts in endometriosis,” says Tommaso Falcone, MD, Chairman, Ob/Gyn & Women’s Health Institute at Cleveland Clinic.

This conclusion is the result of a multicenter, randomized clinical trial comparing the use of traditional laparoscopic surgery with robot assisted surgery in women with endometriosis. The primary outcome was operative time. Secondary outcomes included perioperative complications and quality of life. Continue reading »

A PCP’s Guide to Managing Patients at Genetic Risk of Breast Cancer

Hereditary syndromes that increase the risk of breast cancer are not common, but it is critical to recognize and manage them appropriately. This paper reviews the management of patients with the most common hereditary breast cancer syndromes, ie, hereditary breast and ovarian cancer syndrome, hereditary diffuse gastric cancer, Cowden syndrome (PTEN hamartoma tumor syndrome), Peutz-Jeghers syndrome, and Li-Fraumeni syndrome. Continue reading »

Scientists Seek People with Primary Progressive MS and Other Forms of MS to Study Gut Bacteria

Investigators at the University of California in San Francisco are recruiting people with MS for an international study of the gut microbiome – the population of bacteria in the gut – in MS. They are seeking people with primary progressive MS nationwide (there is no need for onsite visits), as well as people with any other type of MS who can make a one-time visit to San Francisco, New York, Boston or Pittsburgh. The overall purpose of these studies is to investigate the potential role of gut bacteria in MS.

Scientists Focus on Gut Flora for Future Treatments of Autoimmune Diseases

Continue reading »

Vaginal Microbiome in Gynaecological Cancer

The vaginal microbiome is comprised of a plethora of bacterial species (ranging from 20 to 140), with the most abundant representation by Lactobacillus species. Next generation sequencing and other modern methods have been used to characterize healthy vaginal microbiome and discern between different “healthy” profiles that keep vaginal homeostasis in check. Continue reading »

Cervical Biopsy more efficient, less painful via new method

Physicians evaluate new device to test for cervical cancer. Comparison of Tissue Yield Using Frictional Fabric Brush Versus Sharp Curettage For Endocervical Curettage.

Women undergoing cervical biopsies might have lower odds of repeat tests with a rotating fabric brush than a sharp instrument because the soft device may capture more cells for analysis, a recent study suggests. Furthermore, biopsies with the softer tool may be less painful, researchers say. Cervical biopsies sometimes fail to collect enough cells from the cervix to accurately test for cancer, in which case another biopsy is needed. Continue reading »

Message from the CEO

I am proud to say that, with this November 2015 issue, Women’s Healthcare: A Clinical Journal for NPs, is turning 2 years old! When we introduced the journal 2 years ago, we provided quarterly online issues. Now, as an added benefit, we provide our active NPWH members with both the electronic version and a complimentary print copy of each issue.

Since Women’s Healthcare began, we have added more departments such as On the case…, DNP projects: Spotlight on practice, Focus on sexual health, and Commentary. We have always offered one continuing education (CE) article per issue, along with two or three additional feature articles. Our goals for the future are to continue offering these articles and departments, to increase the number of issues per year, and to add more case studies, scientific studies, and clinical updates.

Our journal continues to grow, and is fast becoming a highly valuable asset to nurse practitioners (NPs) caring for women. The open rate – that is, the proportion of people on an email list who open (or view) a given email – for each issue of Women’s Healthcare is rising, and averages more than 30%. To put this statistic in perspective, the industry gold standard is an open rate of 20%. Even more stats support what our readers are discovering with respect to our journal’s content:

• 75% find the information in the journal “useful” to “very useful”;

• 83% engage in the journal’s CE articles;

• 58% utilize the journal’s “How to” and Case study articles;

• 54% find the journal’s research news useful; and

• 50% utilize the journal’s Clinical resources department.

NPWH takes great pride in providing a variety of tools that promote high-quality, evidence-based women’s healthcare. With regard to our 2-year-old journal, our goal moving forward is to ensure that all advanced practice nurses caring for women recognize Women’s Healthcare as the specialty go-to journal for expert women’s health content.

I want to mention a few of NPWH’s other accomplishments in 2015:

NPWH celebrated its 35th anniversary this year, a milestone marked at our 18th Annual NPWH PremierWomen’s Healthcare Conference in Salt Lake City, Utah, in October.

The 2nd Annual Women’s Sexual Health Course for NPs was a great success this year; we sold out of space! We are increasing the number of registrations next year to enable more NPs to participate. Save the Date: June 23-26, 2016.

We added a new component to our mobile app, a women’s cardiovascular health preventative screening tool, which we launched at our annual conference in October.

NPWH proudly welcomed our second class of Student Reporters to participate in our annual conference.

We partnered with Bedsider to provide grants to six clinical sites to measure and improve contraceptive practices for women aged 17-29.

Stay tuned for more CE opportunities, toolkits, and programs for NPs. Our main objective is to continue to provide more services and support for our members. We invite those of you who are not yet members to join NPWHA! And we thank all of you who supported our organization this year. All of us look forward to a wonderful 2016!

– Gay Johnson

Chief Executive Officer, NPWH

 

 

Editor-in-chief’s message

Dear Colleagues,

Are you looking for a challenging but rewarding opportunity to participate in enhancing advanced practice nursing (APN) knowledge? If the answer is yes, I hope you will consider becoming a peer reviewer for our journal. Here are some answers to frequently asked questions.

What is the role of a peer reviewer?

Peer reviewers are important consultants to journal editors and authors. Their major role may be content expert, practice expert, or research methodology expert, although one peer reviewer need not fill all these roles. We match the skills of a peer reviewer with the needs of a given manuscript. When a manuscript has a clinical focus, we try to choose reviewers with expertise in the content or practice area covered in the manuscript. When we receive a qualitative or quantitative research manuscript, we try to choose reviewers who have expertise in that research methodology.

Most important, we strive to identify and maintain a strong cadre of thoughtful and thorough reviewers who are willing to provide truthful and constructive critiques. Diversity among our peer reviewers is also important; we are looking for reviewers who vary in terms  of their role (academic or clinical practice), years of experience,  areas of expertise, and populations served.

What is in it for me?

APNs in the academic world reap the benefits of adding peer reviewer contributions to their CVs and promotion documents. Novice authors may find the process of doing peer reviews helpful in improving the quality of their own writing. Seasoned authors may enjoy fostering the professional growth of novice authors through constructive peer reviews that identify both the positive features of a manuscript and the areas that need improvement. All peer reviewers can take satisfaction in knowing that they are contributing to the APN profession by supporting the publication of high-quality, relevant, evidence-based articles that can help their colleagues provide the best possible care for their patients.

What happens when I receive a manuscript for review?

First, you will receive a request from us that informs you of the topic of the manuscript and our turnaround time (3-4 weeks). This information will help you decide whether you are interested and whether you have time to do the review. (If, after making the commitment, you find that you need a small extension, we are almost always able to grant it.) Next, if you accept our offer, we will send you the blinded manuscript with a peer reviewer evaluation form. The entire review process is completed electronically and takes about 4 hours.

The peer reviewer evaluation form includes a list of questions about the content and about your general impression regarding whether the manuscript merits publication in our journal. You can provide comments and suggestions on the evaluation form, but we encourage you to make them right on the manuscript.

We do not ask you to correct grammar or spelling errors;  in many, if not most, cases, we will have edited the  manuscript before we send it to you. We do ask that you  read the manuscript to determine whether the information is accurate, supported by evidence, relevant, and clearly presented, and to make suggestions for improvement. We also ask you to check the references for timeliness and appropriateness and to identify any important resources that might be missing. For research manuscripts, we ask for a thorough review of methodology.

How can I learn to do a good peer review?

At your request, Dory Greene, our managing editor, and I would be happy to provide feedback on your review. Even for novices, though, if your review is thoughtful, thorough, and truthful, it will be useful and very much appreciated.

How do I sign up to be a peer reviewer?

Click Here! I hope to hear from you soon!

Beth Kelsey, EdD, APRN, WHNP-BC

 

Message from the CEO

Another year has begun, and we are meeting it head on with enthusiasm and energy! This month, February, is American Heart Month. NPWH is proud to be a partner with the Million Hearts® campaign and to promote the Spread the Word campaign, and we are already hard at work developing the cardiovascular portion of our Well Woman Visit mobile app. We recognize the importance of providing more information about women’s heart health and distributing valuable tools to clinicians and their patients. In the spirit of women’s heart health this month, I ask you to please read Editor-in-Chief Beth Kelsey’s message and Suzanne Shugg’s article, and to please take a look at the tip sheet on antihypertensive medication adherence in our Clinical resources department.

I want to share with you some exciting experiences from our 17th Annual Premier Women’s Healthcare Conference, which was held this past October. For starters, we launched a new Student Reporter Program, which was a huge success! We chose 10 students from around the country to participate in this program based on their interest and on recommendations from their faculty (Figure 1). Through an educational grant from Pfizer, we were able to provide transportation to and from the conference and cover registration fees and meals for the duration of the conference.

In return, the students met with NPWH board members and staff, networked with NP colleagues, attended all sessions, assisted as runners, offered assistance in the hands-on workshops, promoted the conference through social media, and recorded their daily experiences. An outbriefing with the students revealed that their experience was unmatched by any they had ever had before. Here is what some of the student participants had to say:

“Participating in the inaugural student reporter cohort for NPWH was a humbling and rewarding experience, one I will never forget. I was able to learn  about new and evolving research from experts in various fields; network with nurse practitioners, physicians, and researchers from across the country; and gain exposure to products and services I will utilize in the future. The conference exposed me to the breadth of information available through NPWH that will inform my current studies, as well as my future practice.”

“Before the conference, I was having second thoughts about finishing school. I was not certain that I wanted to become a NP, but then I attended this conference, which gave me the inspiration and motivation I needed. Since the conference, I find myself excited about school again and I am driven to learn as much as I can so that I can apply it to my practice. This experience has changed my life. I don’t think I would have continued my education in this direction if I had not attended this conference, and I would not have been able to attend without being selected as a Student Reporter.”

“I am thrilled to be graduating in May, and I am so excited to begin my career as a nurse practitioner. I have always had a passion for learning. The NPWH conference was my first experience attending a conference dedicated solely to women’s health issues. It was empowering to be surrounded by a group of other NPs and experts in this field. I have already had the opportunity to apply information I learned at the conference to real-life settings. Thank you so much for contributing to my education and for supporting my passion for women’s health.”

As you can see from the students’ comments, our Student Reporter Program provided a great opportunity for WHNP students. We hope to continue this program in 2015.

At the October 2014 conference, we were able to recognize NPs who are an inspiration to others by providing our 7th annual Inspiration in Women’s Health Awards. These awards were made possible by a generous grant from Teva Women’s Health. This year’s first-place winner is Diane Todd Pace, PhD, FNP-BC, NCMP, FAANP, a Clinical Associate Professor at the Loewenberg School of Nursing at the University of Memphis in Memphis, Tennessee (Figure 2A). Diane is the first NP to serve as President of The North American Menopause Society (NAMS).

We also honored three runners-up. Kayla E. Castañeda, RN, MSN, WHNP-BC, AOCNP, is a Faculty Associate in the Department of Obstetrics and Gynecology at the Paul L. Foster School of Medicine at Texas Tech University in El Paso (Figure 2B). She is also a women’s health and oncology nurse practitioner at Texas Tech University Health Sciences Center in El Paso. Kayla has piloted a cancer group for her patients that supports them through the course of their treatment. Paula Newman-Skomski, MSN, FNP-BC, ARNP, SANE-A, a nurse practitioner/forensic nurse examiner at Providence Intervention Center for Assault and Abuse in Everett, Washington, is the founder of Peoria Home, which will be a residential recovery program for woman exploited through sex trafficking and prostitution (Figure 2B). Susan Moskosky, MS, WHNP-BC, is the Acting Director of the Office of Population Affairs (OPA), U.S. Department of Health and Human Services (Figure 2C). Under Susan’s leadership, the OPA worked jointly with the CDC to develop the Quality Family Planning Recommendations, the first federal evidence-based recommendations for highquality family planning services delivery.

We at NPWH are looking forward to another exciting year. As always, are working to provide you with top-notch education and resources that support best practices and evidence-based care for women.

– Gay Johnson

Chief Executive Officer, NPWH

 

Message from the CEO

NPWH’s roots are firmly planted within the family planning movement. In May 1980, the Metropolitan Executive Director’s Council (MEXDICO) of the Planned Parenthood Federation of America passed a resolution calling for the formation of a national association of family planning nurses. Later in the year, and at the   invitation of MEXDICO, a group of nurse  practitioners (NPs) from 20 of the larger Planned Parenthood affiliates met in Denver, Colorado, to  discuss the formation of a  specialty organization focused on family planning and reproductive health. The Denver meeting participants voted to form a new organization called the National Association of Nurse Practitioners in Family Planning (NANPFP). NANPFP’s mission was “to assure accessible, quality family planning services and reproductive freedom….”

Fast forward to 2015. After having undergone two  name changes, after having fulfilled many of the early visions, and after having accomplished many of the goals set for education and professional development of NPs, NPWH—he National Association of Nurse Practitioners in Women’s Health—s celebrating its 35th anniversary! NPWH has broadened its focus over the years but still remains an organization dedicated to ensuring the provision of quality healthcare to all women by women’s health NPs and other women’s health-focused clinicians.

We will be celebrating this milestone in the life of our organization during the Welcome Reception at our 18th Annual Premier Women’s Healthcare Conference in Salt Lake  City, Utah, on October 14-17, 2015. Our program guide for this year’s conference is provided for you here in the journal on the following pages. It has always been our mission to bring you the most up-to-date information and the highest quality education.

So, mark your calendar and make arrangements to attend the NPWH  conference this year in Salt Lake City. Together, we will raise a glass in celebration of 35 years of this dynamic organization, the National Association of Nurse Practitioners in Women’s Health!

–Gay Johnson

Chief Executive Officer, NPWH

 

Choosing a hormone therapy that’s right for her

Most women will experience symptoms of estrogen decline as they transition through the menopausal years. These can include vasomotor symptoms (VMS)  and those related to vulvovaginal atrophy, now known as genitourinary syndrome of menopause (GSM). These VMS and GSM symptoms can have an adverse impact on quality of life (QOL). 1.2 Although some women tolerate these symptoms or can improve them with lifestyle changes or non-pharmacologic measures, other women, depending on symptom severity and QOL impact, might benefit from hormone therapy (HT).

Nurse practitioners (NPs) caring for women are familiar with HT options such as the various estrogen and progestogen formulations and the combination estrogen/selective estrogen receptor modulators. Providing patient-specific guidance regarding options is critical in improving satisfaction and compliance. This article provides a short discussion of estrogen products in general, and addresses the attributes of a transdermal gel product that some women find appealing in terms of its ease of use and efficacy in treating both VMS and the symptoms of GSM.

Exogenous estrogen options

Once it is determined that a patient is a candidate for HT and that her VMS, and possibly vaginal dryness as well, are significantly affecting her QOL, patient discussion should be initiated regarding HT options. The objective is to arrive at a mutual decision about the particular type of exogenous estrogen, dosage, and route of delivery that is a best “fit” for the woman. For those women who desire an estrogen product and who have been informed of the risks associated with estrogen use, formulations containing estradiol, conjugated equine estrogens, plant-based estrogens, or esterified estrogens are available. Some women may have a preference regarding an animal-derived estrogen, plant-based estrogen, or synthetic estrogen formulations.

Non-oral estrogen products may have a safety advantage over oral estrogen products.3 Because oral estrogen products, including oral estradiol,  undergo first-pass hepatic metabolism, they may be more likely than non-oral estrogens to lead to adverse metabolic changes such as elevated triglycerides, decreased low-density lipoprotein particle size, and increased production of certain coagulation factors and C-reactive protein. 4 A growing boyd of observational evidence suggests that transdermal estradiol, as compared with oral estrogen, may be associated with lower risks for cardiovascular disease, 7 cerebrovascular disease, 6 and venous thromboembolism. 7,8

Transdermal HT options

There are four transdermal options for VMS relief – patch, emulsion, spray, gel – and one intravaginal option. Other intravaginal estradiol products include creams, a ring, and a tablet. These products are reserved for women whose sole menopause-regulated complaints involve GSM symptoms. 9 Numerous clinical trials conducted over the past two decades have evaluated the efficacy and safety of the transdermal patch, 10-16 emulsion, 17 spray, 18 and gel 1,2,19 in controlling VMS.  One aspect of the non-patch transdermal estradiol products is that they vanish after they are applied and then dry, with no visible signs that HT is being used.

More about one estradiol gel product

Among all of the non-patch transdermal estradiol products, including the gel products, only one, EstroGel 0.06% (estradiol gel), has an FDA-approved dual indication: relief of moderate to severe VMS and relief of moderate to severe symptoms of vulvar and vaginal atrophy due to menopause.20 Clinical research showed that the use of EstroGel at a dosage of 1.25 g (containing 0.75 mg estradiol), as compared with placebo, was associated with significant reductions in the frequency and severity of moderate to severe hot flashes at weeks 4 and 12. 20 In the same study, vaginal wall cytology results demonstrated a significant increase from baseline in the percent of superficial epithelial cells at week 12 for EstroGel versus no significant change from baseline for placebo. The most commonly reported side effects of EstroGel in clinical studies were breast pain, headache, and flatulence. 20

A survey of EstroGel users (N=890) related to product satisfaction showed that 88% were satisfied or extremely satisfied with it and 89% thought it was very easy to use. 21 Among the 620 respondents who had used a previous therapy for their menopausal symptoms, 89% reported that they preferred EstroGel, 7% had no preference, and 4% preferred the previous product.

One pump of the EstroGel metered-dose dispenser supplies one dose of the gel (1.25 g), which contains 0.75 mg of estradiol. The gel is applied to clean, dry, unbroken skin at the same time each day. The patient applies the gel to one arm from wrist to shoulder; she need not massage or rub in the gel. after applying the gel, which dries in 2-5 minutes and leaves no odor or sticky residue, she should wash her hands with soap and water to reduce the chance of medication spread.

All systemic estrogen users with an intact uterus should consider adding a progestogen to their HT regimen in order to reduce the risk of endometrial cancer. 3 Several synthetic progestogens and oral micronized progesterone are FDA approved for this purpose. Oral progestogen may be added as a separate pill or a provided as a combined estrogen-progestogen pill. Combination estrogen-progestogen transdermal patches are also available. Topical cream or gel preparations of progestogen may not exert sufficient activity to protect the endometrium and are not approved for this purpose.

Regardless of which HT is used, the North American Menopause Society recommends prescribing estrogen at the lowest effective dose for the shortest time needed. 9 NPs can assist each woman in navigating through the array of HT options to facilitate selection of the regiment and/or delivery system that is most appropriate for her unique needs.

Anne Moore is the Women’s Health Clinical Trainer at the Tennessee Department of Health, Division of Family Health and Wellness, in Nashville, and a member of the Editorial Advisory Board for Women’s Healthcare: A Clinical Journal for NPs. An honorarium funded by Ascend Therapeutics has been received by Ms. Moore.

Visit https://npwomenshealthcare.com/?p=4166 for a complete list of references.

 

Editor-in-chief’s message

Dear Colleagues,

Three full years have elapsed since we celebrated the rollout of the Affordable Care Act (ACA) provision requiring coverage of women’s preventive services recommended by the Institute of Medicine. This provision includes a requirement that most insurance plans cover FDA-approved female contraceptive methods with no co-payment or deductible. The coverage must also include clinical services, including patient education and counseling needed for provision of these contraceptive methods.

Health insurance carriers must cover al least one product in each of the 18 distinct female contraceptive method categories that the FDA has identified in its current Birth Control Guide1 Many women who could not previously afford contraceptives or whose choices were limited because of prohibitive costs now have access to effective methods that meet their own particular needs.

Despite the existence of this ACA provision for the past 3 years, insurance carriers vary in terms of how they are adhering to the guidelines for contraceptive coverage – thereby keeping many women from fully benefitting from this provision. In fact, two recent studies evaluating health insurance coverage revealed numerous violations of the requirements by a large number of insurance carriers across several states. 2,3  The National Women’s law Center(NWLC) reviewed more than 100 plan documents from issuers in the new marketplaces in 15 states, and found that 33 insurance carriers in 13 states offered birth control coverage that did not comply with the ACA. 2 The Kaiser Family Foundation described contraceptive policies used by health insurance carriers as being not easily accessible and not clearly defined. 3

The most commonly identified violation in these studies was a failure to cover all FDA-approved methods. The method(s) not covered varied with different carriers but included progestin implants, contraceptive patches and vaginal rings, over-the-counter contraceptives, and the emergency contraceptive pill Ella. Several insurance carriers were found to impose impermissible cost-sharing on methods such as IUDs and sterilization. Some carriers imposed limitations and cost-sharing on the services associated with provision of contraceptive methods, including office visits for injectable contraceptives and birth control counseling. Other violations included requiring cost-sharing for brand-name contraceptives without generic equivalents and excluding sterilization coverage for dependent children, which includes adults up to age 26. In May 2015, as a result of these two studies’ findings, the U.S. Departments of Health and Human Services, Labor, and Treasury issued FAQs About Affordable Care Act Implementation to help insurance companies and consumers better understand the scope of coverage of preventive services required under the ACA. 4

We must ensure that our patients have access to all FDA-approved female contraceptive methods and related services, with no co-payment or deductible. We have a voice. In one state, after the regional Planned Parenthood and the NWLC brought violations to the attention of insurance regulators, a bulletin clarifying the requirements was sent to health insurance carriers. NWLC operates a national hotline (1-866-745-5487) and website to assist women having difficulty securing coverage for birth control by providing information on the requirements, assisting with filing appeals with insurance companies, and filing complaints with government agencies that regulate insurance plans.

Through the ACA, we have made a tremendous step forward in enhancing access to care for women. As always, however, there are hurdles to overcome and there are risks that the gains we have made will be reversed. Together we can be a mighty force in overcoming these hurdles and in protecting the good work that has been done.

Beth Kelsey, EdD, APRN, WHNP-BC

Visit http://www.NPWomensHealthcare.com/?p=4150 for a complete list of references.

Editor-in-chief’s message

Dear Colleagues,

In so many ways, NPWH and its members are showing that women’s health is about much more than just obstetrics and gynecology. But then, we have know this for a long time. Here are a few examples.

Sue Kendig, NPWH Director of Policy, describes the process and outcome of revising the Women’s Health Nurse Practitioner: Guidelines for Practice and Education in this issue of the journal. As a member of the task force for this 7th edition and for the previous edition of the Guidelines, I can confirm that we definitely did our homework to produce a document that reflects the expanded scope of practice for today’s WHNP. NPWH members have free access to the Guidelines on the NPWH website.

NPWH is a leading organization in the field of evidence-based sexual healthcare, providing the first national Women’s Sexual Health Course for NPs in 2014. The course was so successful that it will be offered again this year. We at Women’s Healthcare, NPWH’s official journal, are proud to present a new department, Focus on sexual health, in this issue. Brooke M. Faught, MSN, WHNP, Clinical Director of the Women’s Institute for Sexual Health in Nashville, Tennessee, has authored the inaugural article for this department. This issue of the journal also features an article on female sexual dysfunction by Casey B. Giebink, MSN, NP-C, WHNP-BC, and Ivy M. Alexander, PhD, APRN, ANP-BC, FAAN. And in our Assessment & management department, Wendy Grube, PhD, CRNP, a member of the task force that developed Preventive Male Sexual and Reproductive Health Care: Recommendations for Clinical Practice, summarizes the key points in this groundbreaking publication.

NPWH is developing  strong presence with regard to mental health as well. In the past year alone, we have offered articles on depression in women, self-esteem, postpartum depression, sexual assault, and depression in adolescents. Appearing now or coming soon are articles on binge eating disorder, PCOS psychosocial effects, and anorexia in adolescents.

To honor our Million Hearts partnership commitment, we have been providing many evidence-based continuing education (CE) activities that give advanced practice nurses the tools they need to promote heart health. In the August 2014 issue of Women’s Healthcare, we published a CE article by Tamera Lea Pearson, PhD, MSN, FNP, ACNP, entitled Cardiovascular Disease in Women: A Journey Toward a Focus on Prevention.At the 2014 NPWH conference in Savannah, Megan McCarthy, MSN, NP-C, presented The Angina Monologues – Update on New Ways to Detect and Prevent Heart Attacks in Women and Jaye M. Shyken, MD, presented Long-Term Health Consequences of Pregnancy Complications, which included a discussion about the relationship between pre-eclampsia and gestational diabetes with future cardiovascular disease. In that vein, Suzanne Shugg, DNP, ACNP, a clinical lipid specialist who runs a Preventive Cardiology Clinic in Berkeley Heights, New Jersey, shares her insights on this topic in her article Pregnancy’s Effect on Cardiovascular Health: A Woman’s First “Cardiac Stress Test” in this issue of the journal. This issue also provides a Million Hearts tip sheet on Improving Medication Adherence Among Patients with Hypertension. This upcoming year, an NPWH task force will develop a white paper on evidence-based best practices and policy recommendations to promote cardiovascular health and wellness for women, including those who are at high risk for cardiovascular disease.

You can rely on NPWH, and Women’s Healthcare, to continue to provide cutting-edge, evidence-based women’s healthcare information to support you in providing high quality care for women from menarche through senescence.

Beth Kelsey, EdD, APRN, WHNP-BC

Message from the CEO

NPWH is dedicated to the continuing education (CE) and professional development of nurse practitioners; we are always pursuing new ways to improve our educational offerings. We are excited about our latest program, the Women’s Sexual Health Course for NPs, which is being held on June 27-29, 2014, at  the Sheraton Dallas Hotel by The Galleria in Dallas, Texas. We are pleased to offer this course in collaboration  with the International  Society for the  Study of Women’s Sexual Health  (ISSWSH). The program  guide is presented here in the journal on the next five pages.

Nurse practitioners see many female patients who have sexual health concerns. The purpose of  this course is to provide education on  state-of-the-art diagnostic and management  strategies available for clinicians  treating women with sexual health problems. This course will provide NPs with up-to-date evidence and expert consensus on the evaluation of female sexual dysfunction and therapeutic strategies to improve the sexual health  of women. The expert faculty will impart the necessary knowledge, skills, and professional attributes that are required for excellence in the practice of sexual healthcare today.

In addition to receiving CE credits,  attendees will receive a Certificate of Completion for the Women’s Sexual Health Course that will document for patients, employers, and peers the knowledge gained in the area of women’s sexual health. We hope that you will take advantage of this exciting new educational opportunity.

– Gay Johnson

Chief Executive Officer, NPWH

 

Editor-in-chief’s message

Dear Colleagues,

I want to take this opportunity to update you on a change in out Guidelines for Authors. 

When we first established the guidelines, we decided that we would not consider student manuscripts, primarily for practical reasons. We do not have sufficient editorial staff to review dozens of manuscripts of DNP students who, as a requirement for graduation, must submit a paper to an advanced practice nursing (APN) journal. And even though our journal is published online, we are still limited in terms of the number of pages that each issue can contain. So we decided to limit the pool of prospective authors to APNs who are in practice and to those who are doing research and/or teaching.

However, we realize that we may be missing out on excellent manuscripts written by DNP students or recent DNP graduates that would be worthy contributions to the APN literature. In addition, NPWH, our managing editor Dory Greene, and I want to support doctoral students and recent graduates in becoming authors and in giving them the opportunity to share up-to-date information with a clinical focus that is useful n everyday practice. Therefore, we are now accepting manuscript submissions from master’s-prepared APNs who are enrolled in a program granting a doctoral degree. Students who have previously authored an article in a peer-reviewed journal may submit a manuscript as a solo author (documentation of this previously published work must be provided at the time of manuscript submission). Otherwise, we require that the student’s faculty advisor or another faculty member, as appropriate, serve as second author on the manuscript.

To qualify as a second author, this person must make a substantive intellectual contribution to drafting the manuscript or revising it critically for important intellectual content and must approve the version of the manuscript to be submitted. In addition, if the manuscript is a report on research that has been conducted, all authors must have made a substantive intellectual contribution to the conception and design of the study, or the acquisition of the data, or analysis and interpretation of the data. These requirements are in accordance with those of the International Committee of Medical Journal Editors. All authors assume responsibility for the content of the manuscript.

Although Dory will know about an author’s status as a doctoral student when a manuscript is submitted to us, our peer reviewers and I receive blinded versions of the manuscript. We do not know the names, credentials, or educational or professional status of any authors until a paper is accepted for publication. Our editorial and peer reviewer decisions are made solely on the merits of the manuscript.

As an alternative to submitting a manuscript in capstone project or dissertation-style, you can disseminate key points or important aspects of your doctoral work using one of these formats:

  • Case study: This relatively short article (maximum, 3000 words, excluding references and graphics) addresses complex women’s health situations and is presented in a way that challenges readers to “solve the case.” The particular challenge may include co-morbidities and/or psychosocial, cultural, or ethical dimensions that complicate the situation. Case studies provide an opportunity to include evidence-based information on diagnostic tests,  pharmacologic and nonpharmacologic aspects of treatment, and the most up-to-date guidelines.
  • Assessment and Management: This department presents short pieces (1000-1300 words) focusing on health promotion/disease prevention screening and counseling or on assessment and management of a specific condition or presenting complaint. You can include short case scenarios to add to the interest, weaving in the assessment and management pieces in a patient-centered manner.
  • Systematic review: If, in the development of your capstone project or dissertation, you used a systematic search method of relevant studies that included identification of those that met pre-determined eligibility criteria and assessment of validity of findings, you might consider using this format. Systematic reviews require several explicit and reproducible steps. Use the PRISMA statement website as a guideline. This website provides a 27-item checklist and a 4- phase flow diagram for systematic reviews and meta-analyses of studies.
  • Research study: Your original research study, with clinical implications, is eligible for consideration and acceptance.

So, let this be a call for manuscripts to all APN authors, including doctoral students.

Need an idea for a manuscript topic? Members of our Editorial Advisory Board have offered these suggestions: abnormal uterine bleeding, anal neoplasia, bacterial vaginosis (persistent/recurrent), benign breast diseases, bleeding in early pregnancy, clinical skills (e.g., pessary insertion, simple cystometrography, pelvic floor electromyography, vulvar biopsy), colposcopic evaluation of lower genital tract disease, common adolescent problems (e.g., abnormal menses, dysmenorrhea, teen pregnancy), contraceptive options for women with chronic health conditions, evidence-based pre-conception care, female sexual dysfunction, HPV update, infertility, IUC placement pearls, mammography guidelines, medication effects on lactation and the newborn/ infant, management of nongynecologic conditions in pregnancy (e.g., epilepsy, asthma, migraine, lupus, coagulation defects, heart disease, rheumatoid arthritis, thyroid disease), nonpharmacologic management of perimeno pausal vasomotor symptoms, Pap test guidelines, pelvic floor wellness, oral neoplasia, parental grieving following an unanticipated pregnancy outcome, post-abortion care, sterilization for women and men, STI prevention counseling, and transgender sexual and reproductive health care.

We look forward to learning from all of you! As a reminder, please follow the author guidelines available on our website. For DNP students, recent graduates, and their faculty advisors, a useful resource is an article by Lorraine Steefel and Cynthia Saver, From Capstone Project to Published Article,” which was published in the May 2013 issue of American Nurse Today.

Beth Kelsey, EdD, APRN,  WHNP-BC

Use of osteoporosis drug with anti-inflammatory medication linked to lower risk of hip fracture

Among older patients using medium to high doses of the anti-inflammatory steroid prednisolone, treatment with the osteoporosis drug alendronate was associated with a significantly lower risk of hip fracture, according to a study published by JAMA. Read more.

Freezing Ovarian Tissue May Be a Promising Fertility Treatment

By 2018, some 76,000 women in the U.S. will freeze their eggs every year to preserve their fertility and increase their odds of getting pregnant later in life. Yet egg freezing is by no means a solid insurance policy. Some estimates suggest that just under 24% of procedures will result in a live birth. The fertility field is looking for other options.

In a new study published in the journal Reproductive Sciences, two fertility experts argue that ovarian tissue freezing—a procedure that removes and freezes ovarian tissue for later use—could offer an alternative, especially for women who can’t undergo egg freezing for medical reasons.

Read more at Time.

Message from the CEO

Welcome to the dog days of summer! August is the time of year when we should try to take a little break to decompress from our jobs; rejuvenate our minds, bodies, and spirits; and enjoy some family time before revving up for school to start and jobs to kick into high gear for the fall and winter seasons. We should take a lesson from those European countries that virtually shut down for the month of August. But the question I always ask myself is, “How do they do that?!”

By the time you’re reading this message, our inaugural Women’s Sexual Health Course for NPs will have been completed. I am happy to report to you that the course was a huge success! With the encouragement of more than 150 satisfied attendees, we have already started planning for another Women’s Sexual Health Course for NPs in 2015!

In this issue of the journal, we present the program guide for the 17th Annual NPWH Premier Women’s Healthcare Conference, which will be held in Savannah, Georgia, on October 15-18, 2014. We continue to strive to bring you, as providers of women’s healthcare, the most up-to-date, clinically relevant information possible. As you will see in the program guide, this conference promises to deliver all things women’s health.

If you haven’t already registered for the conference, please take a look at our offerings and make plans now to attend. You will be sure to gain the in-depth knowledge and specialized skills needed to provide high-quality healthcare to women of all ages. In addition, the conference provides you with a wonderful opportunity to network with your colleagues; where better to meet with colleagues than in beautiful Savannah?! While you’re there, take a carriage ride through the lovely neighborhoods, participate in a ghost tour, and soak up all  the hospitality that the South is known for.

We hope to see you at our conference in October. But for now, go grab that cool drink, relax in your chair, and enjoy this issue of Women’s Healthcare: A Clinical Journal for NPs.

– Gay Johnson

Chief Executive Officer, NPWH

 

A message from editor-in-chief

Dear Colleagues,

August is National Immunization Awareness Month. As nurse practitioners providing primary care for female adolescents and adults, we have a public health responsibility to educate our patients (and, when applicable, their parents) about the importance of vaccinations and to make the recommended vaccinations easily accessible. In honor of National Immunization Awareness Month, let us review our current vaccination practices and consider whether we might be able to do an even better job.

Although all vaccinations are important, I would like to focus on the HPV vaccine in particular because we have so much room for improvement in reaching all females and males who can benefit from receiving this cancer-preventing and potentially lifesaving vaccine. Eight years ago, the Advisory Committee on Immunization Practices (ACIP) began recommending routine HPV vaccination of girls at age 11 or 12. Leading health and professional organizations have called for universal vaccination for preteen girls. Despite this recommendation, the CDC reported that in 2012, only 33.4% of 11- and 12-year old girls received all three doses of the series. In 2011, ACIP began recommending HPV vaccination for boys aged 11 or 12. The CDC reported that in 2012, only 7% of boys this age received three doses of the vaccine.1

Whether or not you see pre-teens in your clinical practice, you likely see teens and you certainly see pre-teens’ and teenagers’ mothers and aunts and maybe even their grandmothers. We can all improve HPV vaccination rates by focusing on three major areas:

Educate parents, adolescents, and young adult women and men about the effectiveness of the vaccine in preventing HPV infection and cervical cancer as well as other genital, anal, and oropharyngeal cancers. Emphasize what we know about the vaccine’s safety. Lack of knowledge about HPV and the vaccine and unfounded fears about HPV vaccine safety are among the top reasons that parents are not getting this vaccination for their children.

Increase the consistency and strength of the recommendations we make regarding HPV vaccination. Another top reason reported by parents for not getting the vaccination for their children is that their healthcare provider simply did not recommend it.

Reduce missed vaccination opportunities by using every healthcare visit, whether routine or for an acute problem, to assess immunization status and provide recommended vaccines when indicated.

The following strategies have demonstrated success in improving rates for all types of vaccinations and can be easily implemented in most practice settings:

Standing orders

Computerized record or chart reminders

Patient reminders via mail, email, or phone

Patient education: see pages 50-51 for a patient education handout on HPV

Personal health records

Expansion of access in healthcare settings

Performance feedback

You can learn more about each of these strategies and how they might fit into your clinical practice at the CDC’s WhatWorks website.

If we all get involved in this effort to increase vaccination awareness, we can make a big difference. Each year in the United States, approximately 26,200 new cancers attributable to HPV are identified. 1 I know that, in my lifetime, I would like to see these vaccine-preventable cancers become a thing of the past.

Beth Kelsey, EdD, APRN, WHNP-BC

Reference

1. Centers for Disease Control and Prevention. Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013 – United States. MMWR Morb Mortality Wkly Rep. 2013;62(29):591-595. www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm

 

A note from Gay Johnson, CEO of NPWH

Wow, time does fly! It has been one year since we launched our new NPWH journal, Women’s Healthcare: A Clinical Journal for NPs. Since last November, we have distributed the journal to more than 31,000 nurse practitioners, and the journal has experienced sustained growth. The open rates—that is, the proportion of NPs to whom the journal is distributed who actually open and read the issue—are well above the industry standard and confirm that our readers are utilizing the journal as an educational resource to help them optimize their patient care.

Along with high open rates, we are seeing incredible engagement numbers, with readers spending an average of more than 15 minutes viewing our content at any one time. The journal’s companion website, www.NPWomensHealthcare.com, has  seen tremendous growth in recent months as thousands of NPs engage with us and utilize our cutting-edge digital platforms. Since the website’s launch in November 2013, we have seen a 160% increase in  page views and a 250% increase in our monthly unique visitors. Visitors are also spending increased time on the website and interacting with more content—all strong indicators that our editorial focus is resonating with our action-oriented NP community.

To top it off, we are receiving a large number of manuscript submissions from NP thought leaders, NPs in clinical practice, and DNP candidates. All of these manuscripts add to the depth and breadth of the content. So, please keep reading our journal and writing for us! In addition, we invite you to provide us with feedback regarding our articles and departments so that we can continue to provide the highest-quality content for you. It has definitely been a busy year for NPWH, with many successful new ventures. Among these new ventures are (1) publication of the 7th edition of the WHNP Guidelines for Practice & Education, which can be used to support NPs in practice and ensure that new WHNPs are prepared for practice in today’s healthcare environment; (2) development and launch of the first Well Woman Visit Mobile App; (3) presentation of the first Women’s Sexual Health Course for NPs; (3) participation in several ACOG committees and task forces; (5) strengthening of our relationships and an increase in our collaboration with a variety of organizations; and (6) implementation of the new NPWH WHNP Student Reporter Program.

We could never have accomplished all these goals without our conscientious and hardworking staff. These individuals include Carol Wiley, our Director of Membership & Office Administrator, who has been a long-time employee of NPWH; Lilly Pinto, our Communications and Outreach Manager; Pam Henry, our Special Projects Coordinator; Vanice Dunn, our Continuing Education Coordinator and Administrative Assistant; Susan Rawlins, our Director of Education; and Sue Kendig, our Director of Policy. I have the privilege of working with these talented and dedicated women every day. I am always gratified by how much work gets done by such a small staff!

NPWH has a lot to be proud of. We hope that you share our pride in this wonderful nurse practitioner organization and visit our websiteA regularly. If you are not already a member of NPWH and wish to join us, please click hereB. It has been a terrific year for NPWH and we thank you for all your support!

– Gay Johnson

Chief Executive Officer, NPWH

Web resources

A. http://www.npwh.org

B http://www.npwh.org/i4a/ams/public/memberapp2.cfm

 

A message from editor-in-chief Beth Kelsey, EdD, WHNP-BC

Dear Colleagues,

What a great first year for Women’s Healthcare: A Clinical Journal for NPs! Gay Johnson, our NPWH CEO, established the journal to provide you, our readers, with comprehensive, timely, useful information to empower you to set a new standard for women’s healthcare. Gay created her NPWH news &  updates column as one more avenue to keep you  informed about what the association is doing to ensure the provision of quality healthcare for women by nurse practitioners.

We have covered a wide variety of topics in the journal, including breast cancer, cardiovascular disease prevention, contraception, depression in adolescents, menopause, ovarian cancer, sexual assault, sexual dysfunction, and vulvar dermatoses. In each issue, one of these topics is developed as a feature article for continuing education credit. We also have a great variety of departments, including Assessment & management, Commentary, Clinical resources, and Patient education. Through her Policy & practice points column, Sue Kendig, NPWH Directorof Policy, keeps us up to date about issues such as the Affordable Care Act, the Consensus Model, and the concept that women’s health is more than just an annual event (i.e., the yearly well-woman visit).

Here are ways for you, our readers, to get involved with the journal:

Write an article: Based on what readers tell us in surveys, we have set a goal to expand the number of practical, evidence-based articles that NPs providing healthcare for women will find interesting, illuminating, and relevant in everyday practice. We especially invite submission of manuscripts that provide (1) updates on clinical guidelines, (2) case studies on complex health situations, (3) innovative strategies for teaching and learning clinical procedures and skills, or (4) tips on the business aspects of clinical practice. Because we want to offer more articles that are both topical and brief, we have updated our author guidelines—available on our journal website at www.npwomenshealthcare.comto provide prospective authors with information about how to structure articles that are shorter than those reporting on research studies or reviewing the literature.

Serve as a peer reviewer: We have placed our peer reviewer forms on the journal website to help authors better understand the criteria used for manuscript review. But you may also want to look at these forms to see if you are interested in serving as a peer reviewer. You need not have had an article published or work in an academic setting in order to serve as a peer reviewer, although we definitely appreciate this experience. We are always looking for NPs who are experts in the clinical setting to review manuscripts with an eye on the usefulness and applicability of the information in daily practice. Our peer reviewers are crucial to ensure the integrity and quality of the journal.

On that note, thank you to our year 1 peer reviewers!

I want to express a special thank you to the following individuals, who reviewed manuscripts submitted during our first year of publication:

Kelly Ackerson Elizabeth Heavey

Helen Carcio Anne Moore

Melanie Deal Suzy Reiter

Brooke Faught Kerri Schuiling

Aimee Chism Holland Carolyn Sutton

A call to action!

I know that our readers represent a wealth of knowledge and expertise worth sharing. If you would like to discuss a potential women’s health topic for an article and/or are interested in serving as a peer reviewer, please contact Dory Greene, our Managing Editor, at dgreene@healthcommedia.com, or me at bkelsey@healthcommedia.com.

I look forward to continuing to serve as Editor-in- Chief of Women’s Healthcare: A Clinical Journal for NPs and to hearing from you about what you want to see in upcoming issues.

Beth Kelsey, EdD, APRN, WHNP-BC

 

Editor-in-chief ’s message

Dear Colleagues,

In January 2017, the NPWH Board of Directors approved our position statement on human sex trafficking, which is published in this issue of the journal. The work of the writing group on the position statement started in October 2016. It seems that, nearly every week since that time, I see something in the media about human trafficking.

At our annual conference last year in New Orleans, Dr. Kimberly Chang gave a highly informative and impassioned presentation on human trafficking. Dr. Chang is nationally known for her advocacy in the prevention of trafficking and the care of trafficking survivors. Along the way, she has provided me with a variety of resources on both sex and labor trafficking that I want to share with all of you.

One of these resources is HEAL – Health, Education, Advocacy, and Linkages. HEAL is an independent network of multidisciplinary professionals dedicated to ending human trafficking and supporting its survivors—from a public health perspective. At the HEAL Trafficking website, you can find educational resources, as well as access a protocol toolkit for healthcare settings.

The Office on Trafficking in Persons (OTIP) is housed within the U.S. Department of Health and Human Services (DHHS). At the OTIP website, you can find factsheets, brochures, and posters supporting DHHS’s Look Beneath the Surface campaign, which can be used to increase community awareness about human trafficking. In addition, the website has information on victim assistance services and training resources, and it provides reports on trafficking from other federal agencies.

The Polaris Project provides trafficking statistics, offers information on a variety of trafficking prevention initiatives, and sponsors the National Human Trafficking Hotline (1-888-373-7888) and the BeFree Textline (text HELP to 233733 [BEFREE]). You can find out more on the Polaris Project website.

If you want in-depth and up-to-date information on a variety of trafficking issues, I recommend the textbook Human Trafficking Is a Public Health Issue: A Paradigm Expansion in the United States (2017). This book has 24 chapters covering topics such as Sex Trafficked and Missed, LGBTQ Youth and Vulnerability to Sex Trafficking, Physical Health of Human Trafficking Survivors: Unmet Essentials, Caring for Survivors Using a Trauma-Informed Care Framework, The Ignored Exploitation: Labor Trafficking in the USA, and Human Trafficking: Perspectives on Prevention. You can download individual chapters or purchase the complete book.

NPWH will continue to provide leadership and collaborate with other organizations and agencies to deliver education to increase knowledge and provide resources for NPs to identify, assess, and respond to the needs of trafficked individuals. Furthermore, we will advocate for policies and public health campaigns that will help stop trafficking.

Message from the CEO

Happy Spring! We have jumped into high gear here at NPWH!

To celebrate National Women’s Health Week, May 14-20, 2017, we participated in the Coalition for Women’s Health Equity’s planning of their first-ever Women’s Health Empowerment Summit. NPWH partnered with Women Against Alzheimer’s to plan the panel, Women’s Health for All Ages: New Trends & Perspectives. Our panelists included NPWH’s Susan Hoffstetter, Immediate Past Chair of the Board of Directors; Mary Worstell, Senior Advisor to the Director, HHS Office of Women’s Health; Jill Lesser, President, Women Against Alzheimer’s; Athena Cross-Edge, Board Member, Black Women’s Health Imperative; and Lynn Yeakel, Director of Drexel University College of Medicine’s Institute for Women’s Health and Leadership and Founder and President, Vision 2020.

Our annual Women’s Sexual Health Course for NPs is in its fourth year, and we are expecting to reach capacity once again for this educational activity. The Vulvoscopy Workshop that we added last year was so popular that we are offering it again this year. The Women’s Sexual Health Course, the only course designed specifically for NPs, has been extremely well received. This course enhances NPs’ ability to promote women’s sexual health and increases their confidence in evaluating, diagnosing, and managing female sexual dysfunction.

We are thrilled to announce that we are in the process of developing our new Patient Portal. This portal will be accessed on our website and will facilitate patient–NP communication. The portal will include information promoting health, as well as information about the specific needs of women with common health conditions and about management of conditions unique to women. In addition, this portal will provide women with direct access to women’s health topics. We will keep you updated on our progress.

This is the 20th year that NPWH will be offering its Annual Premier Women’s Healthcare Conference, and we are excited to be in Seattle, Washington, once again! This year’s presentations will cover topics such as colposcopy, menopause, preeclampsia, hereditary breast and ovarian cancer, and professional development (e.g., writing for publication), just to name a few. New this year is the SOAR Training, which was developed by the U.S. Department of Health and Human Services for recognizing victims of human trafficking. Check out the program guide to see all of our presentations, which cover the very latest developments in women’s health. Please plan to join us; you won’t want to miss this year’s conference!

Research reveals which breast implants pose the greatest risk of implant-associated cancer

Researchers at Macquarie University’s MQ Health have revealed that women implanted with textured breast implants are at a significantly higher risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

Read more at medxpress

Age linked to decreased pelvic floor strength

A new study published in Female Pelvic Medicine & Reconstructive Surgery found that decreased pelvic floor strength after childbirth is 2.5 times more likely to affect women over age 25 years than younger women (Female Pelvic Med Reconstr Surg 2017; 23: 136-140).

“In multivariate analysis, age alone was a predisposing factor for pelvic floor weakness after childbirth, even though we also assessed variables such as race, BMI, length of second stage labor, vacuum delivery, and episiotomy,” said lead author Lieschen Quiroz, MD, of the University of Oklahoma Health Sciences Center, Oklahoma City.

“The issue of pelvic floor weakness is important, because one in five women are affected by pelvic floor dysfunction during their lifetime—often in the fifth or sixth decade of life—but the event that puts them at risk may have occurred years before at the time of vaginal delivery,” Dr. Quiroz said.

Since older women are at increased risk for pelvic floor weakness after vaginal delivery, it’s important that clinicians assess the pelvic floor strength of women over age 25 or 30 before childbirth, Dr. Quiroz noted. “If pelvic floor weakness is found, women can be referred to physical therapy to improve their pelvic floor strength,” she added.

In the study, 68 women with a singleton pregnancy planning a vaginal delivery were assessed for pelvic floor strength at 24 to 37 weeks and between 4 weeks and 6 months postpartum. The median follow-up time was 7 weeks postpartum. Sixty-six percent of the women experienced a vaginal delivery while 34% went into labor but had a Cesarean delivery. Pelvic floor strength was evaluated with a Peritron perineometer during pelvic floor contractions, and the women also underwent physical exams and 3D vaginal ultrasounds during pregnancy and postpartum clinical visits.

via ModernMedicine

Anti-inflammatory diet could reduce risk of bone loss in women

Anti-inflammatory diets — which tend to be high in vegetables, fruits, fish and whole grains — could boost bone health and prevent fractures in some women, a new study suggests.

Researchers examined data from the landmark Women’s Health Initiative to compare levels of inflammatory elements in the diet to bone mineral density and fractures and found new associations between food and bone health. The study, led by Tonya Orchard, an assistant professor of human nutrition at The Ohio State University, appears in the Journal of Bone and Mineral Research. Read more.

Researchers provide new insights into age-related female infertility

 

Researchers at the University of Montreal Hospital Research Center (CRCHUM) have discovered a possible new explanation for female infertility. Thanks to cutting-edge microscopy techniques, they observed for the first time a specific defect in the eggs of older mice. This defect may also be found in the eggs of older women. The choreography of cell division goes awry, and causes errors in the sharing of chromosomes. These unprecedented observations are being published today in Current Biology. Read more.

 

Obesity May Make Rheumatoid Arthritis Tough to Spot, Track

Blood tests to diagnose and monitor rheumatoid arthritis may be thrown off by obesity in women, a new study suggests.

“Physicians might assume that high levels of inflammation mean that a patient has rheumatoid arthritis or that their rheumatoid arthritis requires more treatment, when in fact a mild increase in levels of inflammation could be due to obesity instead,” explained study author Dr. Michael George, who’s with the University of Pennsylvania Health System in Philadelphia.

Blood tests for C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can help physicians check the severity of inflammation in rheumatoid arthritis patients, the researchers said.

Previous studies have suggested that obese women may normally have higher CRP and ESR levels. So, the authors of this study decided to take a closer look at the issue.

The study included information from more than 2,100 people with rheumatoid arthritis. The researchers then compared that information to data from the general population.

A higher body mass index (BMI — an estimate of body fat based on weight and height) was associated with greater CRP in women with rheumatoid arthritis and women in the general population, especially in severely obese women. There was also a modest association between obesity and ESR.

Conversely, in men with rheumatoid arthritis, a lower BMI was associated with greater CRP and ESR.

The findings may help improve understanding of the link between weight and inflammation. It may also help doctors learn more about how this relationship differs between women and men, the study authors added.

The findings were published April 10 in the journal Arthritis Care & Research.

Read more at Medline

Early Use of Triple Drug Cocktail Improves Ovulation in PCOS

Early intervention with a combination of antiandrogen and insulin-sensitizing agents in adolescents with polycystic ovary syndrome (PCOS) may help improve their fertility and overall health later on, a small new study suggests.

The findings were presented April 4 at ENDO 2017: The Endocrine Society Annual Meeting by Lourdes Ibáñez, MD, PhD, professor of pediatrics and director of the fellowship program in pediatric endocrinology, University of Barcelona, Spain.

In a randomized trial of 36 adolescent girls who were not sexually active  who had polycystic ovary syndrome — characterized by hirsutism and oligomenorrhea — a three-drug combination of low-dose spironolactone, pioglitazone, and metformin (SPIOMET) improved ovulation rates more effectively than did the standard oral contraceptive ethinylestradiol-levonorgestrel treatment.

Read more here

More Hot Flashes May Signal CVD Risk

Frequent hot flashes in younger middle-aged women may be a sign of a higher risk of vascular disease, researchers found.

Writing in Menopause, the authors examined 272 non-smoking women ages 40 to 60 years. They examined their endothelial cell function and the effect of hot flashes on the ability of the inner lining of these blood vessels to dilate. While there was a significant association between hot flashes and endothelial cell function among women ages 40 to 53 years, there was no association for older women (ages 50 to 64 years). These associations occurred independent of other heart disease risk factors.

Read more here

Birth control pills may protect against some cancers for decades

When it comes to oral contraceptives, women often hear about the increased cancer risk they pose. A new study, however, finds that the using birth control pills may protect against certain cancers for at least 30 years.
From an analysis of more than 46,000 women, researchers from the University of Aberdeen in the United Kingdom found that women who had ever used oral contraceptive pills were at lower risk of colorectal, ovarian, and endometrial cancers, compared with women who had never used the pill.

Furthermore, the study found no link between the use of oral contraceptives during reproductive years and increased risk of new cancers in later life.

The study was led by Dr. Lisa Iversen, of the Institute of Applied Health Sciences at Aberdeen, and the findings were recently published in the American Journal of Obstetrics and Gynaecology.

According to the Centers for Disease Control and Prevention (CDC), around 16 percent of women in the United States aged between 15 and 44 years are currently using oral contraceptive pills as a method of birth control.

The “combined pill” is the most common form of oral contraceptive used. This contains synthetic versions of the hormones estrogen and progesterone.

Since naturally occurring estrogen and progesterone have been associated with cancer development, numerous studies have investigated whether oral contraceptives might play a role in cancer risk.

Read more at Medical News Today 

Test Strips For Early Cervical Cancer Detection

Purdue researchers are developing a test strip, similar to the common pregnancy test, to detect cervical cancer and eventually other types of cancer and diseases.

Cervical cancer, the fourth most common type of cancer for women, is often detected too late, especially among women living in poor countries. The World Cancer Research Fund International says about 84 percent of cases occur in underdeveloped nations.

Current detection is based on the human papillomavirus, or HPV, test, which doctors say isn’t always able to correctly classify whether somebody has a disease or not.

“This field really needs an additional way to test for cervical cancer. A test that can report cervical cancer right away is very instrumental in a lot of low- and middle-income countries where women often get HPV tests and then never come back,” said Joseph Irudayaraj, professor of biological engineering in Purdue’s School of Agricultural and Biological Engineering. “In higher-income countries, it’s important that anything beyond HPV tests have the ability to complement those tests.”

Here’s how it works:

The strip’s color changes within 15-30 minutes to indicate the presence of specific proteins associated with cervical cancer. Irudayaraj says he’s proven the concept and is working on a prototype.

One day researchers think this test could detect other types of cancers and other diseases, including infectious pathogens.

A USDA grant is funding the research in part. Scientists are also looking for corporate funding to advance the research.

via WVXU

No benefit in treating mildly low thyroid function in pregnancy according to NIH study

There appears to be no benefit to treating mildly low thyroid function during pregnancy, according to a study by a National Institutes of Health research network.

Markedly low thyroid function during pregnancy has long been associated with impaired fetal neurological development and increased risk for preterm birth and miscarriage. Similarly, some studies have indicated that even mildly low thyroid function (subclinical hypothyroidism) could possibly affect a newborn’s cognitive development and increase the chances for pregnancy and birth complications. Read more here.

World’s first ‘menstrual cycle on a chip’ created to develop individualized treatments for women suffering from reproductive problems

The world’s first ‘menstrual cycle on a chip’ could change the future of research into gynecological problems, scientists claim.

The cube-shaped device, called Evatar, is a palm-sized recreation of the female reproductive tract.

It is made with human tissue cultured from stem cells and contains 3D models of ovaries, fallopian tubes, womb, cervix and vagina, as well as the liver.

The creation of the novel tool marks the first time scientists have been able to mimic the interplay between tissues and hormones.

Researchers plan to use the device to investigate conditions such as endometriosis, fibroids, reproductive organ cancers and infertility.

Dr Teresa Woodruff, a professor of obstetrics and gynecology at Northwestern University in Chicago, Illinois, where the device was created, said: ‘This is nothing short of a revolutionary technology.

‘If I had your stem cells and created a heart, liver, lung and an ovary, I could test 10 different drugs at 10 different doses on you and say, “Here’s the drug that will help your Alzheimer’s or Parkinson’s or diabetes”.

‘This will help us develop individualized treatments and see how females may metabolize drugs differently from males.’

The landmark study shows how the 28-day menstrual cycle can be mimicked using ‘organ on a chip’ technology.

The researchers used human stem cells to culture a combination of tissues of the ovary, fallopian tube, womb, cervix and liver in the device for four weeks.

Each ‘organ’ occupies its own brown cube and a special fluid pumps through each pea-sized organ to perform the function of blood.

The organs are able to communicate with each other via secreted substances, including hormones such as estrogen, to closely resemble how they all work together in the body.

The project is part of a larger effort by the US National Institutes of Health to create a ‘body on a chip’.

Read more at The Daily Mail

 

How dietary factors influence disease risk

Having too much sugar, salt, or fat in your diet can raise your risk for certain diseases. Healthy eating can lower your risk for heart disease, stroke, diabetes, and other health conditions. A healthy eating plan emphasizes vegetables, fruits, whole grains, and fat-free or low-fat dairy products; includes lean meats, poultry, fish, beans, eggs, and nuts; and limits saturated and trans fats, sodium, and added sugars.

The major cardiometabolic diseases—heart disease, stroke, and type 2 diabetes—pose substantial health and economic burdens on society. To better understand how different dietary components affect the risk of dying from these diseases, a research team led by Dr. Dariush Mozaffarian of Tufts University analyzed data from CDC’s National Health and Nutrition Examination Survey (NHANES) and national disease-specific mortality data. The study was supported in part by NIH’s National Heart, Lung, and Blood Institute (NHLBI). Results appeared on March 7, 2017, in the Journal of the American Medical Association.

The researchers investigated the relationships of 10 different foods and nutrients with deaths related to heart disease, stroke, and type 2 diabetes. They also compared data on participants’ age, sex, ethnicity, and education. They found that nearly half of all the deaths in the United States in 2012 that were caused by cardiometabolic diseases were associated with suboptimal eating habits. Of 702,308 adult deaths due to heart disease, stroke, and type 2 diabetes, 318,656 (45%) were associated with inadequate consumption of certain foods and nutrients widely considered vital for healthy living, and overconsumption of other foods that are not.

The highest percentage of cardiometabolic disease-related death (9.5%) was related to excess consumption of sodium. Not eating enough nuts and seeds (8.5%), seafood omega-3 fats (7.8%), vegetables (7.6%), fruits (7.5%), whole grains (5.9%), or polyunsaturated fats (2.3%) also increased risk of death compared with people who had an optimal intake of these foods/nutrients. Eating too much processed meat (8.2%), sugar-sweetened beverages (7.4%), and unprocessed red meat (0.4%) also raised the risk of heart disease, stroke, and type 2 diabetes-related deaths.

The study showed that the proportion of deaths associated with suboptimal diet varied across demographic groups. For instance, the proportion was higher among men than women; among blacks and Hispanics compared to whites; and among those with lower education levels.

“This study establishes the number of cardiometabolic deaths that can be linked to Americans’ eating habits, and the number is large,” explains Dr. David Goff, director of the NHLBI Division of Cardiovascular Sciences. “Second, it shows how recent reductions in those deaths relate to improvements in diet, and this relationship is strong. There is much work to be done in preventing heart disease, but we also know that better dietary habits can improve our health quickly, and we can act on that knowledge by making and building on small changes that add up over time.”

These findings are based on averages across the population and aren’t specific to any one person’s individual risk. Many other factors contribute to personal disease risk, including genetic factors and levels of physical activity. Individuals should consult with a health care professional about their particular dietary needs.

—Tianna Hicklin, Ph.D.

via National Institutes of Health

New thinking about urinary tract infections

Urinary tract infections (UTIs) can be tricky in older age. They’re not always as easy to spot or treat as in youth. And the decades-long approach to treatment is changing. “We’ve been hasty in using antibiotics, and we’re learning there are significant consequences that can range from side effects of medication to infections with antibiotic-resistant bacteria,” says Dr. Helen Chen, a geriatrician at Harvard-affiliated Hebrew Rehabilitation Center.

About UTIs

UTIs can occur anywhere in the urinary tract. The most common places are the bladder (where urine is stored) and the urethra (the tube through which you urinate). Less common, but more serious, is infection of the kidneys, which filter waste and extra water from the blood and make urine. Infections may be triggered by sexual activity, catheters, kidney stones, decreased estrogen in the lining of the vagina, or urine that’s pooled in the bladder.

Classic symptoms include a burning feeling with urination, a sense of urgency to urinate, increased frequency of urination, blood in the urine, and fever. Some older adults with a UTI also develop confusion.

The tricky part

Some of these UTI symptoms are similar to the symptoms of other conditions common in older people. “That makes it hard to decide if you have a new infection, or if an existing problem is worse, or if you have something else,” says Dr. Chen. For example:

  • Many older adults already have issues with frequency or urgency from bladder problems or (for men) an enlarged prostate.
  • Confusion can be a medication side effect or a sign of another problem, such as dehydration or a disturbed metabolism (which might occur with abnormal blood levels of calcium or sugar).

Also complicating diagnosis is UTI testing. A urine sample checks for the presence of bacteria and white blood cells (which would suggest an infection). If this initial test is positive, it’s usually necessary to grow the bacteria in a lab to identify the specific type of bacteria. But older women can carry bacteria in their bladders without any symptoms. Doctors call this asymptomatic bacteruria rather than a bladder infection.

Rushing to judgment

Treating a UTI without classic symptoms, based instead on the presence of some bacteria and white blood cells in urine, may have several consequences. It may mean that an underlying condition (or a worsening condition) is not being addressed. And since treatment involves a course of antibiotics, unnecessary treatment may lead to antibiotic resistance.

While the risk of not giving an antibiotic to rid the bladder of bacteria is small, it can sometimes allow bacteria to spread to the kidney and then to the bloodstream. This can lead to sepsis, the body’s toxic and sometimes deadly response to infection.

Treatment

“Anyone with new classic symptoms should probably be treated for a UTI. However, if the only symptom is confusion, considering other causes or waiting a day or two to see if it resolves may be appropriate, if the family can observe the person and is okay with this,” says Dr. Chen.

If your doctor does prescribe an antibiotic, talk about potential side effects. Certain commonly used antibiotics called fluoroquinolones — such as levofloxacin (Levaquin) and ciprofloxacin (Cipro) — can be associated with damage to tendons, joints, nerves, and the central nervous system. The FDA advises that these medications should not be used as a first-line treatment for uncomplicated UTIs. Dr. Chen says other antibiotics, such as amoxicillin and clavulanic acid (Augmentin), cotrimoxazole (Bactrim), or nitrofurantoin (Macrobid), may be better options.

via Harvard Health Publications

AHA Guidelines: Time to Revisit Thinking on Pregnancy in Women with Complex Congenital Heart Disease

In a notable twist on conventional wisdom, a new American Heart Association scientific statement on managing pregnancy in patients with complex congenital heart disease (CHD) supports the notion that most women with complex CHD can have a successful pregnancy and normal vaginal delivery. To optimize outcomes, the statement notes, care should be collaborative and involve both a high-risk obstetrician and a cardiologist versed in CHD.

The new guidelines alter the idea that patients with complex CHD should avoid pregnancy out of concern about potential risks to the mother and child.

A stepped plan for complex pregnancies

“This is an excellent statement that provides a much-needed framework for caring for these patients, covering everything from pre-pregnancy counseling to pregnancy care to post-delivery care,” says obstetrician Jeff Chapa, MD, Head of Maternal-Fetal Medicine at Cleveland Clinic.

The guidelines provide a stepped assessment plan for general cardiologists to follow.

“The process makes it easy to assess risk prior to pregnancy, determine the frequency of follow-up needed once the patient becomes pregnant and identify the level of disease that warrants tertiary care,” says Dr. Chapa. “Knowing the changes that will occur can help with risk stratification and provide an idea of how well a patient is likely to do.”

Cardiologist David Majdalany, MD, Director of Cleveland Clinic’s Adult Congenital Heart Disease Center, trained under several members of the writing group behind the AHA guidelines, so he found no surprises in the document. But he’s delighted that a summary of the latest recommendations is finally at the disposal of all providers.

“Until now, we had only bits and pieces of information from various papers primarily written on individual defects,” Dr. Majdalany explains. “These guidelines coalesce what we know in a detailed document that discusses the pros and cons of pregnancy by every class of congenital lesion. This is very helpful.”

Validated by experience

The new guidelines’ recommendations align with the experience of Drs. Chapa and Majdalany in Cleveland Clinic’s Cardio-Obstetrics Clinic, where a high-risk obstetrician and a CHD cardiologist co-manage patients, with support from colleagues in virtually every subspecialty available when needed.

The decision of whether to proceed with a vaginal delivery is made jointly. “For example, with defects such as aortic root dilation, the patient is at risk for aortic dissection, so we would suggest avoiding natural delivery in such a case,” Dr. Majdalany notes.

Read more at Cleveland Clinic

 

Duke Team Reaches Milestone with Portable Cervical Cancer Screening Device

January was Cervical Health Awareness Month, and this year, that designation held special significance for Nimmi Ramanujam, professor of biomedical engineering and global health and director of the Center for Global Women’s Health Technologies.

Since 2012, she and her research team have been developing and testing a portable colposcope, called the “Pocket Colposcope,” to increase access to cervical cancer screening in primary care settings. Last month, 20 of these devices were produced for distribution to international partners.

SCREENING IS KEY TO EARLY DETECTION AND EFFECTIVE TREATMENT

According to the World Health Organization (WHO), more than 85 percent of the more than 270,000 annual deaths from cervical cancer occur in low and middle income countries. The disease is easily treatable if identified early, but because access to effective screening is limited in low-resource settings, early detection is often not possible.

And even if access to screening is available, for example via human papilloma virus (HPV) testing, a confirmatory test is needed before a woman can receive treatment. In the United States, this test is performed through colposcopy. However, a clinical colposcope is typically not available in a primary care setting, and in many low and middle income countries, often the alternative is to visualize the cervix with only the naked eye—a method that often results in missed diagnoses. The cost of a clinical colposcope—upwards of $20,000—presents yet another barrier.

The Pocket Colposcope is designed to address these barriers. It brings that secondary test—traditionally performed using a clinical colposcope by physicians at referral centers—to the primary care setting. In addition, it’s easy for a broad range of health care providers with different levels of training to use.

ABOUT THE POCKET COLPOSCOPE

After four generations of development, the team has created a beta prototype of the Pocket Colposcope in collaboration with product design and development company 3rd Stone Design, Inc.

The Pocket Colposcope is significantly less expensive, smaller and lighter than a traditional clinical colposcope. Weighing less than two pounds, it fits inside a pocket (hence the name). The device enables healthcare providers to zoom and capture images by pressing a button with their thumb. Images taken with the Pocket Colposcope are transmitted instantly to a smartphone, tablet or laptop.

Read more at Duke Global Health Institute

Promise of PARP Inhibitors for BRCA1/BRCA2 Cancers

For patients with triple-negative breast cancer and BRCA1/BRCA2 mutations, current treatment options may at times be limited; currently, there are no specific treatments for BRCA1/BRCA2-mutated cancers that address the genetic defects seen in these cancers. However, there is growing interest in the use of Poly (ADP-ribose) polymerase (PARP) inhibitors in this setting.

Promise of PARP inhibition in BRCA-mutated disease

“In patients with BRCA1/BRCA2 mutations, PARP inhibitors are one of the most promising treatments to be tested recently in clinical trials,” says Jame Abraham, MD, Director of Cleveland Clinic Cancer Center’s Medical Breast Oncology Program and Co-Director of the Comprehensive Breast Cancer Program.

PARP inhibitors interfere with base excision repair and therefore DNA repair, to effect death of tumor cells. PARP inhibitors can be highly lethal to tumor cells in patients who already have impaired DNA repair from BRCA mutation, Dr. Abraham says.

Although triple-negative breast cancer can be sporadic, these cancers share traits that involve DNA repair defects with those occurring in BRCA-mutated carriers. Eighty percent of hereditary BRCA-mutated cancers share the triple-negative breast cancer phenotype. The prevalence of BRCA1 and BRCA2 mutations in triple-negative breast cancer ranges from 4 to 14.3 percent, and an additional 27 to 37 percent have somatic inactivation of BRCA1.

As a class, PARP inhibitors can cause profound damage to cancer cells in breast cancers that involve DNA repair pathway defects. A number of PARP inhibitors are undergoing clinical development, but none is yet FDA-approved for breast cancer.

OlympiAD and OlympiA: Clinical trial experience with olaparib

Cleveland Clinic is currently participating in two phase III clinical trials evaluating olaparib as a treatment for metastatic breast cancer as well as for stage II/III BRCA1/BRCA2, HER2-negative and triple-negative disease.

OlympiAD, the phase III trial on olaparib in metastatic breast cancer is ongoing but no longer recruiting participants and results are expected soon. In the meantime, Cleveland Clinic is enrolling patients in the OlympiA study, a phase III trial with olaparib as an adjuvant treatment for earlier-stage breast cancers with DNA repair defects — that is, in women with stage II and stage III breast cancer who have completed local treatment and neoadjuvant or adjuvant chemotherapy.

“We have enough evidence from metastatic breast cancer trials to know that olaparib is active in stage IV breast cancer. So now we want to see what kind of benefit stage II/III breast cancer patients will derive from use of olaparib,” Dr. Abraham says.

Olaparib was the first PARP inhibitor approved by both the FDA and the European Medicines Agency for patients with BRCA1/2 mutant ovarian cancer. In 2014, the FDA approved olaparib for patients with germline BRCA-mutated ovarian cancer who have undergone three or more lines of chemotherapy. The treatment was approved along with the BRACAnalysis CDx, a companion diagnostic test.

Read more at Cleveland Clinic

USPSTF: Jury Still Out on Pelvic Exams for Most Gynecologic Conditions

There is insufficient evidence to recommend for or against pelvic exams for most gynecologic conditions among asymptomatic women of reproductive age, said the U.S. Preventive Services Task Force.

Other than cervical cancer, gonorrhea and chlamydia, which have been addressed in separate recommendation statements, the USPSTF cited “insufficient evidence” to assess the balance of benefits and harms of these screenings in asymptomatic, non-pregnant women 18 years of age and older, who are not at increased risk of any specific gynecologic condition.

Notably, the authors reported that they were only able to find “limited evidence” on the accuracy of these examinations to detect ovarian cancer, bacterial vaginosis, genital herpes, and trichomoniasis — with very few studies on screening for other gynecologic conditions with pelvic examination alone.

This final recommendation (I statement) was published on the USPSTF site and simultaneously in the Journal of the American Medical AssociationIt affirms a draft statement issued last June, with a clarification that the USPST is not recommending against screening, and that it did not consider costs in its review.

The Task Force found inadequate evidence of benefits or harms in routine screening, citing only a few studies that reported false-positive rates for ovarian cancer (ranging from 1.2% to 8.6%), and rates of surgery for patients with abnormal findings (ranging from 5% to 36%). No studies quantified the amount of anxiety associated with these examinations, they noted.

separate editorial in JAMA Internal Medicine singled out the high false-positive rates with ovarian cancer screening and suggested the associated harms may be “substantial.” George F. Sawaya, MD, of the University of California San Francisco, characterized pelvic exams as a “ritual,” citing a survey of U.S. ob/gyns where over 85% said they performed bi-manual examination even among patients who had undergone a total hysterectomy, including the removal of both tubes and ovaries.

Read more at MedPage Today

Editor-in-chief ’s message

Dear Colleagues,

I hope you are all enjoying a happy and healthy new year and are looking forward to the upcoming spring season!

The year 2016 was an excellent one for Women’s Healthcare: A Clinical Journal for NPs. Our feature-length articles, as well as our shorter department articles, covered a wide variety of topics important to women’s health. I heartily thank all the authors who wrote articles published in 2016. I also extend a special thank-you to the individuals who peer-reviewed manuscripts for us in 2016. The work of these peer reviewers helps ensure that the articles we publish are the very best:

Kelly Ackerson
Carola Bruflat
Lorraine Byrnes
Joyce Cappiello
Stefani Davis
Melanie Deal
Brenda Deeser
Rebecca Fay
Lauren Hansen
Beth Kutler
Patrice Malena
Anne Moore
Ginny Moore
Charlotte Peavie
Heather Quaile
Suzy Reiter
Beth Steinfeld
Joyce Tow

In addition, I want to recognize Joyce Cappiello and Michele R. Davidson, who are leaving our Editorial Advisory Board. I thank both of them for the important contributions that they have made to our journal. And I am pleased to welcome Barb Dehn and and Amy Levi as new members of the advisory board.

We have other accomplishments to celebrate as well, with four NPWH position statements approved by the board of directors in the past year:

The Doctor of Nursing Practice for Women’s Health Nurse Practitioners

Prevention of Alcohol-Exposed Pregnancies

Prevention and Management of Opioid Misuse and Opioid Use Disorder Among Women Across the Lifespan

Human Sex Trafficking

The writing group members for these NPWH position statements deserve special recognition. I extend a huge thank-you to these individuals for the time and hard work they contributed to make our position statements robust and relevant to NPs who provide healthcare to women:

Diana Drake
Megan Fredericksen
Aimee Chism Holland
Debra Ilchak
Sue Kendig
Ginny Moore
Sylvia Poe-Valesco
Stephanie Pott
Ursula Pritham
Susan Rawlins
Amanda Reynolds
Rebecca Sarabia
Diane Schadewald

I also thank all the individuals who reviewed the position statements and those who provided feedback as part of the public comment process.

Now, as we begin a brand-new year of publication of the journal, we have many outstanding articles in store for you. As always, we invite you to help us to maintain our momentum by submitting a manuscript in one of the multiple formats offered.

In case you need some topic ideas to get you started, I have some suggestions. Consider writing about bipolar disorder, borderline personality disorder, Alzheimer’s disease, epilepsy, multiple sclerosis, systemic lupus erythematosus, hypertension, hyperlipidemia, bariatric surgery, asthma, gastroesophageal reflux disease, or ulcerative colitis—from a women’s health perspective, of course—or about endometriosis, genital herpes, vaginal infections, breastfeeding issues, or autoimmune disorders in pregnancy.

Click here or visit our journal website to access our complete Guidelines for Authors. We welcome query letters about any topic and article format you are considering.

You can reach Dory Greene, our managing editor, at dgreene@healthcommedia.com, or me at bkelsey@healthcommedia.com.

Beth Kelsey, EdD, APRN, WHNP-BC

Less-Invasive Fibroid Treatment May Be ‘Under-Used’

A minimally invasive procedure for uterine fibroids may be “under-used” in U.S. hospitals, compared with surgery, a new study suggests.

The study looked at a national sample of hospitals and found that fewer fibroid patients are undergoing hysterectomy — surgical removal of the uterus.

But hysterectomy remains much more common compared with a less-invasive procedure called embolization.

Fibroids are non-cancerous growths in the wall of the uterus that are usually harmless. But when they cause problems — such as persistent pain and heavy menstrual bleeding — treatment may be necessary.

For women with severe symptoms, the go-to has traditionally been hysterectomy, or sometimes surgery to remove the fibroids only.

There are other options, though. One is embolization, which involves injecting tiny particles into the small uterine arteries supplying the fibroids. The particles block the fibroids’ supply of nutrients and cause them to shrink.

Embolization has been a widely accepted treatment for 10 to 15 years, said Dr. Prasoon Mohan, lead researcher on the new study.

Yet, his team found, it still lags far behind hysterectomy. From 2012 through 2013, hysterectomies were performed 65 times more often than embolization at U.S. hospitals.

When embolization was done, it was usually at a large medical center. Few women treated at smaller or rural hospitals had the procedure, the study found.

That points to a discrepancy in women’s access to the treatment, said Mohan, an assistant professor of interventional radiology at the University of Miami.

How often “should” embolization be done? There’s no way to define that, but Mohan said it seems clear that it’s not offered often enough.

“I think it’s definitely under-used, considering it’s minimally invasive, has a shorter hospital stay and is less expensive,” he said.

Read more at Medline Plus

Incontinence may reflect body fat, not just weight

Being overweight or obese is an established risk factor for urinary incontinence, but a recent study indicates that body composition may also play a role. A multicenter team of researchers examined data from 1,475 women enrolled in the Health, Aging, and Body Composition Study. The participants ranged in age from 70 to 79 at the beginning of the study.

The research team looked at body mass index (BMI), percentage of body fat, and the frequency and type of incontinence episodes among participants over three years. They found that both stress incontinence—episodes of spilled urine during exercise—and urge incontinence—sudden, uncontrollable urination—were twice as common in women with the highest BMIs or greatest proportion of body fat compared with those in the lowest categories. Women who lost grip strength—an indication of reduced muscle mass—also had increased episodes of stress incontinence. However, overweight women who reduced either their BMI or their body fat by 5% were less likely than women who didn’t lose weight or shed fat to experience new or persistent stress incontinence. The study was published online Dec. 5, 2016, by the Journal of the American Geriatrics Society.

These findings suggest that while weight loss alone may help alleviate both forms of incontinence, activities that increase muscle mass may be especially helpful for women with stress incontinence.

via Harvard Health Publications

Inside Knowledge: Get the Facts About Gynecologic Cancer

The Inside Knowledge campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. Inside Knowledge encourages women to pay attention to their bodies, so they can recognize any warning signs and seek medical care.

New television and radio public service announcements in English and Spanish feature actress Cote de Pablo, talking about her own cervical cancer scare, and sharing advice for other women. And check out the new posters telling Cote’s story, as well as our Behind-the-Scenes videos from filming!

Inside Knowledge also has new TV and radio PSAs that highlight gynecologic cancer symptoms. The PSAs encourage women to learn the symptoms, and pay attention to what their bodies are telling them.

Inside Knowledge has resources for women, and for health care providers and organizations to share with their patients and communities.

Read more and access the resources here at the CDC’s website

CMV virus is way more common than Zika. But expectant mothers don’t know their babies are at risk.

WHEAT RIDGE — When Megan Wiedel was pregnant with her second child, she did just as her doctor told her to.

No raw fish. No soft cheeses. No lunch meat.

All along, a much bigger risk — one that her doctor never told her about — loomed.

So, unaware, when Wiedel’s first daughter sniffled, she held her. When Wiedel herself caught a cold in the second trimester, she shrugged it off. And when her second daughter, Anna, was born — at only 5 pounds, full term — and then failed the newborn hearing test, Wiedel and her husband tried not to worry as the pediatrician ordered more tests.

Two weeks later, the results came back. Anna would be deaf for the rest of her life. She might never be able to walk or even hold her head up. It was because she had a virus called CMV.

Wiedel hung up the phone and thought to herself: Why had she never heard about CMV?

“When you talk about it, it seems like it’s really rare,” Wiedel said. “But it’s not. A lot of kids have CMV.”

“That’s the hardest piece for me is that this is a preventable, prevalent, quiet disease.”

But, now, a small community of mothers and medical workers are trying to make CMV awareness a little less quiet.

Cytomegalovirus, or CMV, is the most common nongenetic cause of childhood deafness in the country. Every year, approximately 30,000 babies are born in the United States infected with CMV, and as many as 8,000 of those children suffer lifetime consequences from the disease — which can also include blindness, cognitive delays and microcephaly. As many as 400 infants die every year from CMV, according to the National CMV Foundation.
It is vastly more common than the Zika virus, which prompted alarm last summer for its potential to cause birth defects. But, while Congress invested $1.1 billion in fighting Zika, funding for CMV lags behind, and numerous studies show that as many as 85 percent of expectant mothers have no idea what CMV is. The American College of Obstetricians and Gynecologists does not advise doctors to talk to expectant mothers about CMV — despite the fact that it is an easily spread virus that is present in nearly every elementary school and day care center in the country.

At Children’s Hospital Colorado, physician assistant Shannon Hughes has developed an outpatient clinic for kids dealing with the aftereffects of CMV. The clinic has served about 40 kids in the past two years. Nearly all of the parents she meets had never heard of CMV before finding out that it would forever alter their children’s lives.

“Obviously, that has a big impact on them emotionally that they think they did something wrong and should have prevented it,” she said.

Neonatal nurse practitioner Erin Mestas, who also works at Children’s as well as at Poudre Valley Hospital, is also trying to raise awareness among both mothers and health care workers about CMV.

“There needs to be more education about CMV risk reduction,” Mestas said. “I think childbearing women need to be more educated.”

In some ways, CMV’s ubiquity accounts for its invisibility.

Most adults have been exposed to CMV at some point in their lifetimes, meaning they have antibodies to fight off a new CMV infection. For women with CMV antibodies, then, being exposed to the virus while pregnant is usually no big deal.

Read more at The Denver Post

 

10 Women Who Shaped and Advanced Women’s Health

In honor of Women’s History Month, Healthy Women put the spotlight on 10 women (but there are so many more!) who made important contributions to prioritizing women’s health.

1. Clara Barton, nurse/educator (1821–1912) 
Barton founded the American Red Cross in 1881. Since then, the organization has provided much-needed relief for the vulnerable in America—and abroad. Barton identified her calling while nursing wounded soldiers and searching for missing ones during the Civil War.

2. Elizabeth Blackwell, MD, author, educator (1821–1910)
In 1849, Blackwell became the very first woman to earn an MD degree from an American medical school. She was inspired to break barriers because her female friend wanted to see a female doctor. Now, half of medical school graduates are females.

3. Margaret Sanger, women’s rights activist (1879–1966)
Sanger’s research led to the discovery of a pill to prevent pregnancy, and she coined “birth control.” She founded the American Birth Control League, which is now known as Planned Parenthood. Sanger advocated for reproductive rights after caring for women who attempted self-induced abortions and suffered from poorly performed illegal ones.

4. Rebecca Lee Crumpler, MD (1831-1895)
In 1864, Crumpler became the first African-American woman to receive an MD degree. Her book, Book of Medical Discourses, was one of the first publications about medicine by an African American. In post-Civil War Richmond, Va., she cared for freed slaves who would not have otherwise had access to medical care.

5. Ina May Gaskin, MA, CPM (1940-)
Often described as “the mother of authentic midwifery,” Gaskin advocated for natural and home birth at a time when childbirth was seen as a medical problem. Her efforts empowered women to gain control of their bodies and have a say in how they wanted to deliver their babies.

6. Catherine Switzer, author, television commentator and marathon runner (1947-)
Switzer was the first woman to enter and run the Boston Marathon in 1967. She was able to enter because she didn’t use her full name, but when the race director saw a woman running, he tried to physically remove her from the race. Switzer stayed the course, finished and went on to advocate for the women’s marathon to be added to the Olympics.

7. Jane Fonda, actress (1937-) 
Fonda revolutionized women’s fitness in the ’80s and ’90s when she released her workout videos—donning leotards and legwarmers, of course! Her first tape, released in 1982, is the best-selling home workout video of all time.

8. Michelle Obama, U.S. First Lady, lawyer (1964-)
First Lady Michelle Obama turned children’s healthy eating and physical activity into a national conversation. She started a vegetable garden at the White House in 2009 and launched the Let’s Move campaign in 2010. From doing the dougie to competing in fitness competitions against Jimmy Fallon, Mrs. Obama has made healthy living fun—for kids and adults.

9. Nancy Brinker, founder and chair of global strategy of Susan G. Komen (1946-)
Susan G. Komen is widely known now for its global efforts to fight breast cancer. But Brinker founded the organization in 1982 when the disease was not discussed. She named the organization in honor of her sister who lost her battle to breast cancer in 1980.

10. Melinda Gates, business leader, philanthropist (1964-)
As cochair of the Bill and Melinda Gates Foundation, Melinda Gates has advocated for prioritizing women’s and children’s health around the world. The Gates Foundation invests in maternal and child health, family planning and nutrition programs in developing countries. In the United States, Melinda Gates has become a strong voice in reducing the gender gap.

These are just a small, but mighty, group of women who have fought for women’s health priorities, and we’re thrilled to celebrate them.

via Healthy Women

 

Epidemiology of Adnexal Tumors

The determination of the precise frequency of adnexal masses is impossible as some adnexal tumors go undiagnosed. A variety of age groups need to be considered while estimating the clinical significance of adnexal masses.

Children to adolescents
Nearly 80% of ovarian cysts in girls under 9 years are malignant and those are mostly germ cell tumors.

About half of the adnexal neoplasms in adolescent girls are mature cystic teratomas or dermoid cysts. Women who have a Y chromosome-carrying gonad stand a 25% chance of developing a cancerous growth.

Overall, about 10% of ovarian cancers were found to be hereditary. Patients with a family history of a non-polyposis colorectal cancer syndrome or breast-ovarian cancer syndrome were at an increased risk for developing cancerous tumors.

Endometriosis, though not common in adolescence, may be present in about half of women who have a painful mass. In adolescent women who are sexually active, tubo-ovarian abscess must be considered as a possible cause of an adnexal mass.

Adults
Most adnexal masses in reproductive age women are benign cysts. Only 10% of masses are malignant. The rate of malignancy is low in patients aged under 30.

About 25% of adnexal growths are endometriomas, 33% are mature cystic teratomas, and the rest are functional cysts or serous or mucinous cystadenomas.

No matter what the age group is, physicians must take into account the possibility of structural deformities and uterine masses. Also, in all premenopausal women, pregnancy-related adnexal masses such as ectopic pregnancy, corpus luteum cysts, theca lutein cysts, and luteomas should be considered.

Research findings
A research conducted by the Duke Evidence-based Practice Center on a contract with the Agency for Healthcare Research and Quality found that ovarian cancer is the leading cause of death from gynecologic malignancies in the US. The annual incidence of ovarian cancer was over 25,000 with an annual mortality of about 14,000.

Read more at News-medical.net

Common Virus Tied to Diabetes, Heart Disease in Women Under 50

A type of herpes virus that infects about half of the U.S. population has been associated with risk factors for Type 2 diabetes and heart disease in normal-weight women aged 20 to 49, according to a new UC San Francisco-led study.

A research team, headed by first author Shannon Fleck-Derderian, MPH, of the UCSF Department of Pediatrics, and senior author Janet Wojcicki, PhD, MPH, associate professor of pediatrics and epidemiology at UCSF, found that women of normal weight who were infected with cytomegalovirus (CMV), which typically causes no evident symptoms, were more likely to have metabolic syndrome. This condition includes risk factors such as excess abdominal fat, unhealthy cholesterol and blood fat levels, high blood pressure and elevated blood glucose.

In contrast, women infected with CMV who also had extreme obesity – defined as a body mass index (BMI) of at least 40 – were unexpectedly less likely to have metabolic syndrome than women with extreme obesity who were not infected with CMV.

The study appears Feb. 23, 2017, in the journal Obesity.

Weight Predicts Metabolic Syndrome in CMV+ Women

“The likelihood that women infected with CMV will have metabolic syndrome varies dramatically, depending on the presence, absence and severity of obesity,” Fleck-Derderian said. The UCSF research team did not find these same associations between CMV and metabolic syndrome in the men included in the study.

Scientific evidence indicates that metabolic syndrome may be triggered by long-acting, low-intensity inflammation. But while studies have implicated obesity in chronic inflammation, a large minority of individuals with obesity do not develop metabolic syndrome, and many normal-weight individuals do, leading researchers to search for additional drivers of chronic inflammation that also may influence risk for developing metabolic syndrome.

Read more at ScienceBlog

New Agents, Combinations Showing Durable Benefit in Triple-Negative Breast Cancer

The triple-negative breast cancer (TNBC) pipeline is transforming, experts say, with the potential additions of immunotherapy and PARP inhibitors. These agents are being explored both as monotherapy and in combination regimens with standard chemotherapy options.

At the 2016 San Antonio Breast Cancer Symposium, treatment with pembrolizumab (Keytruda) continued to show a consistent durable benefit with an additional year of follow-up for heavily pretreated patients with recurrent PD-L1–positive TNBC, according to findings from the phase Ib KEYNOTE-012 trial.

At a median follow-up of 10.7 months, the median progression-free survival (PFS) was 1.9 months (95% CI, 1.6-5.5), and the 12-month PFS rate was 17.8%. The median overall survival (OS) was 11.3 months (95% CI, 5.3-18.2), and the 12-month OS rate was 47.1%.

In a recent interview, Joyce A. O’Shaughnessy, MD, chair of Breast Cancer Research at Baylor-Sammons Cancer Center, Texas Oncology, addressed some of the key issues in breast cancer treatment and shared insights on where TNBC treatment is headed based on recent research findings.

Read more at Oncology Nursing News

Message from the CEO

As we enter 2017, we are excited about the new opportunities and programs we have planned for the year. For example, with regard to our Well Woman Visit Mobile App, we are working on adding a Menopause section, which we know you will want to download. At the end of 2016, we completed a new edition of the App, which now includes the assessment of Irritable Bowel Syndrome. Remember, the App is free, and a very helpful tool in your practice, so please share it with your colleagues today!

We are in the process of planning four regional, 1-day, complimentary CE meetings that will cover topics such as HPV Immunizations, Contraception, Bacterial Vaginosis, Menopause, and Hereditary Cancer. Last year, we held a regional meeting in Pasadena, California. Instead of providing just didactic lectures and slides, we introduced case studies on the topics and broke into small groups. The attendees loved the format and were happy they participated. Watch for announcements of future meetings and locations.

Another project we are working on for 2017 is our Patient Portal. Over the years, we have provided nurse practitioners with toolkits comprised not only of educational materials for you, but also helpful information for your patients. In addition to the toolkits, we want to provide a place for your patients to access NPWH-vetted materials that are easy to understand, visually engaging, and easy to use, and that serve as an excellent resource for practical information regarding their health. This Patient Portal will give you, the provider, an opportunity to print the materials to give to your patients and/or direct them to our website. At a later date, we will provide this information in Spanish as well.

The year 2017 is the fourth in a row that we will be off ering the Women’s Sexual Health Course for NPs. This course will enhance your ability to promote women’s sexual health and increase your confidence in being able to evaluate, diagnose, and manage female sexual dysfunction. The course will be held on June 8-11, 2017, at the Sheraton Inner Harbor in Baltimore, Maryland.

For your convenience, we have included the program guide and registration information in this issue of the journal. Don’t miss this opportunity; register today!

Gay Johnson
Chief Executive Officer, NPWH

Satisfaction, acceptability high with vaginal estradiol softgel capsules

Postmenopausal women with vulvar and vaginal atrophy reported high satisfaction and acceptability with vaginal estradiol softgel capsules compared with previously used therapies to treat their symptoms, study data show.

“[Vulvar and vaginal atrophy] is a chronic condition associated with genitourinary syndrome of menopause and affects 50% to 70% of postmenopausal women,” Sheryl A. Kingsberg, PhD, division chief, obstetrics and gynecology behavioral medicine, UH Cleveland Medical Center and professor of obstetrics and gynecology and psychiatry, Case Western Reserve University School of Medicine, told Endocrine Today. “Symptoms include pain with sexual activity, dryness and discomfort. Despite safe and effective prescription therapies, [vulvar and vaginal atrophy] remained under-treated. The availability of a new applicator-free delivery system may be one step to increasing discussion of [vulvar and vaginal atrophy] and treatments between women and [health care providers].”

Read more at Healio

NPs are a new lifeline for opioid addicts

WASHINGTON—Doctors working on the front lines of the nation’s heroin epidemic may be getting some fresh troops starting in 2017—battle-ready health professionals such as Danielle Eddings.

Eddings is a nurse practitioner in Springfield, Mo., eager to take advantage of a new federal law that will allow nurse practitioners and physician assistants to administer a highly effective anti-addiction medication called buprenorphine. Right now, only physicians can prescribe that drug, and they are limited to treating 275 patients per year.

That means a tide of patients get turned away every day at the Ozarks Community Hospital’s Northside Clinic where Eddings works, because the only doctor in the practice has hit his patient cap.

“There’s a dire need,” said Eddings, a psychiatric mental health nurse practitioner at the clinic. “There’s tons of people who can’t get treatment because it’s so limited.”

Congress approved a sweeping bill to address the opioid crisis earlier this year. That measure, now law, included a provision allowing certain non-physicians to treat addicts with buprenorphine.

Last week, federal health officials paved the way for that to take effect—detailing 24 hours of required training for nurse practitioners and physician assistants to complete before they can begin prescribing buprenorphine and similar medications. Buprenorphine is classified as a Schedule III narcotic, and it works by blocking opioid receptors in the brain and minimizing withdrawal symptoms.

It’s part of a treatment regimen called medication-assisted therapy, or MAT, and it’s been proven highly successful. Given in combination with behavioral therapy and other counseling, 70 to 80 percent of patients become stable.

Some doctors worry that allowing non-physicians to treat addicts with the medication will lower the quality of treatment and increase street access to another powerful drug with potential for misuse. But even those who express such concerns say the scope of the opioid crisis requires this expansion.

“We’re in the middle of an unprecedented epidemic,” said Dr. Arturo Taca, a St. Louis psychiatrist and president of the Midwest Society of Addiction Medicine. “There’s a lack of providers and a lack of experts in the field” to treat a growing number of patients suffering from addiction.

Taca said there are only about 30 addiction specialists practicing in Missouri, while the opioid problem in the state has risen rapidly. From 1999 to 2014, opioid-related death rates in Missouri have increased 7.6 times for women and 3.8 times for men, according to the state Department of Mental Health. More than 1,000 Missourians died in 2014 from opioid overdoses.

The trend is playing out across the country, where the nation’s approximately 5,000 addiction specialists struggling to respond, said Stuart Gitlow, past president of the American Society of Addiction Medicine and a Rhode Island physician.

Trying to get more doctors into the field won’t work, Gitlow said, because it’s more difficult and less profitable than other specialties. “So one of the decisions was ‘Okay, let’s go with PAs and NPs and see if that helps’,” he said.

While these are highly qualified professionals, Gitlow noted that they do not have same years-long medical training as doctors have and may have little to no addiction education.

Feds prosecute pain-clinic workers as drug dealers
“Imagine if we don’t have enough plumbers and as a result, I’m bringing in electricians to work on my sink,” he said. “We’re kind of sitting on pins and needles waiting to see how this will all work out.”

He and others say there’s no question the new rule will tap a vast new pool of providers for addiction treatment. There are about 220,000 licensed nurse practitioners in the U.S. and 110,000 physician assistants—and many of those folks are already lining up for the 24 hours of training.

Under the new rule, PAs and NPs will be able to treat 30 patients annually with buprenorphine starting in 2017 and then up to 100 patients each year after that.

“The interest is extremely high,” said Josanne K. Pagel, president of the American Academy of PAs and executive director of PAs at the Cleveland Clinic Health System.

Pagel noted that PAs already regularly see patients suffering from addiction but were limited in their ability to help them.

“We felt that our hands were tied,” she said. “PAs just need the tools to be able to treat them.”

Since passage of the addiction law, Pagel said, she’s been besieged with emails and phone calls from PAs eager to sign up for the training, which will focus on opioid detoxification, patient assessment, and the pharmacology of buprenorphine.

“I think it’s going to move the needle in combating this crisis,” Pagel said. “It’s going to make a difference.”

Eddings agreed and said she plans to complete the coursework in early January, so she can start seeing patients in Springfield.

Her boss, Dr. Salvador Ceniceros, said that could help cut the clinic’s approximately 75-person waiting list in half. But, he added, it’s still not enough.

“It will help, there’s no doubt,” he said. But he said it’s not unusual for his clinic to get 20 calls a day from new patients seeking treatment, and they need other care besides buprenorphine—including scarce counseling or therapy services.

“The numbers are just … you have no idea,” Ceniceros said.

via USA Today

Medical Therapy for Uterine Fibroids

Medical Therapy for Uterine Fibroids Draws Nearer as Phase 2 Trial Brings Promising Results

Women with large uterine fibroids suffer with many quality-of-life issues, including limitations on work, travel, hobbies and sexuality. Unfortunately, our treatment options are primarily surgical ‒ hysterectomy or myomectomy. There is a real need for medical options to help these patients, and Cleveland Clinic recently participated in a Phase 2 placebo-controlled dose-related trial (ASTEROID 1) to investigate the progesterone receptor modulator vilaprisan (Bayer Pharma AG) for this purpose. The study was sponsored by Bayer Pharma AG. Continue reading »

Irregular Sleep During Menopause May be Hard for Older Women’s Hearts

The sleep woes that many women suffer during menopause may be more than a nuisance: New research suggests a link between lost sleep and an increase in risk factors for heart disease and stroke.

When loss of sleep was measured both objectively and subjectively, the researchers found it correlated with a higher risk of plaque buildup in blood vessels and a thickening of artery walls. Continue reading »

Message from the CEO

This September marked NPWH’s 19th Annual Premier Women’s Healthcare Conference, and it was a huge success! The main conference began with presentations by dynamic women who set the tone for the rest of the event. First, we enjoyed Conversation with Loretta Ford, EdD, RN, PNP, FAAN, FAANP. Loretta was co-founder of the first nurse practitioner (NP) program in the United States. Loretta, along with Henry Silver, MD, inaugurated the pediatric NP program at the University of Colorado in 1965. Then in 1972, Loretta joined the University of Rochester as founding Dean of the Nursing School. Jacki Witt, Chair of the NPWH Board of Directors, and I presented Loretta with a Leadership Award with this inscription: For Extraordinary Vision, Remarkable Dedication, Passionate Commitment to Excellence in Creating the Nurse Practitioner RoleLoretta Ford is truly an inspiration to everyone who meets her.

The next two speakers were Teresa Gardner Tyson, DNP, MSN, FNP-BC, FAANP, and Paula Meade, DNP, MSN, FNP-BC, PNP-BC, FAANP. Teresa and Paula are lifelong friends who grew up in the rural Appala – chian Mountains of Virginia. They left the area to pursue their education and clinical experience, and then returned to start a free nurse-managed health clinic, The Health Wagon, for uninsured patients. These two NPs and The Health Wagon were featured in a segment on 60 Minutes, which showcased their efforts to provide access to healthcare for the poor and marginalized people of Appalachia. Their clinic also received notable recognition by Nightline, CBS Nightly News, Inside Edition, The Washington Post, and The New York Times. Teresa and Paula continue to extend their reach to underserved populations. For the past 17 years, they have provided services to the Remote Area Medical Health Expedition in Virginia, which is the largest healthcare outreach in the U.S. They currently manage two mobile units and two stationary Health Wagon clinics.

Once again, NPWH was proud to present the Inspiration in Women’s Health Award to four different NPs. The Inspiration Award Winner for Education was Sharon D. Baker, BSN, MS, CWHNP, CMP, of Georgia; the Inspiration Award Winner for Clinical was Jennifer Kurkowski, MSN, WHNP-BC, of Texas; the Inspiration Award Winner for Research was Naomi Jay, PhD, RN, NP, of California; and the Inspiration Award Winner for Policy was Denise Link, PhD, WHNP-BC, CNE, FAAN, FAANP, of Arizona. The award winners received free conference registration, travel to and from New Orleans, and accommodations for the duration of the conference, as well as an award and a scholarship to continue their great work. All of these awards were made possible through a grant from Hologic, Inc. “Inspiration” was clearly a theme throughout the conference; the sessions and symposia—notable for their captivating content and spirited speakers—were truly inspiring to the attendees.

One last thing: We are all inspired by the contributions that you make every day to the healthcare of women! Thank you, and have a happy and healthy holiday season!

Editor-in-chief’s message

Dear Colleagues,

It was wonderful to meet some NPWH members for the first time, as well as catch up with those members

I already knew, at our 19th Annual NPWH Premier Women’s Healthcare Conference in New Orleans. I have missed only one conference in these 19 years, and I can say without a doubt that they just keep getting better and better. This is the women’s healthcare conference that covers it all—contemporary issues to keep us up to date, challenging issues that we face clinically and professionally every day, and the very practical skills that we need to provide comprehensive, quality healthcare for women.

If you want to be inspired, as well as informed, this conference is always the one to attend. This year, we had the exceptional opportunity to have a conversation with Dr. Loretta Ford, founder of the nurse practitioner (NP) profession. Dr. Ford wove together the past and present for NPs. When asked what we needed to do to ensure that our profession thrives in the future, she advised us to “Keep moving!” Our keynote speakers, two NPs serving the rural Appalachian population with their health mobile, demonstrated the power of commitment and perseverance in helping those in need. As always, our four Inspiration in Women’s Health Award winners this year reminded us of the remarkable work our colleagues have accomplished.

If you attended the conference this year, you may have faced the same difficulty I did in terms of choosing among the breakout sessions. Fortunately, these sessions were recorded and are available free to conference attendees on the NPWH website E-Learning Portal. If you missed the conference, you can purchase individual recorded sessions and obtain CE credits. Each session is $10 for members and $15 for non-members.

Our annual NPWH conferences are so successful because of the extraordinary team effort of our Planning Committee, our Board of Directors, our staff members, and our CEO, Gay Johnson. We are also grateful for the meticulous behind-the-scenes work accomplished by our Education and Research Committees to ensure that the presentation and poster content is evidence based and relevant to NPs providing healthcare for women. Exhibitors at the conference afford us an opportunity to learn and get questions answered about women’s health products, services, and pharmaceuticals.

I extend a huge thank-you to everyone, including the attendees, who made this conference such a success. I want to extend a special thank-you to the New Orleans WHNPs who served on the Hospitality Committee. They greeted us at the Hospitality Booth with festive Mardi Gras beads and information on what we could see and do while in the Big Easy, as well as helping us in the break-out session rooms.

I am already looking forward to our 20th Annual NPWH Premier Women’s Healthcare Conference, which will take place on October 11-14, 2017, in Seattle. I hope to have the opportunity to meet more of you, as well as catch up again with the many colleagues I have already met.

The holidays are upon us! I wish you all happy time spent with family and friends as we move into the new year!

Message from the CEO

As I am sure many of you know, NPWH always strives to provide you with tools and information that you can use to further your professional development and your education. I am proud to announce that NPWH has developed the Women’s Health Nurse Practitioner Certification Exam Review Course and Women’s Health Update! This 22-module package provides a comprehensive review course that will help new WHNP graduates prepare for the National Certification Corporation (NCC) WHNP certification examination. In addition, the review course package includes a module on test-taking strategies, with more than 200 review questions that are presented in the NCC question format.

This course is designed to meet the needs of not only new WHNP graduates but also students and practicing NPs. In addition, current WHNP students can use selected modules to supplement course content as they progress through their academic program. The added benefit of this review course is that WHNPs will earn continuing education credit and pharmacology hours for each module.

These modules have been created and presented by 15 NCC-certified WHNPs who are experts in women’s health. All presenters of the modules either currently teach or have taught in WHNP programs and were chosen specifically because they specialize in the topic. Exposure to multiple WHNP experts enables participants to experience a variety of presenting styles that will keep them engaged throughout the course.

As a final important note, each module was reviewed by two external NPs with a range of experience, from recent graduates to veteran WHNPs.

For more information on how to purchase the entire review course or selected modules, please visit www.npwh.org and click on E-Learning and then Curriculum.

We hope to see you in New Orleans for our 19th Annual PremierWomen’s Healthcare Conference, which will be held from September 28 through October 1, 2016. This conference promises to be an exciting event in a fabulous location! Visit our website for more information.

– Gay Johnson

Chief Executive Officer, NPWH

Editor-in-chief’s message

Dear Colleagues,

August is National Breastfeeding Awareness Month. As providers of women’s healthcare, we all know the benefits of breastfeeding for babies and mothers. The American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists recommend that infants receive nothing but breast milk for the first 6 months of life and that mothers continue breastfeeding until the end of a baby’s first year.

Breastfeeding rates. In 2011, 76% of new mothers began breastfeeding and 47% continued doing so at 6 months, but only 26% were breastfeeding at 12 months.1 Only 18.8% of infants were breastfed exclusively through the first 6 months. Healthy People has set target goals for 2020 that include increasing the proportions of infants who are breastfed at 6 months to 60.6%, are breastfed at 12 months to 34.1%, and are breastfed exclusively through the first 6 months to 25.5%.1

Breastfeeding and the workplace. One obstacle to continuing breastfeeding is the desire and/or need for mothers to return to work. Although the Family and Medical Leave Act provides for unpaid maternity leave of up to 12 weeks after giving birth, only 20% of working mothers meet the eligibility criteria.2 Even among working mothers eligible for this benefit, many choose not to participate because they cannot afford to take unpaid leave. One-third of working mothers return to work within 3 months of the birth of their child and two-thirds return within 6 months.2 Women employed full time are less likely to initiate breastfeeding or to continue breastfeeding once they return to work. How can we support working women who want to breastfeed their babies?

Evidence shows that a supportive work environment, where women have access to a quality breast pump and a private place to express milk, helps women feel better about continuing to breastfeed after returning to work.

Access to electric breast pumps.Women should be able to obtain breast pumps prior to giving birth and should have an expedited process to acquire a breast pump quickly when they need it. Current federal guidance that allows plans to cover only manual pumps should be changed. When women return to work, they may find using an electric pump more compatible with the need to express milk quickly and efficiently.2

Access to a private place to express milk. Twenty-seven states plus the District of Columbia have legislation specifying the rights and responsibilities of employers in supporting breastfeeding employees.3 The National Conference of State Legislatures provides a summary of breastfeeding state laws.3 Most of these laws require that employers provide reasonable time and private accommodations (other than a bathroom) for employees to express milk at the workplace. In 2009, 25% of employers provided onsite lactation rooms. As of 2014, 28% of employers did so.2 Healthy People has set a 2020 target goal to increase this rate to 38%.1 The Center for Prevention and Health Service of the National Business Group on Health has published Investing in Workplace Breastfeeding Programs and Policies: An Employer’s Toolkit,2 which includes information on workplace breastfeeding options; tools for employers to use to start, maintain, and evaluate outcomes of their workplace breastfeeding support programs; and information for breastfeeding employees.

Insurance coverage. The Affordable Care Act requires insurance plans to cover breastfeeding supplies, support, and counseling without co-payments, deductibles, or co-insurance. Although this coverage represents a huge step forward in providing women with the support and equipment to successfully breastfeed as long as they want, obstacles remain. The National Women’s Law Center’s State of Breastfeeding Coverage describes some of the violations of the provision that have impeded women’s access to these mandated services.4 Insurance plans that do not have trained providers for lactation counseling support within their own network must provide timely access to out-of-network providers at no cost-sharing. This access must extend throughout the duration of breastfeeding.

NP role. As advocates for healthy women and babies, we should help women navigate the sometimes burdensome insurance coverage process. We should report violations by insurers. We can also promote workplace programs that support employees who desire to breastfeed after returning to work.

Beth Kelsey, EdD, APRN, WHNP-BC

References

1. Healthy People 2020. Maternal, Infant, and Child Health. 2014.

2. National Business Group on Health. Center for Prevention and Health Services. 2009. Investing in Workplace Breastfeeding Programs and Policies: An Employer’s Toolkit.

3. National Conference of State Legislatures. Breastfeeding State Laws. 2015.

4. National Women’s Law Center. State of Breastfeeding Coverage: Health Plan Violations of the Affordable Care Act. 2015.

Message from the CEO

In case you haven’t noticed, NPWH is striving to provide more and more educational offerings for nurse practitioners. We just completed our complimentary continuing education (CE) 1-day regional course, Managing Women’s Health Issues Across a Lifespan, in Pasadena, California. I am pleased to report that the attendees found the content very informative and the expert faculty highly inspiring. They felt it was worthwhile to give up a Saturday in order to learn more about long-acting reversible contraceptives, endometriosis, genitourinary syndrome of menopause, and obesity, and to earn free CE credits. We are working toward providing more of these regional courses covering additional hot topics in women’s health next year.

Another update: We are building out our Well Woman Visit mobile app to include assessment and treatment options for irritable bowel syndrome. Stay tuned for the announcement indicating that this updated app is available to download. For those of you who haven’t already downloaded our mobile app, please visit npwh.org or go to the Apple Store and download it for free. The app is available for both Apple’s iOS and Google’s Android operating systems. We have received praise from members of organizations such as the American Association of Nurse Practitioners, who recognize that our WWV app is easy to use, is scientifically sound, and serves as a handy and immediate reference during a patient visit.

And here’s more good news: Registration is still open for the Women’s Sexual Health Course for NPs, which will be held on June 23-26, 2016, in San Diego, California. This is the only post-graduation educational offering on women’s sexual health for nurse practitioners. You will receive not only CEs but also a Certificate of Completion, which documents that you have gained knowledge in the area of women’s sexual health.

And, finally, the 19th Annual NPWH Premier Women’s Healthcare Conference, our national clinical conference, is almost here! This year, our conference takes place in the vibrant city of New Orleans on September 28-October 1, 2016. The conference program guide, which appears on pages 23-26 of this issue, reveals the variety of leading-edge topics we are offering this year, along with courses covering essential primary skills to incorporate into your practice. You’ll want to register early to take advantage of the discount; the complete program guide, including the registration form, is available at npwh.org. As always, NPWH takes great pride in offering up-to-date women’s health content imparted by experts in their fields so that you can gain the knowledge and skills you need to provide high-quality healthcare to women of all ages.

Gay Johnson

Chief Executive Officer, NPWH

Editor-in-chief‘s message

Dear Colleagues,

I am excited to now serve as Publication Coordinator for NPWH along with my continuing role as Editor-in-Chief of the journal. In the role of Publication Coordinator, I work with the Board of Directors (BOD), our Chief Executive Officer (CEO) Gay Johnson, and our staff to expand the benefits NPWH brings to its members. It is my pleasure to share with you some of the activities with which I am engaged.

One of the responsibilities of my new role is to coordinate the development of position statements for NPWH. Position statements provide an explanation, justification, or recommendation for a course of action that reflects the organization’s stance regarding a specific issue or concern. Position statements can be used to facilitate development and advocacy for health policies, direct educational activities, promote evidence-based practice, support research, and/or encourage collaboration with other agencies and organizations. In keeping with the mission of NPWH, position statements for the organization always advocate for women’s health and the practice of WHNPs and other nurse practitioners who provide women’s healthcare.

With input from the membership, the NPWH BOD and professional staff are charged with identifying priority issues and concerns. The process for writing position statements is inclusive, and requires active involvement of NPWH members—from identifying issues, to participating as a writing group member, to reviewing and providing feedback on drafts.

We have collaborated with Sigma Theta Tau International Honor Society of Nursing to establish collections in both the “Nursing Organizations—Events” and the “Nursing Organizations—Resource Papers” communities on the Virginia Henderson Global Nursing e-Repository. The NPWH events collection will enable our conference research and innovative clinical project poster and podium presenters to have abstracts posted in the e-Repository, making their work available to nurses around the globe. The resource papers collection will provide another avenue for NPWH to reach nurses and other constituents with our position statements, guidelines, and other important documents to promote women’s health. Watch for our entries in both of these collections later this summer.

We have been hard at work on the online NPWH Certification Review Course for WHNPs and are pleased to let you know that it will be available early this summer. The course will have 21 modules covering the topics outlined in the NCC WHNP certification examination guide, with review questions at the end of each module. Continuing education credit will be provided.

I am looking forward to continuing to work enthusiastically with the NPWH BOD, our CEO, our staff, and our members to support our organization’s mission and goals.

Beth Kelsey, EdD, APRN, WHNP-BC

Message from the CEO

February may have been the shortest month of the year, but all of us at NPWH made the most of it by preparing for a busy and productive year. We welcome a new board chair, Jacki Witt, who is from Kansas City, Missouri, and three new board members: Diana Drake, from Minneapolis, Minnesota; Shelagh Larson, from Fort Worth, Texas; and Jordan Vaughan, from Nashville, Tennessee. We are also pleased to announce that Beth Kelsey, Editor-in-Chief of this journal, has added a new role: NPWH Publication Coordinator. Congratulations to all!

In January, we launched “Women’s Health Wisdom,” NPWH’s own blog! The purpose of the blog is to share thoughts, updates, and new information and opportunities related to women’s health policy, primary care, sexual health, pregnancy, pre-conception, postpartum concerns, heart health, mental health, overactive bladder, and many other topics. You can access the new blog by clicking here or by logging on to the NPWH website.

In April, we are offering a new regional CE course, Managing Women’s Health Issues Across a Lifespan. This live, interactive, 1-day meeting will be held at the Sheraton Pasadena Hotel in Pasadena, California. The course will include topics such as LARC, endometriosis, obesity, and genitourinary syndrome of menopause. You can register for this course here. See the back cover of this issue for much more information. And we proudly present the third annual Women’s Sexual Health Course for NPs on June 23-26, 2016, at the Sheraton Mission Valley San Diego Hotel in San Diego, California. New to the sexual health course this year will be a post-conference session for hands-on vulvoscopy training. The program guide for the Women’s Sexual Health Course for NPs appears on pages 8-12 in the journal; registration is available at npwh.org.

Make the most of this exciting year of 2016 by joining NPWH! You won’t want to miss out on all the exciting activities we have planned. And you will want to take advantage of the membership discounts and value-added features that we provide throughout the year.

– Gay Johnson

Chief Executive Officer, NPWH

Editor-in-chief’s message

Dear Colleagues,

I hope you’re all enjoying a happy and healthy new year and looking forward to the upcoming spring season!

Women’s Healthcare: A Clinical Journal for NPs is now entering its third year of publication! We are looking forward to providing you, our readers, with another year of up-to-date, useful information as you continue your important work of providing high-quality healthcare to women.

We have many excellent feature-length articles, as well as a large number of shorter articles (in our departments), coming up in 2016. You’ve likely noticed that we’ve expanded our journal departments in response to your request for shorter articles that still provide timely and relevant information to meet your clinical and professional needs. Our departments now include Assessment & Management, On the Case, Clinical Resources, Professional Development, Patient Education, DNP Projects: Spotlight on Practice, Policy & Practice Points, Commentary, and Focus on Sexual Health.

I hope that you will help us keep the momentum going by submitting a manuscript in one of the multiple formats we offer. We are especially interested in the shorter articles for our journal departments. As always, we welcome feature-length manuscript submissions as well.

Click here to visit our journal website to access the complete Guidelines for Authors. In case you need inspiration, please consider writing about topics such as abnormal uterine bleeding, adolescent health, cancer in women, coding for ob/gyn diagnoses, contraception for women with chronic health conditions, human trafficking, male reproductive health, older women’s health, or pregnancy complications. We welcome query letters about any topic and article format you are considering; you can reach us at bkelsey@healthcommedia.com and dgreene@healthcommedia.com. Even if you’re not quite ready to write for us, please let us know if you have a particular topic that you want to see covered in the journal.

In this first journal issue of 2016, I extend a special thank-you to the individuals who peer-reviewed manuscripts for us in 2015:

Kelly Ackerson, Cynthia Adams, Ivy Alexander, Carola Bruflat, Lorraine Byrnes, Joyce Cappiello, Helen Carcio, Janie Daddario, Melanie Deal, Brenda Deeser, Linda Dominguez, Caroline Hewitt, Susan Hoffstetter, Amy Levi, Patrice Malena, Anne Moore, Suzy Reiter, Michelle Schramm, Beth Steinfeld, Carolyn Sutton, and Jordan Vaughan.

In the November 2015 issue, I wrote about the opportunity to become a peer reviewer for our journal. I was happy to hear from many of you. Please click here for an application form to join this fine cadre of nurse practitioners and nurse midwives who have helped to make the articles we publish the very best!

Beth Kelsey, EdD, APRN, WHNP-BC

NPWH news & updates

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Message from the CEO

I am proud to say that, with this November 2015 issue, Women’s Healthcare: A Clinical Journal for NPs, is turning 2 years old! When we introduced the journal 2 years ago, we provided quarterly online issues. Now, as an added benefit, we provide our active NPWH members with both the electronic version and a complimentary print copy of each issue.

Since Women’s Healthcare began, we have added more departments such as On the case…, DNP projects: Spotlight on practice, Focus on sexual health, and Commentary. We have always offered one continuing education (CE) article per issue, along with two or three additional feature articles. Our goals for the future are to continue offering these articles and departments, to increase the number of issues per year, and to add more case studies, scientific studies, and clinical updates.

Our journal continues to grow, and is fast becoming a highly valuable asset to nurse practitioners (NPs) caring for women. The open rate—that is, the proportion of people on an email list who open (or view) a given email—for each issue of Women’s Healthcare is rising, and averages more than 30%. To put this statistic in perspective, the industry gold standard is an open rate of 20%. Even more stats support what our readers are discovering with respect to our journal’s content:

  • 75% find the information in the journal “useful” to “very useful”;
  • 83% engage in the journal’s CE articles;
  • 58% utilize the journal’s “How to” and Case study articles;
  • 54% find the journal’s research news useful; and
  • 50% utilize the journal’s Clinical resources de-
    partment.

NPWH takes great pride in providing a variety of tools that promote high-quality, evidence-based women’s healthcare. With regard to our 2-year-old journal, our goal moving forward is to ensure that all advanced practice nurses caring for women recognize Women’s Healthcare as the specialty go-to journal for expert women’s health content.

I want to mention a few of NPWH’s other accomplishments in 2015:

  • NPWH celebrated its 35th anniversary this year, a milestone marked at our 18th Annual NPWH Premier Women’s Healthcare Conference in Salt Lake City, Utah, in October.
  • The 2nd Annual Women’s Sexual Health Course for NPs was a great success this year; we sold out of space! We are increasing the number of registrations next year to enable more NPs to participate. Save the Date: June 23-26, 2016.
  • We added a new component to our mobile app, a women’s cardiovascular health preventative screening tool, which we launched at our annual conference in October.
  • NPWH proudly welcomed our second class of Student Reporters to participate in our annual conference.
  • We partnered with Bedsider to provide grants to six clinical sites to measure and improve contraceptive practices for women aged 17-29.

Stay tuned for more CE opportunities, toolkits, and programs for NPs. Our main objective is to continue to provide more services and support for our members. We invite those of you who are not yet members to join NPWH! And we thank all of you who supported our organization this year. All of us look forward to a wonderful 2016!

– Gay Johnson
Chief Executive Officer, NPWH

 

Editor-in-chief’s message

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Dear Colleagues,

Are you looking for a challenging but rewarding opportunity to participate in enhancing advanced practice nursing (APN) knowledge? If the answer is yes, I hope you will consider becoming a peer reviewer for our journal. Here are some answers to frequently asked questions
.

What is the role of a peer reviewer?

Peer reviewers are important consultants to journal editors and authors. Their major role may be content expert, practice expert, or research methodology expert, although one peer reviewer need not fill all these roles. We match the skills of a peer reviewer with the needs of a given manuscript. When a manuscript has a clinical focus, we try to choose reviewers with expertise in the content or practice area covered in the manuscript. When we receive a qualitative or quantitative research manuscript, we try to choose reviewers who have expertise in that research methodology.

Most important, we strive to identify and maintain a strong cadre of thoughtful and thorough reviewers who are willing to provide truthful and constructive critiques. Diversity among our peer reviewers is also important; we are looking for reviewers who vary in terms of their role (academic or clinical practice), years of experience, areas of expertise, and populations served.

What is in it for me?

APNs in the academic world reap the benefits of adding peer reviewer contributions to their CVs and promotion documents. Novice authors may find the process of doing peer reviews helpful in improving the quality of their own writing. Seasoned authors may enjoy fostering the professional growth of novice authors through constructive peer reviews that identify both the positive features of a manuscript and the areas that need improvement. All peer reviewers can take satisfaction in knowing that they are contributing to the APN profession by supporting the publication of high-quality, relevant, evidence-based articles that can help their colleagues provide the best possible care for their patients.

What happens when I receive a manuscript for review?

First, you will receive a request from us that informs you of the topic of the manuscript and our turnaround time (3-4 weeks). This information will help you decide whether you are interested and whether you have time to do the review. (If, after making the commitment, you find that you need a small extension, we are almost always able to grant it.) Next, if you accept our offer, we will send you the blinded manuscript with a peer reviewer evaluation form. The entire review process is completed electronically and takes about 4 hours.
The peer reviewer evaluation form includes a list of questions about the content and about your general impression regarding whether the manuscript merits publication in our journal. You can provide comments and suggestions on the evaluation form, but we encourage you to make them right on the manuscript.

We do not ask you to correct grammar or spelling errors; in many, if not most, cases, we will have edited the manuscript before we send it to you. We do ask that you read the manuscript to determine whether the information is accurate, supported by evidence, relevant, and clearly presented, and to make suggestions for improvement. We also ask you to check the references for timeliness and appropriateness and to identify any important resources that might be missing. For research manuscripts, we ask for a thorough review of methodology.

How can I learn to do a good peer review?

At your request, Dory Greene, our managing editor, and I would be happy to provide feedback on your
review. Even for novices, though, if your review is thoughtful, thorough, and truthful, it will be useful and very much appreciated.

How do I sign up to be a peer reviewer?

Click here! I hope to hear from you soon!

Beth Kelsey, EdD, APRN, WHNP-BC

 

Editor-in-chief’s message

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By Beth Kelsey, EdD, APRN, WHNP-BC

Dear Colleagues,

Three full years have elapsed since we celebrated the rollout of the Affordable Care Act (ACA) provision requiring coverage of women’s preventive services recommended by the Institute of Medicine. This provision includes a requirement that most insurance plans cover FDA-approved female contraceptive methods with no co-payment or deductible. The coverage must also include clinical services, including patient education and counseling needed for provision of these contraceptive methods.

Health insurance carriers must cover at least one product in each of the 18 distinct female contraceptive method categories that the FDA has identified in its current Birth Control Guide.1 Many women who could not previously afford contraceptives or whose choices were limited because of prohibitive costs now have access to effective methods that meet their own particular needs.

Despite the existence of this ACA provision for the past 3 years, insurance carriers vary in terms of how they are adhering to the guidelines for contraceptive coverage—thereby keeping many women from fully benefiting from this provision. In fact, two recent studies evaluating health insurance coverage revealed numerous violations of the requirements by a large number of insurance carriers across several states.2,3 The National Women’s Law Center (NWLC) reviewed more than 100 plan documents from issuers in the new marketplaces in 15 states, and found that 33 insurance carriers in 13 states offered birth control coverage that did not comply with the ACA.2 The Kaiser Family Foundation described contraceptive policies used by health insurance carriers as being not easily accessible and not clearly defined.3

The most commonly identified violation in these studies was a failure to cover all FDA-approved methods. The method(s) not covered varied with different carriers but included progestin implants, contraceptive patches and vaginal rings, over-the counter contraceptives, and the emergency contraceptive pill Ella. Several insurance carriers were found to impose impermissible cost-sharing on methods such as IUDs and sterilization. Some carriers imposed limitations and cost-sharing on the services associated with provision of contraceptive methods, including office visits for injectable contraceptives and birth control counseling. Other violations included requiring cost-sharing for brand-name contraceptives without generic equivalents and excluding sterilization coverage for dependent children, which includes adults up to age 26. In May 2015, as a result of these two studies’ findings, the U.S. Departments of Health and Human Services, Labor, and Treasury issued FAQs About Affordable Care Act Implementation to help insurance companies and consumers better understand the scope of coverage of preventive services required under the ACA.4

We must ensure that our patients have access to all FDA-approved female contraceptive methods and related services, with no co-payment or deductible. We have a voice. In one state, after the regional Planned Parenthood and the NWLC brought violations to the attention of insurance regulators, a bulletin clarifying the requirements was sent to health insurance carriers. NWLC operates a national hotline (1-866-745-5487) and website to assist women having difficulty securing coverage for birth control by providing information on the requirements, assisting with filing appeals with insurance companies, and filing complaints with government agencies that regulate insurance plans.

Through the ACA, we have made a tremendous step forward in enhancing access to care for women. As always, however, there are hurdles to overcome and there are risks that the gains we have made will be reversed. Together we can be a mighty force in overcoming these hurdles and in protecting the good work that has been done.

Beth Kelsey, EdD, APRN, WHNP-BC

References

  1. FDA Office of Women’s Health. Birth Control Guide. fda.gov/downloads/ForConsumers/ByAudience/ForWomen/FreePublications/UCM356451.pdf
  2. National Women’s Law Center. State of Birth Control Coverage: Health Plan Violations of the Affordable Care Act. April 29, 2015. nwlc.org/sites/default/files/pdfs/stateofbirthcontrol2015final.pdf
  3. Kaiser Family Foundation. Coverage of Contraceptive Services: A Review of Health Insurance Plans in Five States. April, 2015. http://files.kff.org/attachment/report-coverage-of-contraceptive-services-a-review-of-health-insurance-plans-in-five-states
  4. Department of Health and Human Services. FAQS About Affordable Care Act Implementation (Part XXVI). May, 11, 2015. cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf

Message from the CEO

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NPWH’s roots are firmly planted within the family planning movement. In May 1980, the Metropolitan Executive Director’s Council (MEXDICO) of the Planned Parenthood Federation of America passed a resolution calling for the formation of a national association of family planning nurses. Later in the year, and at the invitation of MEXDICO, a group of nurse practitioners (NPs) from 20 of the larger Planned Parenthood affiliates met in Denver, Colorado, to discuss the formation of a specialty organization focused on family planning and reproductive health. The Denver meeting participants voted to form a new organization called the National Association of Nurse Practitioners in Family Planning (NANPFP). NANPFP’s mission was “to assure accessible, quality family planning services and reproductive freedom….”

Fast forward to 2015. After having undergone two name changes, after having fulfilled many of the early visions, and after having accomplished many of the goals set for education and professional development of NPs, NPWH—the National Association of Nurse Practitioners in Women’s Health—is celebrating its 35th anniversary! NPWH has broadened its focus over the years but still remains an organization dedicated to ensuring the provision of quality healthcare to all women by women’s health NPs and other women’s health-focused clinicians.

We will be celebrating this milestone in the life of our organization during the Welcome Reception at our 18th Annual Premier Women’s Healthcare Conference in Salt Lake City, Utah, on October 14-17, 2015. Our program guide for this year’s conference is provided for you here in the journal on the following pages. It has always been our mission to bring you the most up-to-date information and the highest quality education.

So, mark your calendar and make arrangements to attend the NPWH conference this year in Salt Lake City. Together, we will raise a glass in celebration of 35 years of this dynamic organization, the National Association of Nurse Practitioners in Women’s Health!

– Gay Johnson
Chief Executive Officer, NPWH

Message from the CEO

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Spring has arrived in Washington, DC, and how welcome it is after the long, cold, snowy winter of 2015! The cherry blossoms were just beautiful this year (the blooms usually peak here in mid-April), and now we are looking forward to the sights and sounds of summer.

I have some exciting news to share: NPWH can now provide our current members with a complimentary print version of Women’s Healthcare: A Clinical Journal for NPs, our quarterly journal, in addition to the online version. For those of you who have not yet joined NPWH, and for those of you who have not yet renewed your NPWH membership, we hope that this added benefit will encourage you to join us or renew your membership with us. We welcome your active participation in our association.

As I reported to you last August, our Women’s Sexual Health Course for NPs, held in Dallas, Texas, in June 2014, was a huge success. This year, we are proud to offer the 2nd Annual Women’s Sexual Health Course for NPs. The course will be held at the Caribe Royale Orlando in Orlando, Florida, on June 26-28, 2015. In collaboration with the International Society for the Study of Women’s Sexual Health (ISSWSH), we have updated the course to provide you with the latest information. For your convenience, we are pleased to provide the program guide and registration information on the following pages. As a reminder, you will receive CE credits for the course, along with a Certificate of Completion (suitable for framing) that will document for patients, employers, and peers the knowledge you have gained in the area of women’s sexual health. Space in the course is limited, so please register as soon as possible. You won’t want to miss this informative and one-of-a-kind educational course!

– Gay Johnson

Chief Executive Officer, NPWH

Click here for the program guide.

Editor-in-chief’s message

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Dear Colleagues,

Memorial Day, originally named Decoration Day, is a day of remembrance for those individuals who died in military service for the United States. Initiated after the Civil War on May 30, 1868, the holiday was called Decoration Day because observers honored persons who died in defense of their country by decorating their graves. On the first Decoration Day, 5,000 people placed flowers at the graves of 20,000 Union and Confederate soldiers buried at Arlington National Cemetery. Today, we continue this tradition in our home towns to honor all who served and died for their country. I would like to take this opportunity to recognize the brave nurses who have died during military service—from the founding of our country through all the major wars and military conflicts that have occurred since that time.

To date, more than 100,000 nurses have served their country in war and military conflict zones. The statistical information on these nurses varies somewhat, depending on the source. However, we know that many of these nurses died while providing crucial medical care in these areas.
More than 1,000 nurses, the great majority female, died while serving their country during the Civil War, the Spanish–American War, World War I, World War II, the Korean War, the Vietnam War, the Gulf War in Kuwait, or the war on terror in Iraq and Afghanistan. Many of these nurses, who cared for injured, sick, and/or dying soldiers during these wars, died of communicable diseases such as typhoid, malaria, yellow fever, and influenza. Other nurses lost their lives in aircraft and vehicle accidents in the line of duty. Some nurses, especially in more recent wars, have been victims of enemy fire, suicide bombers, and improvised explosive devices.

Nurses first served in wars such as the Civil War and the Spanish–American War in roles such as volunteer or contract civilian. The founding of the Army Nurses Corps and the Navy Nurses Corps in 1901 and 1908, respectively, enabled women to officially serve in the U.S. military for the first time. But it was not until 1947 that nurses in the Army and Navy corps were granted permanent commissioned officer status. Male registered nurses, regardless of whether they volunteered or were drafted, were generally not assigned as military nurses until the Korean War. Today, not all women serving in the military are nurses, and not all military nurses are women. I would like to pay tribute to all nurses, to all the women and men who have sacrificed their lives in service to our country. The next time you are in our nation’s capital, please take the opportunity to visit memorials specifically dedicated to our military nurses (see photo).

This Memorial Day, please consider observing the National Moment of Silence at 3:00 PM local time. Encourage others to do the same. Pause, reflect, and remember those persons who lost their lives for our freedom. Visit a local or national memorial site. Place flags at the grave markers of soldiers. Hug a military family. Thank a veteran.

Beth Kelsey, EdD, APRN, WHNP-BC

Message from the CEO

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Another year has begun, and we are meeting it head on with enthusiasm and energy! This month, February, is American Heart Month. NPWH is proud to be a partner with the Million Hearts® campaign and to promote the Spread the Word campaign, and we are already hard at work developing the cardiovascular portion of our Well Woman Visit mobile app. We recognize the importance of providing more information about women’s heart health and distributing valuable tools to clinicians and their patients. In the spirit of women’s heart health this month, I ask you to please read Editor-in-Chief Beth Kelsey’s message and Suzanne Shugg’s article, and to please take a look at the tip sheet on antihypertensive medication adherence in our Clinical resources department.

I want to share with you some exciting experiences from our 17th Annual Premier Women’s Healthcare Conference, which was held this past October.
For starters, we launched a new Student Reporter Program, which was a huge success! We chose 10 students from around the country to participate in this program based on their interest and on recommendations from their faculty (Figure 1). Through an educational grant from Pfizer, we were able to provide transportation to and from the conference and cover registration fees and meals for the duration of the conference.

In return, the students met with NPWH board members and staff, networked with NP colleagues, attended all sessions, assisted as runners, offered assistance in the hands-on workshops, promoted the conference through social media, and recorded their daily experiences. An outbriefing with the students revealed that their experience was unmatched by any they had ever had before. Here is what some of the student participants had to say:

• “Participating in the inaugural student reporter cohort for NPWH was a humbling and rewarding experience, one I will never forget. I was able to learn about new and evolving research from experts in various fields; network with nurse practitioners, physicians, and researchers from across the country; and gain exposure to products and services I will utilize in the future. The conference exposed me to the breadth of information available through NPWH that will inform my current studies, as well as my future practice.”
• “Before the conference, I was having second thoughts about finishing school. I was not certain that I wanted to become a NP, but then I attended this conference, which gave me the inspiration and motivation I needed. Since the conference, I find myself excited about school again and I am driven to learn as much as I can so that I can apply it to my practice. This experience has changed my life. I don’t think I would have continued my education in this direction if I had not attended this conference, and I would not have been able to attend without being selected as a Student Reporter.”
• “I am thrilled to be graduating in May, and I am so excited to begin my career as a nurse practitioner. I have always had a passion for learning. The NPWH conference was my first experience attending a conference dedicated solely to women’s health issues. It was empowering to be surrounded by a group of other NPs and experts in this field. I have already had the opportunity to apply information I learned at the conference to real-life settings. Thank you so much for contributing to my education and for supporting my passion for women’s health.”

As you can see from the students’ comments, our Student Reporter Program provided a great opportunity for WHNP students. We hope to continue this program in 2015.

At the October 2014 conference, we were able to recognize NPs who are an inspiration to others by providing our 7th annual Inspiration in Women’s Health Awards. These awards were made possible by a generous grant from Teva Women’s Health. This year’s first-place winner is Diane Todd Pace, PhD, FNP-BC, NCMP, FAANP, a Clinical Associate Professor at the Loewenberg School of Nursing at the University of Memphis in Memphis, Tennessee (Figure 2A). Diane is the first NP to serve as President of The North American Menopause Society (NAMS).

We also honored three runners-up. Kayla E. Castañeda, RN, MSN, WHNP-BC, AOCNP, is a Faculty Associate in the Department of Obstetrics and Gynecology at the Paul L. Foster School of Medicine at Texas Tech University in El Paso (Figure 2B). She is also a women’s health and oncology nurse practitioner at Texas Tech University Health Sciences Center in El Paso. Kayla has piloted a cancer group for her patients that supports them through the course of their treatment. Paula Newman-Skomski, MSN, FNP-BC, ARNP, SANE-A, a nurse practitioner/forensic nurse examiner at Providence Intervention Center for Assault and Abuse in Everett, Washington, is the founder of Peoria Home, which will be a residential recovery program for woman exploited through sex trafficking and prostitution (Figure 2B). Susan Moskosky, MS, WHNP-BC, is the Acting Director of the Office of Population Affairs (OPA), U.S. Department of Health and Human Services (Figure 2C). Under Susan’s leadership, the OPA worked jointly with the CDC to develop the Quality Family Planning Recommendations, the first federal evidence-based recommendations for high-quality family planning services delivery.

We at NPWH are looking forward to another exciting year. As always, are working to provide you with top-notch education and resources that support best practices and evidence-based care for women.

– Gay Johnson
Chief Executive Officer, NPWH

Editor-in-chief’s message

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Dear Colleagues,

In so many ways, NPWH and its members are showing that women’s health is about much more than just obstetrics and gynecology. But then, we have known this for a long time. Here are a few examples.

Sue Kendig, NPWH Director of Policy, describes the process and outcome of revising the Women’s Health Nurse Practitioner: Guidelines for Practice and Education in this issue of the journal. As a member of the task force for this 7th edition and for the previous edition of the Guidelines, I can confirm that we definitely did our homework to produce a document that reflects the expanded scope of practice for today’s WHNP. NPWH members have free access to the Guidelines on the NPWH website.

NPWH is a leading organization in the field of evidence-based sexual healthcare, providing the first national Women’s Sexual Health Course for NPs in 2014. The course was so successful that it will be offered again this year. We at Women’s Healthcare, NPWH’s
official journal, are proud to present a new department, Focus on sexual health, in this issue. Brooke M. Faught, MSN, WHNP, Clinical Director of the Women’s Institute for Sexual Health in Nashville, Tennessee, has authored the inaugural article for this department. This issue of the journal also features an article on female sexual dysfunction by Casey B. Giebink, MSN, NP-C, WHNP-BC, and Ivy M. Alexander, PhD, APRN, ANP-BC, FAAN. And in our Assessment & management department, Wendy Grube, PhD, CRNP, a member of the task force that developed Preventive Male Sexual and Reproductive Health Care: Recommendations for Clinical Practice, summarizes the key points in this groundbreaking publication.

NWPH is developing a strong presence with regard to mental health as well. In the past year alone, we have offered articles on depression in women, self-esteem, postpartum depression, sexual assault, and depression in adolescents. Appearing now or coming soon are articles on binge eating disorder, PCOS psychosocial effects, and anorexia in adolescents.

To honor our Million Hearts® partnership commitment, we have been providing many evidence-based continuing education (CE) activities that give advanced practice nurses the tools they need to promote heart health. In the August 2014 issue of Women’s Healthcare, we published a CE article by Tamera Lea Pearson, PhD, MSN, FNP, ACNP, entitled Cardiovascular Disease in Women: A Journey Toward a Focus on Prevention. At the 2014 NPWH conference in Savannah, Megan McCarthy, MSN, NP-C, presented The Angina Monologues—Update on New Ways to Detect and Prevent Heart Attacks in Women and Jaye M. Shyken, MD, presented Long-Term Health Consequences of Pregnancy Complications, which included a discussion about the relationship between pre-eclampsia and gestational diabetes with future cardiovascular disease. In that vein, Suzanne Shugg, DNP, ACNP, a clinical lipid specialist who runs a Preventive Cardiology Clinic in Berkeley Heights, New Jersey, shares her insights on this topic in her article Pregnancy’s Effects on Cardiovascular Health: A Woman’s First “Cardiac Stress Test” in this issue of the journal. This issue also provides a Million Hearts® tip sheet on Improving Medication Adherence Among Patients with Hypertension. This coming year, an NPWH task force will develop a white paper on evidence-based best practices and policy recommendations to promote cardiovascular health and wellness for women, including those who are at high risk for cardiovascular disease.

You can rely on NPWH, and Women’s Healthcare, to continue to provide cutting-edge, evidence-based women’s healthcare information to support you in providing high quality care for women from menarche through senescence.

Beth Kelsey, EdD, APRN, WHNP-BC