rcrn70

Heart Disease Fun Facts: According to the CDC Every 34 seconds, someone dies of heart disease in the US. 697,000 people die annually of heart disease in the US. That's 1 out of 5 deaths. In 2017-2018, the cost of healthcare services, medication, and lost productivity due to heart disease totaled about $229 million. Heart Disease and LDL For the last thirty years, the statin class of drugs (HMG-CoA reductase inhibitors) remains one of the most widely used drugs. Drugs like atorvastatin, pravastatin, and simvastatin are given to reduce LDL (low-density lipids) and stabilize plaque on vessel walls. Statins are the standard for reducing arterial inflammation, and the risk of myocardial infarctions and strokes. However, millions of patients suffer from statin intolerance due to myalgia, myopathy, and in severe cases, rhabdomyolysis, leaving them with few treatment options. Alternatives and Adjuncts to Statins CoQ10 is believed to alleviate the myalgia some patients experience when taking statins. Studies on the efficacy of CoQ10 have been promising but inconclusive. Niacin is another cholesterol-reducing agent which causes many patients to have severe hot skin flushing and dizziness. Red rice yeast is an alternative supplement some patients swear by, while others report it didn't lower their LDL at all. Questran (cholestyramine) is a bile acid sequestrant that has been in use since the 1970s. Bile acid sequestrants are highly positively charged molecules that bind to negatively charged bile acids in the intestine, inhibiting their lipid solubilizing activity, and thus blocking cholesterol absorption. Zetia (Ezetimibe) is a cholesterol absorption inhibitor that performs well to lower cholesterol when combined with a statin (simvastatin) =Vytorin. Although, trials showed that ezetimibe combined with statins didn't have much effect on heart-related death. Praluent (alirocumab) & Repatha (evolocumab) PCSK9 Inhibitors are a new class of LDL-reducing drugs. The route is by injection, and many patients do not like to self-inject. Bempedoic acid (ATP citrate lyase inhibitor). An alternate choice became available when bempedoic acid was approved by the FDA in February 2020. At the time, bempedoic acid was meant to be used as an adjunct with statins, it was unclear whether the drug was associated with a reduced risk of a major adverse cardiovascular event (MACE). Major adverse cardiovascular events include death from cardiovascular causes, nonfatal myocardial infarction, nonfatal cerebrovascular accident, and coronary revascularization. CLEAR OUTCOMES Trial On March 4, the CLEAR OUTCOMES Trial, presented at the annual American College of Cardiology 23/WCC (World Congress of Cardiologists) in New Orleans, revealed that in patients with statin intolerance, bempedoic acid was associated with a lower risk of major adverse cardiovascular events. According to Steven E. Nissen, MD, MACC, the chief academic officer of the Heart Vascular and Thoracic Institute at Cleveland Clinic and chair of the study, "Most people can take statins, but some cannot. This is the first study that directly addressed the problem of statin-intolerant patients. We achieved what we hoped we would get – a very positive result in a population of people who just could not tolerate statins." Given that heart disease remains the number one killer of men and women, clinicians need more treatment options to offer patients. It's difficult to get patients to comply with these treatments if they have uncomfortable side effects. And that may have a negative impact on their outcomes. Bempedoic Acid Overview The CLEAR OUTCOMES Trial showed that bempedoic acid lowered study participants' LDL cholesterol by 20%-25% on average throughout the study. Participants taking a placebo saw an average of 10% reduction in LDL, which demonstrates closer monitoring and the addition of other cholesterol-reducing agents as part of their background therapy, according to researchers. Bempedoic acid is not without side effects. Participants experienced renal impairment, gout, gallstones, and elevated hepatic enzymes. Nevertheless, side effects didn't indicate discontinuation of the drug. As a rule, statins reduce LDL by about 40-50%, suggesting that bempedoic acid is not as effective at reducing cholesterol as statins or other drugs such as PCSK9 inhibitors (Praluent, Repatha). Moreover, the study determines that this measure of change can still make a difference in the risk of cardiac events for patients who cannot take statins. Bempedoic acid may be prescribed under the brand name Nexletol and is manufactured by Esperion Therapeutics. A one-month supply costs about $400. Insurance companies need to consider that the cost of not taking this medication could greatly outweigh the expense of taking it when factoring in the cost of a hospital course for an MI or stroke. When patients are: Non-compliant with their disease management. Do not take their medications. Blow off follow-up appointments. Continue to smoke with freshly deployed drug-eluting stents in their major coronary arteries, The risk of MACE increases. Many patients report that they cannot or will not take their prescribed statin because it gives them terrible life-altering discomfort. These are patients who: have had multiple MIs have multiple stents have CABG are already at risk for additional major adverse cardiovascular events. Recall the fact I shared above; the cost of health care services, medications, and lost productivity secondary to heart disease totals about $229 million annually. As advances in technology and new therapies are discovered, clinicians can offer patients alternative options. Offering alternatives keeps patients compliant and reduces their overall risk of a major cardiac event. Bempedoic acid bears a two-fold benefit in that it can contribute to cost reduction and reduce the risk of MACE. References/Resources Bempedoic Acid Improves Outcomes in Statin-Intolerant Patients: American College of Cardiology Foundation Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients: The New England Journal of Medicine Heart Disease Facts: Centers for Disease Control and Prevention Ezetimibe for the prevention of cardiovascular disease and all‐cause mortality events: National Center for Biotechnology Information: National Library of Medicine What is Atherosclerosis? - Atherosclerosis and cholesterol: American Heart Association, Inc. Ezetimibe: National Center for Biotechnology Information: National Library of Medicine

Until the 21st century, approximately 90% of combat-related deaths occurred before a casualty arrived at a medical treatment facility. Three major potentially survivable causes of death are extremity hemorrhage exsanguination, tension pneumothorax, and airway obstruction. According to JAMA Surgery, in an analysis of all US military casualties from October 2001 through December 2017 (Operation Iraqi Freedom, Operation Enduring Freedom), researchers found that survival among the most critically injured casualties increased 3-fold during the course of those respective conflicts and that three key interventions, tourniquets, blood transfusions, and prehospital transport within 60 minutes, were associated with 44% of mortality reduction. This finding led to multiple innovations in state-of-the-art trauma training for our military that would further curtail battlefield mortality. In 2017 the National Defense Authorization Act initiated a directive for the Military Health System to establish partnerships with civilian institutions to obtain and sustain trauma care competency accompanied by standardized combat care instruction to enhance quality of care outcomes for trauma care. Since the US pivoted away from the Middle East, MISSION ZERO was signed into law as part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act. In case you were wondering, funding is authorized. A congressional sign-on letter that fifteen U.S. senators advocated for convinced a U.S. Senate Appropriations Subcommittee to earmark $11.5 million in FY 2022 funding for the Military and Civilian Partnership and Trauma Readiness Grant Program. Furthermore, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) submitted statements to House and Senate appropriators also urging funding. The Military Health System consists of Army, Air Force, and Naval medical personnel who currently engage in partnerships with civilian healthcare systems all over the US. Perhaps you have encountered these partnerships in your own practice. Maybe you have worked alongside an Army nurse in your ED or OR on a polytrauma patient or taught an Air Force medical technician how to measure intracranial pressure in your ICU, or instructed a Navy Corpsman how to change dressings on an open GSW. Perchance you worked with an Army, Air Force, or Navy trauma surgeon in one of many affiliations that include Cooper University Healthcare in Camden, NJ, Oregon Health and Sciences Center in Portland, OR, Penn Presbyterian Medical Center, Philadelphia, PA, Cook County Health in Chicago IL, Cincinnati Medical Center UC Health, Cincinnati, OH, the University of Nebraska Medical Center, Omaha, NE, Soin Medical Center, Beavercreek, OH, R. Adams Cowley Shock Trauma Center, Baltimore, MD, Grady Memorial Trauma Center, Atlanta, GA, St. Louis University Hospital, Cardinal Glennon Children's and Mercy Medical Center, in St. Louis, MO and The University of Las Vegas Medical Center, Las Vegas, NV. These are only a handful of the institutions that entered into partnerships with the Military Health System. Military medical treatment facilities lack the acuity and volume medical servicemembers need to sustain operational readiness to deploy downrange and provide high-quality care to our injured heroes. AMCT3 (Army Military-Civilian Trauma Team Training) and the Air Force C-STARS (Center for the Sustainment of Trauma and Readiness Skills) are premiere programs that give servicemembers clinical immersion in a level 1 trauma center that they cannot obtain working in their military medical treatment facilities. Base populations are generally healthy, and they're not going to see poly traumas, GSWs, and tension pneumothorax in their troop medical clinics and community hospitals. If you encounter them on your unit, it helps to know that military medical technicians are highly trained to the level of licensed practical nurses. They possess NR-EMT certifications and receive classroom, clinical, and field medical training before they begin working at their permanent duty stations. Many of them possess advanced certifications and college degrees. Physicians, nurses, medical technicians, respiratory technicians, OR technicians, and Special Operations medics participate in clinical rotations that include areas such as the ED, OR and ICUs. The programs also consist of didactics, high-definition sim lab scenarios and cadaver lab workshops. They experience live telemedicine conferencing with military personnel in field hospitals overseas and can track a casualty during the en-route care transport system all the way back to our US hospitals. Recent news garnered attention for USAF surgeon Lt.Col. Valerie Sams, who was part of the team at UC Health's University of Cincinnati Medical Center that cared for Buffalo Bills' safety, Damar Hamlin, the night his heart stopped on the field. Dr. Sams is the director of the C-STARS program at Cincinnati and trains Air Force medics attending an advanced course in Critical Care Air Transport (CCAT). Air Force physicians that administer the program are embedded in the faculty and staff. They see patients and take call as attending physicians while training military medical personnel. Every hospital that engages in these partnerships further embodies the tenets of its mission. If you work in these settings, maybe you never realized you are providing our armed forces with valuable experience as well as hopefully taking something away for yourself in an exchange of ideas and knowledge that is unique and gratifying. You are contributing to the reduction in battlefield mortality. Support and expansion of these programs are imperative for the Military Health System to maintain operational readiness. The military and civilian men and women who administer these programs have a personal, vested interest and love what they do. Military-Civilian partnerships will soon be a mainstay in US healthcare. Your support is a gift. Rosemarie Tracy, RN, BSN References/Resources Building a sustainable Mil-Civ partnership to ensure a ready medical force: A single partnership site's experience: National Library of Medicine-PubMed Military trauma training at civilian centers: a decade of advancements: National Library of Medicine-PubMed Eliminating Preventable Death on the Battlefield: American Medical Association-JAMA Network Use of Combat Casualty Care Data to Assess the US Military Trauma System During the Afghanistan and Iraq Conflicts, 2001-2017: National Library of Medicine-PubMed From the battlefield to the football field: Air Force surgeon's skills knows no bounds: Airforce Medical Service Senators Champion Funding for Military-Civilian Trauma Program: American Association of Neurological Surgeons

I'm going to COT soon, I'm looking for tips and hints. Help please, the 5 week course.

Just for sh*ts and giggles, and I know the circumstances are TOTALLY 100% different, when I was in the Army, my first duty station was a clinic at West Point☺

Congratulations, so happy for you!!!!!!!

morgan_porgan, so sorry to hear this. I have been wondering for all of you who are trying to go AD, have you considered going reserves or guard first then AD? Has anyone asked a recruiter? It's probably so much easier that way if it is possible...

Exactly, that is why I am trying to be proactive!

Thank you again for your advice jfratian! You are correct regarding the "good years" which I have at least 8 good guard years. And that is exactly the rumor I have heard, I may get and have seen nurses with similar background before me come in at: O2E with one year for promotion to O3E. Not too shabby, good start. They did inform me that for the officer's pension I need to stay in for minimum 10 years. Now to pass the MEPS physical at 44 years old :/ Then swear in!!!! Pixie.RN, documenting your ED hours I would assume, was because you were coming into a specialty. I am filling a clinical nurse spot in the Air National Guard, despite my critical care background. It hurts a little that I am penalized for part time, as the nature of my specialty is intense and frankly very advanced.

Wow thank you, right, original Army contract was 4 AD plus 4 IRR. I did the 4 AD had a 10 mo break in service then went in the ANG. I have AD deployments (which I have DD214S for) that I thought would bring me over the 4 years, does that not count?

I wonder if anyone can advise me: I was selected for direct commission in Air National Guard as RN. I have 8.5 years in this Medical Group as 4N TSgt ( no slots for promo) deployment with Expeditionary Forces to Operation Northern Watch and Enduring Freedom. Been out for 8 years. Also have 4 years AD Army as 91 Bravo. BSN with 11 years in critical care high risk cardiac cath lab (no CCRN yet but + ACLS), 4 years full time, part time since 2007 with a lot of extra time and call, tremendous experiences with leadership roles. I have reviewed AFI 36-2005 which is confusing. I want to ensure I come in at the proper rank as I have heard stories of those who were not properly compensated. How do I go about this diplomatically and with finesse? My recruiter who does not seem experienced at bringing in direct commissions and the MSC officer will be determining my rank. Please advise, thankyou!!

I wonder if anyone out there can advise me: I was selected for a direct commission in the Air National Guard as a RN. I served 8.5 years in this Medical Group as a 4N reaching TSgt ( very hard to obtain promo slots), and 4 years AD Army 91Bravo. I have BSN and have been working in critical care (no CCRN yet) high risk cardiac cath lab for 11 years, 4 of them full time, a lot of extra time and call ( however I have been part time since 2007). I have a deployment with Expeditionary Forces to Operation Northern Watch and one Operation Enduring Freedom. At the least I figured I would be awarded 1st LT but have heard that Captain may be possible. I have reviewed AFI 36-2005 although it is confusing, can someone please advise me on how to go about making sure I obtain the rank I deserve as I have heard stories of those who were not properly compensated. Thank you!

enova, what stage are you at in the process? Active Duty is a big adjustment, will you be bringing a family along with you?

enova, thank you so much for your kind words and prayers. The board selection process is over with and I am waiting to hear....torture.

If anyone is out there reading this thread: I had two interviews in July. I am talking about the Air National Guard which I learned is very different from AD. One state was willing to just bring me right back in ( I am prior service, 4 years AD Army as a 91B, followed by 8.5 years in the Air National Guard as a 4N, RN since 2003 with critical care, current high risk cath lab experience, BSN), no application packet, no board interview. As I later learned they were bringing me in on "overage" which is not a great thing, making it difficult for promotion. In addition this unit is a grueling 3 hour commute so I turned it down. Surprisingly a position opened at the base 10 minutes from my home, great opportunities for advancement, they went through the whole painful process, chief nurse interview, application packet and I have the board interview this Friday and am VERY nervous, as there are 4 additional candidates. Subsequently, a friend of mine offered me an opportunity at another unit, also about 2.5 hours from my home, which I will consider should I not be accepted to the unit 10 minutes from my home. Please, someone give me some advice as to what they may expect me to discuss and what questions they may present at this interview, even if you only have AD advice, I want to hear it!

I have two interviews this week with two different Air National Guard units. I will post a lot of info after the interviews!!!