0:00:00: thank you so much for fast that really warm introduction it's really
such a pleasure to be presenting on this webinar today especially cuz I know the
nurse practitioners are really on the front lines of providing quality effective
and patient-centered Care in the u.s. today

0:00:15: I know that each and every person on this webinar is making a big
difference especially for women and we really really appreciate your time away
from the clinic today I'm here to discuss cervical cancer

0:00:30: cancer is a preventable disease that results from abnormal growth of
cells on the cervix that really all sexually active women in the US are risk for
today until you were going to focus on providing screening for women at the
community level

0:00:45: and that's really an effective way to reach women with the highest risk
and to catch growth at an early stage when it's so can be easily treated as
everyone knows nurse practitioners are really at the center of the conversation
and how to reach higher

0:01:00: women for cervical cancer especially and who really need this screening
most and today first I'm going to take you through the crisis of cervical cancer
in the u.s. today

0:01:15: simple four steps to providing screening are expanding services today
if you're not already providing screening in your clinic and today 79 million

0:01:30: are living with something called the human papillomavirus that's
commonly referred to as HPV and 14 million people are newly infected each year
with the virus now nearly every American will contract HPV

0:01:45: but this is important because HPV can lead to six different types of
cancers and cervical cancer is one of the most common type that can result from
the virus that's certainly not the only one in today cervical cancer

0:02:00: cause more than 90% of its caused by in Moore knighted by the HPV virus
but it doesn't clear on its own because they're such a high we really need to
make sure that all women at risk

0:02:15: stopping cervical cancer are in a proper screen Cycles prevent
morbidity and mortality now the good news is that most HPV infections do clear
on their own but when the virus that can lead to pre cancer

0:02:30: lesions on the cervix and when it goes untreated for a long period of
time it can lead to invasive cervical cancer now here on this slide you can see
the visual progression of a normal cervix all the way to invasive cancer on the
left you'll see it

0:02:45: the cervix this is a great time to vaccinate against HPD to prevent
cervical cancer in the future unfortunately not all women today have

0:03:00: needed for HPV in women can track the high-risk strain of the virus and
it doesn't clear up on its own HPV can lead to these precancerous lesions on the
cervix do you see in that third picture

0:03:15: United States it sounded as precancerous stage when women are in a
normal screening cycle and it can be treated pretty easily but if it's left
untreated or less I'm found it can result in invasive cervical cancer

0:03:30: found the right now the good news is we can certainly prevent that
pretty bad-looking cervix by preventing invasive cervical cancer in the first
place by screening and if needed treating women and it really early stages of
serve

0:03:45: cancer and how do we do that we make sure that they follow different
screening intervals in cycles and the leading body to determine these types of
Cycles in the United States today is the American Society for colposcopy and
cervical pathology

0:04:00: we normally call in a sec p and they recommend different intervals
depending on age and medical history and risk it really most often every three
to five years and there's different types of methods to screen for cervical
cancer

0:04:15: we break them out into three into three different parts the first is
primary screening methods and this is really what a woman comes the office for
the first time and you want to make sure that she is not at risk for cervical
cancer during a normal

0:04:30: murdering her annual Gynecology exam depending on the type of patient
who served the most well-known United States

0:04:45: he says you insert a speculum into the into the vagina I need simply
use a dedicated brush to scrape or brush around the cervix to collect a sample
of cells basically what we're trying to see is if a woman is HPV positive

0:05:00: we know that she's at risk for cervical cancer because more than 90% of
cases in the US occur among women who are hiv-positive she definitely needs to
be more closely screen to make sure the no lesions appear

0:05:15: Jason cytology so the sample is put on a slide under a microscope in a
lab and the cells are review to see if there's any type of abnormal changes now
are found to have an abnormal primary screening meaning

0:05:30: they're hpv-positive or than a square came back with some sort of
presents of dysplasia whether it's low grade or high grade ourselves of unknown
significant they really should be called back to see what's going on that's when
we started you a visual damn cold

0:05:45: I'm colposcopy is done with the medical device called the Copa scope
and like the first exam a speculum is inserted and the the little picture on the
right show the provider just visually looking at the canal inside vaginal

0:06:00: what the cervix and a very magnified way to see what types of Legions
maybe they're offering a special diluted a state called acetic acid is applied
to the cervix and any suspicious lesions are usually White

0:06:15: now today I'm not going to go into the clinical side of colposcopy but
you are able to go to a website and see webinar by dr. Mary Ruben who does
explain some more of the clinical indications if there are suspicious to be
found

0:06:30: the United States today was often women will undergo confirmatory bias
see to tell the Titanic grade of lesion is then used to make a treatment option
in most cases women will start will not get to the secondary screening parts

0:06:45: we have a negative times a negative vaccinated in the second screening
method is really only for women who had abnormal primary screening

0:07:00: have a precancerous lesion or perhaps cancer in most cases before the
invasive cancer stage treatment is pretty easy providers do things like
cryotherapy

0:07:15: but in more advanced cases at lasers or even hysterectomy hysterectomy
and in rare cases maybe use

0:07:30: especially the primary level and that's why more than 69% of women in
America today generally follow the screening recommendations yet still even with
these efforts in place place and the relative ease to do

0:07:45: raining more than 13000 cases of invasive cervical cancer are found in
the US every year and more than 4,000 women will die from the disease that
really means they both primary and secondary screening or not reaching always

0:08:00: and the recommended intervals unfortunately the group of women found to
have invasive cancer most and dying from the disease are most often women from
ethnic minorities and disadvantaged groups and when it comes to see

0:08:15: your license cervical cancer not all women in America have equal access
or certainly equal opportunity to appropriate Healthcare and I think this group
knows that that it better than anyone today only 22.8%

0:08:30: American women don't undergo screening within the recommended intervals
but more importantly the groups that are the most high-risk those from ethnic
minorities and lower socio-economic groups

0:08:45: call timely for work and family and for many other complex reason 92.8%
of the 9.8 million underserved women in the u.s. today or not

0:09:00: Affordable Care Act making screening more affordable than ever women
are still not going under screening from the highest risk groups and the rates
of incidence immortality follow the same narrative because women really aren't
getting

0:09:15: raining enough and it's 2017 study found that black women in America
today or dying from cervical cancer rates 77% higher than we previously thought
and they're dying it's a cervical cancer at a rate of 41%

0:09:30: white women and they're also being diagnosed at a much later stage if
they are found to have cancerous lesions Hispanic women I also have a very high
incidence of cervical cancer mostly in areas around the

0:09:45: Mexico border of the Lower Mississippi Valley in southern Appalachia
and these women have rates 40% higher than those non Hispanic communities Native
American women also face significant rest and are nearly twice as likely to
develop cancer

0:10:00: and really for these women the remarkable success of the past mirror
and different primary screening techniques in the United States that has reduced
cervical cancer deaths by 75% is still Out Of Reach for these women

0:10:15: immobility we really believe that there is no end in sight to these
disparities in from our personal experience building digital tools for
healthcare providers and more than 26 countries around the world we certainly
believe it's possible

0:10:30: do a giraffe the lack of culturally appropriate education about
cervical health and the constraints and resources for healthcare Outreach that
really further entrench the seemingly intractable disparities in a cost-
effective manner

0:10:45: in general how do we reach these women how do we make sure that we get
to the community level and we guess a high-risk women to make sure that they are
part of it is really quite easy to maintain

0:11:00: started we really believe that starts with nurse practitioners and and
I don't have to preach to the choir this group knows better than anyone that
nurse practitioners really have a critical role in both primary and secondary
screening

0:11:15: cancer because of the more holistic perspective an advanced practice
skills that enable this group that really to intervene for clients at all levels
of healthcare from encouraging women to be screened in the first place raising
awareness and

0:11:30: women who may not go to the gynecologist outside of her problem is that
are outside of childbirth to make sure that they're performing screening and
successfully shepherding women through the treatment process one of the biggest
challenges

0:11:45: communities women may have been diagnosed but they may not have gone
through the proper treatment process they may be really far from gynecologist
and they may not know how to make an appointment to make sure that they get
their proper

0:12:00: time away from work what what can nurse practitioner

0:12:15: become the barriers and we know that it's not just medical it's not
just having the past mirror that's not just having the equipment it really means

0:12:30: getting cervical cancer screening and these really include psychosocial
so so so you can all make and cultural factors this really needs to be dressed
at the community level and that means nurse practitioner

0:12:45: especially in high-risk Community serving some of the minorities to
beat High incidence and mortality rate in today there is finally in improving
recognition the nurse practitioner the nurse practitioners take charge not

0:13:00: Staffing The House of the other female patient that more medical side
that we talked about but also the system that serve patient needs that really
that really include the education building the counseling and now also include

0:13:15: more clinical side to doing the primary and secondary treatment and
really because Nat women now more than ever because of the Affordable Care Act
have access to insurance to cover cervical cancer screening it's critical

0:13:30: the nurse practitioner is in to Gracie's clinical practices into their
normal services and Outreach that also come from a holistic perspective to the
woman and make sure it make sure she includes this type of spring as part of her

0:13:45: Animal Health Care and again does underscoring the point that nurse
practitioners had the best tools any health care provider to understand the
circumstances contributing to Patient Health beliefs and behaviors to get them
into

0:14:00: GreenCycle to begin with and this is a quote from Carrie Sue than Wendy
Groove that I really love and it points out the nurse practitioners you know try
to foster a constructive therapeutic partnership with patient and the emphasizes
how

0:14:15: decision making and these are all principles that links the clinical
side they certainly guide advanced practice nurses isn't as they provide
screening and diagnostic services today is cervical biopsy that I spoke about

0:14:30: treatment for pre-cancerous lesions and finally I am certain really
certain that this group is consistently cost-efficient to Cross Timbers practice
setting to help and I think it'll really help lower the current 6.6

0:14:45: dollar price tag that we have for cervical cancer screening each year
in the u.s. today I think that if more nurse practitioners pick up screening at
Birth we can really scratch that dollar amount every woman everywhere and really

0:15:00: currently lower some of these mortality rate of some groups in the
United States that are similar to those in sub-Saharan Africa

0:15:15: when should I get a smoothie as from nurse practitioners is there a way
for me to provide both primary and secondary screening to my clients and a low-
cost and the answer is absolutely yes and it's probably not

0:15:30: then you think to integrate cervical cancer screening into your
practice and to start offering Well Woman exams and it's not just pretty simple
today I'm going to break it down into four simple steps and on the following

0:15:45: I'm going to go through each step a little bit more in-depth the first
step is to get trained and cervical cancer screening the second step is to work
with your local laboratory you probably already have an existing relationship
from blood test

0:16:00: other types of preventive Health Care Services you have to get the
tools to do pap smear and HPV testing in your office today and this is the
really critical part for primary printing services in your clinic and your
health care

0:16:15: the third step is investing in low-cost tools to offer that secondary
part of screening that colposcopy and confirmatory biopsy to make sure that
women with abnormalities I'm really come back

0:16:30: confirmation of disease this is important there may be cases where
there are false positives but we still want to make sure that that all women are
our screen and we don't lose them in the process where they may have to be
referred to other places

0:16:45: InStep for as as you expand services and your new or to providing
cervical cancer screening or you have a really difficult case in your office we
need to make sure that nurse practitioners have the tools for real time

0:17:00: patience and support from expert gynecologist or colposcopy test using
different new technologies out there so you can help your patients Aid extra
time from going to specialist time away from work Star Travel extra copies and

0:17:15: fences Etc by bringing the expert opinion right to your device right in
your office and now we're going to go into each step of the training

0:17:30: and it's probably easier than you think a lot of nurses at nurse
practitioner is my password a little bit nervous to get it

0:17:45: options the first is new course is led by the secp that are really
fantastic they provide both training and colposcopy as well as treatment like
leaves and cryotherapy nurse practitioners who can then go back home

0:18:00: corporate their skills into their practice depending on your
institutional policies little different but it's only a five-day course and
afterwards a couple is it coupled with the mentor and then you just do 25 to 30
super

0:18:15: exams in your Ventures office now more than 500 individuals have
already completed this really excellent course but interesting Lee 90% of them
are nurse practitioner so it is already happening and

0:18:30: kind of training there's also a new online colposcopy training course
Mobility she is newly enabling this training course it's a remote online
didactic session for different times of the course of a month

0:18:45: then there is one day in person Hands-On training and they're offered
across the United States different schedule but what's really cool about it is
that this course you don't you no longer have to have an in-person Mentor if
it's difficult

0:19:00: and you'll be able to have remote mentorship through live video feed
with other nurse practitioners next for colposcopy to do these supervise the
exams these courses are led by expert nurse practitioners

0:19:15: hours and take a holistic approach and Mobility is just a technology
provider to make it but again

0:19:30: are led by experts in the colposcopy field today OneNote on this it's
really important that you just check with your state regulation is some require
additional documentation mentorship components if you undergo the trading

0:19:45: the second piece is to work or expand your relationship with the local
laboratory and after training you're going to need to start offering pap smears
and HPV in your office again it's pretty easy you just answered the speculum
scraper brush

0:20:00: mr. Banks and send that kid off the lab and newer test also have
combined HPV in cytology so you do one scrape one kit that's all your local lab
likely has already in place an advanced system

0:20:15: they'll drop off the specimen containers to your office you label them
collect the samples and then at the end of every day that lab will pick up the
results to pick up the samples and have a pathologist review them and the
results will just be sent back

0:20:30: electronic health record or fax depending on how your lab work again I
think most of you already have relationships so just give them a call and you're
offering when you're ready now

0:20:45: want to start doing that next that's secondary screening many women
still have the challenges to get they need to get the care they need if they
have that abnormal results and some of the challenges they face is lack of
access to transportation

0:21:00: to and from The Clinical Services especially in Rural America women
have to drive many many hours and may have for access to knowledge how to make
an appointment they may also not have access to treatment options info for

0:21:15: reason following the the training as well as the writing test you can
consider take before I get into different tool to do colposcopy

0:21:30: and there's been your research that indicates nurse practitioners can
perform colposcopy and diagnostic procedures of course

0:21:45: all around that are a little nervous in a 2012 study conducted really
to compare physician and nurse practitioner accuracy and recognizing cervical
dysplasia during colposcopy found at these two groups of

0:22:00: were similarly capable and also studies in the United Kingdom the New
Zealand to reach similar conclusions today I'm going to talk to you a little bit
about the Eva system is one such tool that can help you expand colposcopy in
your clinic

0:22:15: and this is before I get into housing even system works I just want to
read a quote from dr. Mary Ruben who has pioneered the colposcopy by nurse
practitioners in the field today and she told us it

0:22:30: system really opened up a new world of user-friendly telemedicine for
cervical Health that can be utilized from anywhere to provide a broader spectrum
of care and education to Patient so what is an Eva system

0:22:45: EVAP system is a portable connected kolbusz go that's low cost and
going to be moved between exam room as well as between between clinics and for
mobile base after if you go to different places it's pretty small

0:23:00: you can scan the screen and it takes up really really little room in
your clinic and what it is is the really a new generation of hopeless go help
nurse practitioner

0:23:15: more affordable and a portable way and if you just don't call us go
then had instead of online enable quality assurance tools including remote
review by supervisors and pure and the Eva system helps ensure that repeating
the same

0:23:30: to get the same results by making the records from exams available
security online for mediately review no consensus can be agreed upon by the
healthcare team taking care of the patient and it doesn't require all the
members of that team to be present in the same Clinic

0:23:45: it's an FDA clear device and the software does meet all of the security
and privacy regulations required by some of the largest Hospital Systems across
the US on Eva system has been well-received by both the patient and provider and

0:24:00: variety of small handheld and all you do is you go ahead and you can

0:24:15: you can record the exam results right on the phone and for the biofuel
location and you can enjoy automatically formatted it formatting that integrates
directly in your EMR

0:24:30: affordable and enables Healthcare Providers to focus on the majority of
their resources on providing direct chair instead of purchasing and maintaining
on some of that expensive some of that expensive equipment

0:24:45: I'm on how one of our providers one of her Partners dr. Cheryl Gibson
at Vermont Gynecology is using the system today

Can't Understand

Can't Understand

Can't Understand

Can't Understand

Can't Understand

Can't Understand

Can't Understand

0:26:45: great and what what you desire from dr. Charles Gibson it's just a
video of how the coldest go can be used in York

0:27:00: if you see it's really small and can be used for a patient education
hope you have the actual exam all the records and be seen any time

0:27:15: anything related to the cervical how you can have access to records and
you can search by name by date abnormality and on the portal you can do full
quality assurance if you have training is underneath you and you can really do
support of

0:27:30: vision and remote supervision directly from the QA Tab and was really
great about the online portal is it makes the patient tracking easier and faster
and more visual I really do want to make sure that the women who have

0:27:45: primary screening that you have abnormalities and of course you can
always pull up old records images easily over over over time for women who need
repeat screening

0:28:00: I want to hear one final quote from one of our are great Partners money
bass in there another nurse practitioner and she said that Eva Cobo is one of
the greatest things to happen to women cervical Health it allowed

0:28:15: review service image after an examination and it's really helpful for
patients to be shown harder their data me they don't usually get an opportunity
to visualize and this is a great tool for nurse practitioner

0:28:30: approach and I think what's really exciting about it is that again it's
not just the point of care but you can get secondary

0:28:45: you can use some of the online integrated tools to track your patient
and really make your at your practice more efficient and better serve women who
fall in this abnormal

0:29:00: same both on cervical cancer in the United States today as well as the
different steps you can take to provide or expand screening in your clinic again
those four staffs which are getting trained calling your last offer

0:29:15: TB testing in pap smear testing expanding your tools by getting a cool
scope assist them or another I'm in making sure you have the structure to ask
questions and get that real-time life consultation

0:29:30: Ashley is your new or disturbances or you see a particularly Advanced
case I think I just want to reiterate

0:29:45: and we particularly are happy to support you along the way if you do
get trained I'm really sure that together we can reach Every Woman everywhere to
get the to get the care that they need and deserve and we can really low or that
works

0:30:00: especially among ethnic minorities in high-risk today and I want to
thank everyone for their time away from their patients away from the clinic at
if you're if you're taking any of your free time

0:30:15: we really appreciate it I'm now going to go ahead and open up the floor
to any questions please I welcome any and all questions don't be shy and again
thank you for your time

Can't Understand

Can't Understand

0:31:00: sure no problem you were the video okay

0:31:15: so awesome

0:31:30: Let it rain over sorry can you just tell me can you just tell me the
last time we were cut off

0:31:45: okay oh okay sounds good story start over

0:32:00: okay great

0:32:15: and I can ask I can ask her to send you the file over and for now I can
send you the website link where the video is hosted

Can't Understand

0:32:45: okay sounds good

0:33:00: okay so answer you saw a Doctor on Doctor Gibson video the evil system
is really easy to use at the point of care and it what are the things

0:33:15: often is the contact of the cervix selfie that's what we call it when
you turn around the EVAP system to show the patient at what kind of procedure
has been done and if there are any abnormalities present help her understand and
feel more empowered

0:33:30: except for treatment and what are the things shall Gibson told you it's
how small it is in the clinic on the Vive system can also go wherever you go go
from room to room to Clinic the clinic or if you're working in some type of
mobile Outreach set up

0:33:45: comes in a box and portable stand so you can really bring it anywhere
in one of the great things about the even system is that it's not just confined
to the point of care like a standard so you can access all of your

0:34:00: anytime on an online portal it's really a master portal for cervical
health and anything related to cervical cancer screening that you've done in
your office you have all of your records

0:34:15: seamlessly no cord no transferring none of this hard process and that
really allows you to search by a woman's name the date of the exam

0:34:30: there's also a full quality of quality assurance school so if you have
trainees in your clinic underneath you and you want

0:34:45: agree with their decision or disagree you can put in the type of
treatment or diagnosis you would have made based on the information

0:35:00: your diagnosis as well as general agreement so you can make sure that
they're getting the right supportive supervision on the challenges they faced it
was really great about the cervical cancer

0:35:15: can always pull up old records and look at it women's images so you can
pair you can compare exams overtime and documentation that you need

0:35:30: Pony Bats she said that Eva Cobo is one of the greatest things to
happen to Encircle Health that allows clinicians to review cervical images after
an exam and also really helpful for patients to be shown part of their

0:35:45: don't normally get an opportunity to visualize in what's in in in one
of the things she she she touches on his ability for the Eva system to go beyond
that traditional exam and of course because it is a digital tool

0:36:00: also go ahead and request I real-time consultation and support brr
Securus Library feature to reach out to each person your network to get a second
if you do have a high-risk

0:36:15: prevent women having to travel really far schedule appointment with an
expert or really increase the cost of care from co-pays Etc you can get that
that you can get that second and third opinions your office

0:36:30: save your patient that extra cost and time I know if you're a lot of
information both on cervical cancer and the u.s. today and some of the new
findings and research on the incidence and mortality being high

0:36:45: as well as the different steps you can take to provider expand spring
in your clinic again it's those for simple stop getting train getting the lab
test you need any pass

0:37:00: one example is the Eva system that we think is easy in portable there's
also many other different types of Scopes out there you can use to provide that
secondary screening and the 4th is Casino making sure

0:37:15: help you better serve patients in your office we really want to
reiterate it's easier than you think we'd be happy to support you along the way
and anyway we can and together we are sure that we can reach Every Woman
everywhere in the US

0:37:30: to get the care they really need and deserve through welding exams and
gynecological exams I want to thank every person for taking time away from their
Clinic if you use your free time to come to really appreciate it

0:37:45: and now I'm going to go ahead and welcome any questions don't be shy
and thank you again for your time