The Dec. meeting was held at The Meadoview Conference Center in Kingsport, TN. The meeting was sponsored by Wyeth Neuroscience.  John Fenley, MD was our speaker for the evening with the topic “Clinical Data on Recurrence Prevention during Maintenance Phase Treatment of Major Depressive Disorder.”  

PRESENTATION HIGHLIGHTS

Major Depressive Disorder  

DEPRESSION IN ADOLESCENTS:  

• Early onset of major depression (before age 17 yrs) has about a 25% risk of being bipolar
• SSRI’s are still a good choice for treatment.  Black box warning is for increased risk of suicidal ideation and suicidal acting out, but not for suicide.
• Consider using Lamictal as an alternative  

DEPRESSION SEQUALE:

• The degree of impairment from depression is worse than CVD, DM, and HTN.
• It is the second leading cause of disability in the U.S.
• It is a chronic disease that is often recurrent
• Sleep apnea often goes along with depression

DEPRESSION SCALES:

• PHQ-9
• Beck Depression Inventory

RECURRENCE:

• Each successive episode = increased risk of recurrence
• The more episodes that occur, the more disconnected the patient becomes to stressful events.
• Increased episodes of depression leads to a decrease in hippocampal volume making rebound more difficult.

TREATMENT GUIDELINES FROM THE APA:

• Acute phase should be treated 4-8 weeks
• Continuation phase requires at least 4-5 months of treatment to prevent relapse
• Exercise is an excellent treatment for mild depression
• Must treat with psychiatric medications as well as psychotherapy if moderate to severe depression
• Continue to use the same medications that brought the patient to remission for maintenance
• Treat 1st episode of recurrence for 4-9 mos, 2nd episode for 2 yrs and 3rd episode requires lifelong treatment.

CLINICAL TRIALS:

• STAR D: Clinical trial for relapsed depression. Revealed that patients with residual symptoms were 3x a likely to relapse and 3x as fast to relapse.  28% remission on citalopram.
• PREVENT: Revealed Effexor XR was 92% effective in preventing a 2nd relapse

STRATEGIES TO EFFECTIVE TREATMENT:

• Assess adequacy of treatment response
• Maximize initial treatment
• Always increase the dose of the current treatment before changing medications
• Change treatment when maximum dose is not working
• Augment/Combine treatments if obtaining a partial response
• Discuss adverse events up front
• Tell patient that they will most likely be on treatment at least 6-9 mos

Business Meeting

President Kathy Sharp opened the meeting by thanking our Wyeth representatives and Dr. John Fenley  

Secretary’s Report: The minutes were approved by unanimous vote.  

Treasurer’s Report: Deferred  

Old Business:

• State-wide Salary Survey:  please go online to www.tnaonline.org and complete the survey.  We are helping sponsor this and thus far only a little less than 400 have completed the survey.  This ends on Dec. 31, so please, please, please respond.  It takes 5 minutes or less and the data is very important.  We at NETNPA initiated this with our regional survey, so we need to have adequate representation at the state level.  The data will be available to us by the February meeting, possibly by the January meeting.
• Federal Motor Carrier:  I would like to again ask that each of you go online to sign up to be among those providers who will be certified to perform DOT physicals.  I received an email from Connie Morgan who stated that there are still many openings for NP’s.  There are already 100 PA’s on board, we need equal representation.  Go to www.nrcme.fmcas.dot.gov to register.
• State regulations regarding nurse practitioners:  At last months meeting we discussed the fact that for the DNP to be instituted in some states, the nurse practice act would have to be opened.  Thankfully, in Tennessee, we are very fortunate that our language states that an APN must be a masters degree or higher in a nursing specialty and national specialty certification as a nurse practitioner.  This wording means that our practice act will not have to be opened for DNP.
• Pharmaceutical Samples:  We have talked about the issue of some pharmaceutical companies asking our collaborating physicians to sign a paper of approval, allowing NP’s to sign for certain samples.  Specifically sampling of Lyrica (made by Pfizer), has continued to cause a stir in the community.  I would like to have some feedback regarding your experiences.

New Business:

• It has come to the attention of one of our members that the Tennessee Board of Regents has approved an online FNP program. This was discovered after a FNP student contacted one of our members requesting assistance with finding a preceptor.  Your comments, thoughts, etc. are welcomed.
• In reviewing the speaker’s bureau list, I realized that we desperately need to update this.  I will be sending out an email shortly asking for volunteers to be speakers.
• AANP elections:  Would anyone be interested in being a state representative or a regional director.  I especially would like to have someone who is interested in helping keep us up to date and keep AANP up to date on local and regional legislative issues.  This is a 2 year term.  Please consider this!!  Since NETNPA is now an affiliate member we really need to have someone to represent us in East TN I have more details if anyone is interested.
• The Center for Nursing Advocacy:  This group is a non-profit organization devoted to helping nurses improve public understanding of their work and work with obtaining resources for clinical nursing practice, research and education.  Please go to www.nursingadvocacy.org to sign up for their news alerts and emails. They can also use financial support and accept donations.
• Dues for all members are due at the January meeting.  Dues are still $35.00 annually and $15.00 for students.  

Job Opportunities:

• Cardiovascular Associates, P.C. in Bristol has openings for 2 Nurse Practitioners
• The Heart Center of Memphis needs a NP for cardiology office.  Some cardiology experience needed.  Email resume to lmcewen@theheartcenterof Memphis.com.
• The TN Department of Health has 2 full-time primary care APN positions available in Church Hill and Greeneville. Clinic hours at 8:30-5 pm M-F.  Mail a CV and letter of interest to:

  Linda McClure FNP, Family Nurse Practitioner

  Director of Primary Care Services

  Northeast TN Regional Health Office

  1233 Southwest Avenue Extension

  Johnson City, TN 37604-6519

  Linda.McClure@state.tn.us

• College of Nursing-Student Health Services-Clinical Services Director-Level 15.  Student Health Services (SHS) is part of the Faculty Practice Network of the College of Nursing (CON) and is a nurse managed clinic providing a broad range of primary care and health promotion services to university students with the potential for care of faculty and staff to be added.  SHS also serves as a clinical site for educational experiences for health professions students and a practice site for CON faculty.  The Clinic Director reports directly to the CON Director of Practice. Essential Functions:  The Clinic Director provides clinical leadership and direction for SHS and is responsible for assuring in the development of the annual budget and administration of operating expenditures; developing and implementing clinical policies; supervising and evaluating clinical personnel; developing and evaluating short and long-term goals; and assisting in the implementation of expanded clinic services.  This position offers an opportunity to lead a team of dynamic professionals and to be part of a college environment that encourages creativity and excellence. The advanced practice nurse in this position will combine clinical practice with administrative leadership.  Qualifications:  master of science in nursing and national certification as a Nurse Practitioner; must be licensed or eligible for licensure as Registered Nurse in TN and obtain advanced practice certification and certificate of fitness in Tennessee prior to the start date; must demonstrate ability to communicate effectively; show evidence of successful leadership skills; possess administrative/supervisory experience; knowledge and experience in advanced practice, team building, clinical practice management, continuous quality improvement and Human Resource Management required.  Experiences in college health or related health care setting preferred.  Send letter of interest, resume or curriculum vitae and three references to:  Nancy Alley, PhD, RN, Director of Practice, College of Nursing, East Tennessee State University, Box 70617, Johnson City, TN  37614-1709

Next Meeting:   January 18th at 6:30 pm-place to be announced at a later date. Please plan to attend!!