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Diabetes – Summer 2012
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Fluids & Electrolytes
We are pleased to provide PCNA members with an update on our activities in the area of advocacy. In 2003, PCNA joined forces with the American Heart Association (AHA) and other professional groups to advocate for the passage of the Medicare Cholesterol Screening Bill. This became part of the overall Medicare legislation that was signed into law on December 8, 2003, by President Bush. This law includes several benefits to Medicare recipients such as prescription drug coverage and coverage for cardiovascular screening.
The cardiovascular screening legislation was first introduced on February 13, 2003. The bill was called The Medicare Cholesterol Screening Coverage Act of 2003. This legislation initially requested coverage for cholesterol screening for Medicare patients who do not carry a diagnosis of cardiovascular disease, dyslipidemia, or other illnesses associated with elevated cholesterol. Under the Medicare reform bill, the screening includes a fasting lipid profile (cholesterol, triglycerides, HDL, LDL), diabetes screening, as well as noninvasive testing if the individual is at risk of cardiovascular disease. The screening is allowed every two years, beginning January 1, 2005. The identification of dyslipidemia in this population will allow the initiation of lipid-lowering therapy, both lifestyle and pharmacologic, directed to reducing the risk of cardiovascular events. This allows every senior to benefit from treatment if indicated. Prior to this new law, measurement of the lipid profile for healthy seniors was not a covered service. PCNA provided both human and financial resources in lobbying for this provision and we were particularly gratified that it was included as part of the overall legislation.
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 will initially provide discounts on prescription drugs and will eventually offer comprehensive prescription drug coverage in 2006. In May 2004, Medicare recipients will be able to enter the program receiving a prescription drug card that will provide discounts on prescription medications. The program will offer a 10% to 25% reduction in the cost of prescription medications. This is a voluntary program to allow for immediate assistance with medication expenses. The discounts apply only to specific medications supplied by approved sponsors. (The program is for Medicare recipients only and does not apply to Medicaid beneficiaries.) Additional assistance is available for those individuals with low incomes of less than $12,124, or married couples with a yearly income less than $16,363 who do not have additional assets.
On January 1, 2006, the comprehensive prescription drug plan will take effect. This is a voluntary program and Medicare recipients who choose to participate will select a prescription drug plan that meets their needs. Each plan has a cost of $35.00 per month and carries a $250.00 deductible. Several plans will be available. Seniors can evaluate their particular needs and determine which plan will offer the most savings. Healthy seniors who have an existing form of prescription drug coverage may opt against the new Medicare program. A concise, consumer-friendly summary of the various provisions of the legislation is available at http://www.medicare.gov/Publications/Pubs/pdf/11054.pdf.
In addition to advocating for the Medicare Cholesterol Screening Bill, PCNA weighed in on an issue before the Cardiovascular and Renal Drugs Advisory Committee of the Food and Drug Administration (FDA). The American Heart Association and the United States Preventive Services Task Force (USPSTF) both include recommendations for the role of aspirin in the primary prevention of cardiovascular disease. The advisory committee was considering an expansion in the professional labeling of low-dose aspirin for primary prevention in response to a petition by the Bayer Corporation. The committee decided against the expanded label, citing a need for more research into the benefit/risk ratio for the population in question, citing in particular the paucity of data in women. The FDA is not bound to abide by the advisory committee's decision, but generally follows their recommendations.
We feel that it is important to take a stand on issues affecting cardiovascular health improvement and risk reduction. It has been very interesting to attend these hearings and follow the progress of the issues. The advisory committee allows time for professional groups such as PCNA, AHA, ACC, and others to add their endorsement or disagree with the issue at hand, following the industry presentation. Patient advocacy groups are often also represented, and private individuals may request time to speak. The advisory committee may ask questions of any of the speakers. PCNA used this opportunity to deliver a statement expressing the viewpoint of this organization. In our statement, we emphasized the importance of both professional and consumer education (and the role of nurses in the effort) should the label be expanded. For a transcript of the meeting, visit http://www.fda.gov/ohrms/dockets/ac/03/transcripts/4012T1.doc.
This past year, PCNA began working with the National Alliance for Nutrition and Physical Activity (NANA). NANA advocates for national policies and programs to promote healthy eating and physical activity to help reduce the illnesses, disabilities, premature deaths, and costs caused by diet- and inactivity-related diseases such as heart disease, cancer, high blood pressure, diabetes, and obesity. NANA alerts coalition members regarding issues of interest, disseminates background information on public health and legislative issues, and provides opportunities for organizations to join forces. The issues can range from labeling requirements on food products to soda pop in school vending machines to public transportation and urban planning. Being part of NANA has been helpful in keeping us informed on important issues and making our voice heard as we join with other groups with missions similar to ours.
We are pleased with the opportunities we have had to add the voice of PCNA to these important public health issues. We look forward to continuing these and other advocacy efforts in 2004.
On January 9th and 10th, the PCNA Board of Directors held their winter board meeting at Disney's Coronado Springs Resort, the headquarters of the 10th Annual Symposium. After touring the resort, everyone agreed that it will be a wonderful family-friendly location for the Annual Symposium. It promises fun for all ages, especially those able to arrive early or stay late to enjoy this vacation hot-spot.
Disney's Coronado Springs Resort has reduced its room rate to $139.00 for PCNA Symposium attendees!! Reserve your room today by calling (407) 939-1020. Take a virtual tour of the resort by visiting http://www.disinv.com/offsite/onsitecsr.html.
This fantastic resort, in the heart of Walt Disney World, features five pools, a full health club/spa, an arcade, four restaurants, and FREE shuttle service to and from Disney World theme parks. Disney promises fun for the entire family!! Florida residents may be eligible for additional discounts.
Great discounts on advance purchased Disney Park-Hopper Tickets are available for PCNA Symposium attendees. Park-Hopper Tickets allow you to go park-to-park with unlimited admission to Magic Kingdom, Epcot, Disney-MGM Studios, Disney's Animal Kingdom, plus complimentary admission to Downtown Disney, Pleasure Island, or DisneyQuest Indoor Interactive Theme Park. Visit http://www.pcna/symposium.html for pricing and to order your tickets today!!
Make your travel arrangements soon as flights and hotel rooms are filling fast!!
PCNA has negotiated contracts with Northwest and Delta Airlines who will provide a 5% to 10% discount off the lowest applicable published fare for travel to PCNA's Annual Symposium. An additional 5% discount is applicable when tickets are purchased 60 days prior to travel. In order to price or book your flight, please call PCNA's official travel agency, Carlson Wagonlit Travel, at 1-800-822-8018, ext.72, from 8:30 AM to 5:30 PM (CST). To obtain the discounted rate, be sure to mention that you are attending the PCNA meeting.
* Bakris GL, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 42(6):1206-1252.
This is the full report of the updated guidelines for hypertension, the express version of which was published in JAMA in May 2003.
* Heart and Stroke Statistics-2004 Update.
The American Heart Association's Heart Disease and Stroke Statistics-2004 Update is now available on the AHA website. The statistics are available as PDF files as well as in PowerPoint format, downloadable for presentation purposes: http://www.americanheart.org/presenter.jhtml?identifier=1200026
* Ewing R, Killingsworth R, Raudenbush S, Schmid T, Zlot A. Relationship between urban sprawl and physical activity, obesity, and morbidity. Am J Health Promot. September-October 2003;18:47-57.
* Cody M et al. Women's early warning symptoms of acute myocardial infarction. Circulation. 2003;108(21):2619-2623.
* Cooper CJ, et al. Effect of recombinant ApoA-I Milano on coronary atherosclerosis in patients with acute coronary syndromes: a randomized controlled trial. JAMA. 290(17):2292-2300.
* Diabetes Care. 2004;27(suppl 1).
This supplement includes the most recent guidelines for the diagnosis and classification of diabetes and important topics for the prevention and treatment of diabetes including nutritional, physical activities, and risk factor recommendations. It is also available online: http://care.diabetesjournals.org/content/vol27/suppl_1/
* American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27:S5-S8.
* Balady GJ, Banzer JA, Kennerdy CM, Maguire TE, O'Malley CJ. Results of cardiac rehabilitation in patients with diabetes mellitus. Am J Cardiol. 2004;93:81-84.
* Girman CJ, et al. The metabolic syndrome and risk of major coronary events in the 4S and AFCAPS/ TexCaps studies. Am J Cardiol. 2004;93:136-141.
* Todaro JF, Shen BJ, Niaura R, Spiro A, Ward KD. Effect of negative emotions on frequency of coronary heart disease (The Normative Aging Study). Am J Cardiol. 2003;92:901-906.
* Swenson JR. Influence of depression and effect of treatment with sertraline on quality of life after hospitalization for acute coronary syndrome. Am J Cardiol. 2003;92(11):1271-1276.
* Brunner E, et al. Social and psychosocial influences of inflammatory markers and vascular function in civil servants (The Whitehall II Study). Am J Cardiol. 2003;92:984-987.
Because of PCNA's extraordinary growth and accomplishments, we felt it was necessary to update our Web site and allow PCNA members and healthcare professionals easier access to important information surrounding cardiovascular risk reduction.
By logging on to http://www.pcna.net, you can find information on PCNA member benefits, new educational programs, and PCNA's Annual Symposium. You can also join the organization or renew your membership, search for jobs, purchase your favorite PCNA publications, and learn more about the ANCC Cardiac/Vascular Certification Exam. As a member, you will be able to access over 1600 member names or leave a message on the PCNA's new online forum.
The PCNA regional chapters have just recently begun to offer continuing education units for approved educational programs. To find out when and where the next regional chapter meeting is in your area, go to http://www.pcna.net.
I joined PCNA because I believed in its mission. Little did I realize what a wealth of educational tools accompanied that membership!!
This statement is echoed by nurses who join PCNA. A visit to the website will highlight the wide range of benefits of membership. PCNA is continually striving to provide tools to enhance nurses' ability to conduct cardiovascular risk reduction and to manage patients with cardiovascular and vascular disease. One example is A Guide to Developing a Successful Cardiovascular Risk Reduction Program (CVRRP). This 81-page manual provides extensive information, advice, and tools to utilize in your practice setting. The authors have made a concerted effort to address the full scope of topics involved in outpatient care, from the initial strategic planning stages to the fundamental information regarding reimbursement services provided by nurses. A variety of models and examples are woven throughout the chapters to address the diversity that exists in the outpatient workplace. Sample chapters include
[black small square] Rationale for a CVRRP program
[black small square] Planning for success
[black small square] Reaching patients at risk
[black small square] Marketing the CVRRP
[black small square] Setting up the CVRRP
[black small square] Reimbursement and documentation
[black small square] Evaluating clinical outcomes; measuring success
[black small square] An extensive appendix that includes sample documentation sheets, treatment algorithms, marketing materials, sample job descriptions, and coding for reimbursement
Setting up a risk reduction clinic is challenging enough. Why also struggle with creating tools for assessment, education, and documentation of progress? Take advantage of this member benefit: PCNA Forms-Practical Information for Your Cardiovascular Risk Reduction Clinic.
This 56-page manual was designed with the clinician in mind. Sample forms were submitted by PCNA members and evaluated by an editorial committee to provide the most comprehensive product for clinical use. Examples include patient assessment forms, flow charts, contracts, self-monitoring logs, evaluation tools, follow-up materials, and educational handouts, as well as key Internet sites for cardiovascular resources. The most recent edition has additional forms specifically designed for use with diabetic patients. PCNA members receive one complimentary copy of each guide. Additional copies are available for a nominal fee for both members and nonmembers by calling the national office or visiting http://www.PCNA.net.
The newest project, to be released soon, was the result of collaboration with the American Diabetes Association to promote their "Make the Link" campaign. This campaign is focused on increasing patient awareness that two out of three people with diabetes die from heart disease or stroke. PCNA members were instrumental in reviewing the Comprehensive Tool Kit containing reproducible patient education materials related to diabetic cardiovascular disease. Inside are more than 25 topic areas including type 2 diabetes and glucose control, risk factors and lifestyle management, coronary heart disease, and vascular disease. In addition, this tool kit includes forms for tracking key goals and for logging daily eating and physical activity patterns. This valuable product will be mailed to all PCNA members and will be available in hard copy or CD-ROM through either the PCNA or American Diabetes Association websites. To view a comprehensive list of all PCNA publications, please visit our website at http://www.pcna.net.
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