President's Message, Mary W. Sears

Dear PCR Members:

The address, telephone number, fax number and email addresses of every officer are listed in each issue of Timely Topics and on this Website, so please feel free to contact any one of us directly with any concern, comment, or question you might have. We always are glad to hear from you and we welcome your input.

We had an exciting meeting at our regional function in Ontario! Betty Razor and her wonderful, energetic committee kept every detail running smoothly. I have seen superb examples of teamwork in my twenty-eight years as a nurse, but I have never seen a team function so efficiently and always with a smile on the face and love in the heart. Thank you Betty and team for making everything so special for each of us!!

Now preparations are in full force for our next regional meeting on October 7, 8, and 9th in Long Beach on the Queen Mary. Donna Goudberg-Lockhart, our newly elected Education Coordinator, has diligently worked with some key people to put together an educational offering, which should appeal to all. Again, we will have an opportunity to work on a computer segment to help each of us "get up to speed" in our quest to embrace this form of communication. I am not sure what the focus will be for this portion of the program, but please make your requests for types of education concerning computers known to Donna so we may include it in future meetings, if unable to address it at this meeting.

Peggy Donat-Rael, our vice president, and myself represented PCR at the Professional Practice Institute held last month in Las Vegas. In addition, Nancy Gustafson, the WOCN Nominations Committee chairperson, and Bev Jacksich attended from our region. Again, this was an informative and well-spent two days. Bernie Cullen, WOCN President and the WOCN Council took special care to include added sharing sessions and focus group time for the participants. This was in direct response to the comments and input furnished by the participants following the PPI last year. I would encourage each of you to consider attending this in the future. It is an excellent opportunity to be able to have some input and get questions answered by our national leadership.

It does not seem possible that National WOCN Conference is less than one month away! I hope many of you will be able to attend in Minneapolis. It is a beautiful city and surely there will be a little time to sight see and enjoy. We will be having a regional meeting in response to membersí requests. There will be no agenda mailed out prior to this meeting. This meeting will be more an informal, informational, and sharing time and while somewhat structured, we do not intend to present any key issues.

The Board, as always, welcomes your input and comments and is looking forward to seeing you at a future meeting. Please join in making PCR a fun and enjoyable time for all!

Sincerely,

Mary W. Sears, RN, BA, CWOCN

President

Mary Sears Presents Awards

Mary Sears proudly presents awards at the spring PCR meeting .

ET Nurse of the Year-Joy Edvalson Joy has her Masters Degree in Nursing Administration as well as completing a post graduate Family Nurse Practitioner program at USC. After working as an ET subcontractor for five years Joy now has her own business called "Wound Ostomy Innovators." Joy states that she has a love and drive for advancing the practice of nursing by role modeling expert assessment and ostomy education and the title of her business represents the focus of her clinical direction.

Kelle Herrick Wins President's Award

PCR President Mary Sears presented the President's Award during the PCR Spring Meeting to Kelle Herrick RN, MSN, CWOCN. Kelle has been a member of PCR for six years and has been doing the Timely Topics newsletter for four of those years.Candidates who win this award demonstrate leadership, are actively involved in sharing and communicating their expertise, and are actively engaged in research, presentations, posters, abstracts and publications at any level

Lifetime Achievement Award

Gene Galindo owner of Nu - Hope Laboratories Inc has generously and consistently supported PCR in every way possible. Here Gene is being presented the lifetime achievement award by former Manuscript Award Winner Betty Razor.The history of Gene's business is a unique story which goes beyond being soley a business enterprise. Gene's wife Mickey is a fellow CWOCN who also actively contributes to PCR and we hope to enjoy their presence in this organisation for a lifetime.

Harriet Weisenberger- "Special Recognition Award"

Harriet's support and contributions to PCR are many, varied and long standing making her an easy choice for the Special Recognition Award.

Manuscript Award

Barbara Bates- Jensen receives her Manuscript Award from Margaret Landry. This former PCR President, USC faculty member and noted author in the Wound Care Industry plans to present her dissertation at UCLA by May 1999.

The award for the Manufacturer Rep of the year goes to Tom Fry. Tom is a Sween/Coloplast rep located in the San Diego area. He was nominated by Ursula Coats.

Vascular Assessment of People with Diabetes

(AKA: The Disguised Compromised)

by Shelly Burdette-Taylor RNc, MSN, CWOCN

The classic triad of neuropathy, immunologic dysfunction and ischemia combine uniquely in people with diabetes that precipitate foot sepsis, gangrene and amputation. Non-invasive vascular tests provide a safe, accurate and reproducible estimation of blood supply of the foot.

Palpating pulses and obtaining an ankle-brachial index are initial methods of assessment of the macro-circulation. Unfortunately, 20% of the people with diabetes have calcified vessels due to athlerosclerosis. That statistic alone necessitates the need to use other procedures that are more valid and reliable for assessment of micro-circulation of people with diabetes. Obtaining a toe blood pressure (TBP) or transcutaneous oxygen tension (TcPO2) can be used to determine the extent of ischemia in people with diabetes. Clinicians need to be aware of these facts and the options to either perform another procedure more conclusive of ischemia or refer to a vascular surgeon.

Ischemia, lack of blood supply, is the single most important factor that can lead to an amputation if not addressed early and proactively. Diabetes disguises the ischemic foot. There are numerous options in determining blood supply.

Prompt diagnosis of critical lower-extremity ischemia and meticulous revascularization offer people with diabetes the best hope for limb salvage and normal ambulation.

Sykes,M.T. & Godsey, J.B. (1998). Vascular Assessment and Limb Salvage. Podiatry Today,

December, pp. 32-34, 55-56.

PCR/WOCN Fall Conference

"Information for Improving Clinical

Practice in the New Millenium"

Dates: October 7, 8. & 9
Place: Queen Mary
1126 Queens Highway
Long Beach, CA
(562) 435-3511
Rooms $114 per night: Reservation deadline is 7 September 1999 (goes up to $175)

The Queen Mary is an enormous ocean liner, much bigger than the QE2 or the Titanic. She used to be owned and operated by Cunard but is now retired and permanently moored at Long Beach, California, USA. To see more of Queen Mary, go to her World Wide Web page: queenmary.org

Brochures will be mailed July 1, 1999 Requesting poster presentations
Any questions contact:
Donna Goudberg Lockhart
619-659-1156
dgconsulting@webtv.net

Vice Presidents Message re U.O.A. Convention - July 1999

The 1999 U.O.A. convention will be in Sparks, Nevada this year-July 29 to the 31.

(Sparks is a suburb of Reno). We have been asked to provide an E.T. Nurse clinic during the conference as an educational service to those attending. As you know there are many areas of the country with minimal E.T. services and even in large metropolitan areas some individuals have not seen an E.T. in years. In order to participate you must have a Nevada license. Nevada has a temporary 4 month license available with proof of a license in another state. I have the forms that need to be filled out. If you are interested in participating, please let me know mmediately so that I can send you the form and you can submit it to the B.R.N in Nevada. We especially want participation on Saturday which will probably be the busiest day but any time you can give is most appreciated. The conference is at the Nugget but there is plenty of inexpensive motels and hotels in the immediate area and I would be happy to give you that information.

This is an excellent opportunities for the E.T.'s in Nevada who we do not see too often at P.C.R. conferences to actively participate.

Peggy Donat Rael, R.N.,B.S.N.,C.E.T.N. --Vice-President

Diabetes

The Economic Burden of Diabetes

by Shelly Taylor RNc, MSN, CWOCN

It is estimated that $98 billion dollars were spent on medical expenditures in the USA on diabetes-related complications and general medical conditions in 1997. The majority of the expenditures were for inpatient care. People with diabetes are much more likely to have macrovascular disease, renal failure, blindness and amputations. There is an intense focus on containing the rapidly increasing cost of medical care. Diabetes affects more than 10.3 million individuals. People with diabetes consume 3-4 times more health care resources than non-diabetics. There is also a disproportionate disparity borne by the elderly, obese, sedentary and minority populations.

The economic burden in the USA is enormous. Health education focusing on obesity, smoking cessation, proper nutrition and hydration can help reduce the incidence and delay the onset of diabetes. Until we as a country focus on improving glycemic control and ultimately preventing diabetes we will continue to have this enormous burden on economics, lives and limbs.

Reference:

Simonson, D. (1999). The Economic Burden of Diabetes, Clinical Diabetes,

17, 1,pp. 47-48.

Management of Diabetes in the Elderly

by Shelly Taylor RNc, MSN, CWOCN

Type 2 diabetes accounts for 90% of all people with diabetes. It affects 20% of the people over the age of 65 in the United States. Recently recommendations have been established to screen everybody over the age of 45 for elevated glucose levels.

Diabetes is the 4th leading cause of death. It is the most frequent cause of blindness and renal failure and the microvascular complications of diabetes rise with increasing disease and worsening glycemic control.

Diabetic neuropathy affects over 50% of patients who have had type 2 diabetes for more than 15 years. With aggressive management of glycemia the incidence of neuropathy could be reduced.

Nutrition, exercise, smoking cessation and weight loss are still the tried and true measures to reduce risk of getting diabetes and definitely reducing risk of complications from diabetes. Regular attention to detail such as eye, foot, and cardiac exam are methods of prevention. Education regarding nutrition, hydration, exercise with emphasis on promoting increased activity allows for near normal glucose levels and prevention of illness.

Reference:
Wallace, J. (1999). Management of diabetes in the elderly.
Clinical Diabetes, 17, 1, pp. 19-25.

Capital Update

***** Reimbursement for Continence Services*****

***Continence Coalition Update***

Judy A. Wells, MN, RN, GNP,C, CWOCN

WOCN Representative, Continence Coalition

Here is an update on the latest information regarding reimbursement for continence therapies.

As you know, the Continence Coalition has been monitoring governmental and legislative issues that have the potential to impact on continence care and the provision of continence services across the country. Most of our initial work focused only on issues surrounding the modality of biofeedback. Thanks to a lot of hard work and support from numerous medical and nursing organizations we successfully lobbied HCFA on this issue. In January of this year we were told HCFA would hold a public forum in the spring of 1999 on the use of biofeedback for urinary incontinence. We all have been anxiously awaiting definitive information on the public forum.

HCFA has recently announced that the public forum will be held in September 1999. In a conversation with Dr. John Whyte of HCFA, Diane Smith, Chair, Continence Coalition, was told that the delay in holding the public forum was due in part to the development of new urologic devices and procedures for urinary incontinence. Therefore, the scope of the forum will be broadened to include other modalities for urinary incontinence; e.g., e-stim, sacral nerve root stimulation, other surgical procedures and perhaps electromagnetic therapy.

A panel is being convened to review reports and to hear presentations from clinicians, industry and technical experts. At this time we do not know the exact makeup of the panel. We have been informed that in order to bring an unbiased perspective to the proceedings, the panel will be comprised of medical specialists, many of which are not urology or continence specialists, and have no working knowledge of urinary incontinence. However, We have formally requested that Diane Smith be included as a panelist or as a technical consultant.

HCFA is seeking specific information on each of the modalities; e.g., effectiveness, cost, determinants of medical necessity and utilization parameters. All interested parties should be prepared to address these issues and provide scientific support of their assertions when submitting reports or giving presentations.

HCFA has stated that this work of the Coalition is first time that so many disciplines have effectively partnered in this manner to address common patient-care concerns. This is truly the best way to effect change.

The Continence Coalition will endeavor to keep allinterested parties apprised of new information as it becomes available. Updates on this subject can be found at profprac-forum@wocn.organd continence-forum@wocn.org.

In addition, updates can be found in the WOCN News. THE CONTINENCE COALITION
Diane Smith, RN, MN, CRNP Sheila Fiers, RN, MS, FNP, CETN
Chair and SUNA Representative WOCN Representative
Francie Bernier, RNC, BSN Judy Wells, RN, MN, GNP,C, CWOCN
SUNA Representative WOCN Representative
BOARD OF DIRECTORS Bernie Cullen, MSN, RN, CETN Gerry Sue Young, RN, CNOR
President, WOCN President, SUNA
Dorothy Doughty, RN, MN, FNP, CWOCN
Vice-President, WOCN
ADVISORY PANEL Greg Andrews Mikel Gray, PhD, RN Marta Krissovich, MSN, RN, CCCN
Lobbyist Editor, JWOCN Past Chair and Founder