Backto Vol. 1 No. 1 Article IndexHomeWelcome to the first edition of Pennsylvania NP Issues, aforum of news and ideas for nurse practitioners in Pennsylvania.
The notion to start an informative newsletter came after Iattended my first meeting of the Pennsylvania Nurse PractitionerCoalition in Harrisburg in September '95. At that gathering, I wasdismayed to find out that the Coalition discusses issues and decideswhat actions to take upon those issues affecting all PennsylvaniaNPs, yet there was no vehicle of communication to get the results ofthose meetings to all NPs. Unless a nurse practitioner lived in anarea that had an attending representative, who then returned andreported the minutes at her local NP meeting, one might never beaware of the state organization. This thought was distressing,especially since there was so much happening in the statelegislatively that concerned NPs. It was hard to imagine how NPscould grow as a group without a method of informing all NPs of whatwas happening in their field statewide.
The idea of a nonprofit newsletter seemed like a step in the rightdirection, but the lack of money to distribute the first edition toevery Pennsylvania NP was a hurdle. Thankfully, another NP with whomI had discussed the idea of a newsletter came up with a solution. Shecontacted a representative from Merck & Company, Inc., and Merckgenerously donated $600 to cover the mailing costs. District 1 (Erie,Crawford, Mercer and Lawrence counties) of the Northwest PennsylvaniaNurse Practitioner Association then offered to pay printing and papercosts. Thus Pennsylvania NP Issues got off the ground.
This newsletter will not be an official voice for any NPorganization. Rather, it will be your opportunity to read about theactivities and decisions of the Pennsylvania NP Coalition, to offeryour opinions or comments about issues that affect our profession,and to communicate with other NPs across the state.
Topics in future issues will be the history of NPs inPennsylvania, past attempts to secure prescriptive authority, theon-going efforts of the NPs at the University of Pennsylvania inPhiladelphia to identify and eliminate barriers to our practice, NPeducational programs in the state, and NP-managed clinics in thestate.
Are there subjects you would like researched and reported? Arethere issues you would like to inform other NPs of in Pennsylvania?This will be your opportunity to do so. I encourage all NPs who haveinformation they would like to share with other NPs to send it to mefor inclusion in future newsletters. A note here: I hesitate givingthis newsletter a clinical focus, since there are many other suchpublications already available.
This newsletter will be published quarterly, unless some majorevent occurs that Pennsylvania NPs need to be notified of quickly. Inthat instance, extra editions would be mailed. The cost of printingand mailing each issue is about 48 cents, so the subscription pricehas been set at $5 for 10 issues. You're welcome to copy and sharethis newsletter with others, especially student NPs and NPs who workin Pennsylvania but live out of state. This initial edition is beingmailed only to NPs who are registered to practice in Pennsylvania andwho live in Pennsylvania.
I hope you enjoy reading this first issue and find it useful. I amanxious to hear from you and to receive your feedback on the eve ofthis new venture.
Susan Murawski, MSN, CRNP
Backto Vol. 1 No. 1 Article IndexHomeAnyone who subscribes to the journal The NursePractitioner, published by Springhouse Corporation, also receivesNP News. The News is an excellent bimonthly publicationwith a focus on non-clinical issues of concern to NPs across thenation.
If you do not subscribe to The Nurse Practitioner, thepublisher is now offering a free subscription to NP News. Justcall 1-800-490-6580 or write: NP News, PO Box 5053, Brentwood, TN37024-5053.
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If you are planning on attending the "Issues, Updates andImplications 1996" NP conference in Cambridge Springs (CrawfordCounty) this April, take note: the conference date is Friday,April 26. The deadline date of registration is April 12. Pleaserefer to your conference brochure for details. If you have notreceived a brochure but would like one, call 814-725-5764 and leaveyour name and address with your request.
Backto Vol. 1 No. 1 Article Index Homeby Jan Towers
The Pennsylvania Coalition of Nurse Practitioners is an allianceof seven nurse practitioner organizations in this state. These groupswork together on issues of importance to NPs and their patients.
The Coalition was formed in the early 1980s in order to beproactive instead of reactive to issues of concern toboth NPs and the Commonwealth of Pennsylvania. At that time, themembership consisted of the five NP groups in Pennsylvania:Philadelphia Area Nurse Practitioner Association, DelVal NAPNAP,Northeast PA Coalition of Primary Care Nurse Practitioners, CentralPA Nurse Practitioner Association, and the Nurse PractitionerAssociation of Southwest PA. As other NP groups formed in the state,they too joined the Coalition. Early representatives to the Coalitionincluded Jane Mayers and Andrea Price from the Philadelphia group,Shirley Negley Kobert from the Southwest group, Patty Johnson fromthe Northeast group, and Jan Towers from the Central group.
The Coalition's predominant initial activity was the formation ofNP networks throughout the state. Members took responsibility fordeveloping initiatives on legislative, marketing, educational andnetworking issues. In 1986, the Coalition was instrumental in thepassage of the third-party reimbursement mandate for NPs inPennsylvania. It has been a liaison to the State Board of Nursing anda consultant to the state's Departments of Health, Welfare andTransportation.
In the past, in order to network and act on NP concerns, theCoalition had sponsored several statewide meetings on clinical topicsand NP interests. The group has also organized legislativedays, where NPs from across the state gather at the capitol tomeet with their state representatives. Currently, the Coalitionmembers are actively working on the issue of prescriptive authorityfor NPs in the Commonwealth.
If you are a member of any of the groups listed below, you are amember of the Coalition. Each of these organizations has Coalitionrepresentatives that meet together on a regular basis in Harrisburgto strategize, discuss, and plan for actions that will be taken onbehalf on NPs in the state. If you are interested in learning moreabout the Coalition, or want to join your region's NP group, pleasecontact the representative closest to you.
See Pennsylvania Coalition ofNurse Practitioners in Vol. 2No. 3 - September 1997 for an updated representative list.
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(Source: Pa. Bureau of Professional & Occupational Affairs,1995)
NPs in surrounding states registered to practice in Pennsylvania:Ohio - 13, West Virginia - 10, Maryland - 17, Delaware - 35, NewJersey - 201, New York - 38
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by Charles Herbst, MD
Arthritis Associates; Erie, Pa.
Osteoporosis is a metabolic bone disorder characterized by lowbone mass and increased bone fragility, resulting in increased riskfor fracture. As our population becomes older, the importance ofunderstanding osteoporosis becomes critical to health care providers.A recent consensus statement on osteoporosis suggests that some 25million Americans are effected. There may be as many as 275,000 newosteoporotic hip fractures each year, with twice as many fracturesoccurring in women than in men. These osteoporotic hip fractures leadto an excess mortality of 15 to 20 percent, and somewhere aroundeight billion dollars a year for short-term care following thefracture.
There seems to be a widespread misconception among lay individualsthat the bone you're born with is the bone you die with. However,bone is constantly undergoing a remodeling process. Bone cells calledosteoclasts resorb old bone, and osteoblasts lay down new bone intothose cavities previously resorbed. When bone remodeling occurs withequal osteoclastic and osteoblastic activity, the bones remainstrong. However, increased osteoclastic activity or decreasedosteoblastic activity lead to decreased bone mass and fragilityfractures.
The point of maximum bone density reached during one's life isknown as peak bone mass. Men have a 10 to 15 percent greater peakbone mass than women. One's adult peak bone mass is normally attainedsomewhere during the third or possibly the fourth decade of life.After 30 years of age, bone tends to soften and become less dense.This occurs at a rate of around 3 to 5 percent per decade. Bone lossin women seems to parallel that of men until menopause, at whichpoint it accelerates. The rate of bone loss for postmenopausalfemales can be anywhere from 1 to 5 percent each year, depending onwhich skeletal areas are measured. With this understanding, twoobvious factors determine a given individual's risk for osteoporoticfracture: low peak bone mass and accelerated bone loss in the postmenopausal years.
Over the last years, several new breakthroughs have occurred inthe field of osteoporosis treatment. In the past, we really had noway of monitoring therapy or diagnosing patients with osteoporosisuntil they had sustained a fracture. We now have a method of bonemineral density measurement called the Dual Energy X-rayAbsorptiometry, or DEXA. The DEXA scan is a very quick, precise andaccurate method of measuring bone mineral density. This scan can beused in women at risk for osteoporosis. It will compare their bonemineral density to that of other women's peak bone mass, and to bonedensity of other women in their age group. This is extremelyeffective in identifying populations of patients who would benefitfrom osteoporosis therapy, and in monitoring osteoporosis drugtherapy.
Within the last three to four months, we have also seen the FDAapprove its first oral agent for osteoporosis in the medicationalendronate (Fosamax, from Merck). Alendronate directly suppressesosteoclast activity, thereby resulting in a favorable balance of boneformation over resorption. Double blind studies have shown thatalendronate does increase bone mineral density in the lumbar spineand the femoral neck, plus it reduces new vertebral fractures afterthree years by nearly 50 percent.
Osteoporosis is a major medical problem in our country today. Ourgoal is to try to reduce risk factors (see Table) in young people andhelp them attain a normal peak bone mass. Through continued controlof diet, modifications of lifestyle, and appropriate use ofmedication, we can hopefully maintain bone mineral density and reducethe risks of osteoporotic fractures. New technologies should not onlyhelp us identify at-risk individuals, but also to treat thosepatients at risk for fragility fractures. Increased awareness by thehealth care community of the consequences of undiagnosed anduntreated osteoporosis is a step in controlling this debilitatingbone disorder.
Factors Associated with Increased Risk of OsteoporoticFracture
Backto Vol. 1 No. 1 Article IndexBelow is a list of all of the Merck Market Development Associates(MDAs) in Pennsylvania and the counties they serve. MDAs provideeducational programs and materials not only to health careprofessionals, but also to community groups like senior citizenassociations, women's clubs, and civic organizations. These MDAs havemany resources available for health care professionals, such aspamphlets for your office on osteoporosis. Please feel free tocontact the MDA in your county for support and assistance in patienteducation and professional development. All can be reached by firstdialing 1-800-737-2088, then adding on the individual's voice mailnumber.
| Marikay Malley | #43911 | Bucks, Chester, Delaware, Montgomery |
| Vicki Petro | #43912 | Bucks, Montgomery, Philadelphia |
| Catherine Manning | #43913 | Delaware, Montgomery, Philadelphia |
| Camie McGrath | #43914 | Berks, Bucks, Carbon, Lancaster, Lehigh, Monroe, Montgomery, Northampton, Schuykill |
| Babak Bazmi | #43915 | Armstrong, Bedford, Blair, Cambria, Cameron, Centre, Clarion, Clearfield, Elk, Forest, Fulton, Huntingdon, Indiana, Jefferson, Mifflin, Potter, Somerset, Venango, Westmoreland |
| Jeff Scheuring | #43916 | Allegheny, Beaver, Westmoreland |
| Joe Anderson | #43917 | Adams, Berks, Centre, Clinton, Cumberland, Dauphin, Franklin, Juniata, Lebanon, Lycoming, Mifflin, Northumberland, Perry, Potter, Sullivan, Tioga, Union, York |
| Jean Fioti | #43918 | Bradford, Carbon, Columbia, Dauphin, Lackawanna, Luzerne, Monroe, Montour, Northumberland, Pike, Schuykill, Snyder, Susquehanna, Wayne, Wyoming |
| Marilyn DeDionisio | #43919 | Allegheny, Armstrong, Beaver, Butler, Clarion, Crawford, Erie, Lawrence, Mercer, Venango, Westmoreland |
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