This presentation will provide an in-depth overview of the latest updates in maternal mental health treatment, tailored for primary care, acute care, and psychiatric nurse practitioners. Attendees will explore current best practices for managing a broad range of perinatal psychiatric disorders, with an emphasis on evidence-based pharmacologic and non-pharmacologic interventions. The session will address safety in prescribing medications, including controlled substances, and debunk common myths associated with psychiatric treatments in pregnant and breast-feeding mothers. Liability and documentation concerns will also be discussed. Additionally, the presentation will delve into the social determinants of health that impact maternal mental health, highlighting how factors such as socioeconomic status, access to care, and support systems can influence outcomes. Through case studies and practical examples, participants will gain a comprehensive understanding of how to navigate the complexities of treating maternal mental health issues, ensuring both the safety and well-being of mother and baby. This session aims to equip nurse practitioners with the knowledge and skills needed to effectively and confidently support the mental health of mothers during the perinatal period.

This session explores acute aortic syndromes, pathologies, clinical findings, diagnostic algorithms, and management to enrich the learner's knowledge of disease processes and treatment. Complex pathophysiology, advanced diagnosis, treatment modalities, and common challenges that contribute to high mortality in these cases are discussed. CT scan reviews and case studies are discussed to reinforce the discussion points.

Pediatric neck masses are often a chief complaint that cause angst in the provider seeing the patient, as they do not want to make an incorrect diagnosis. This session will use a case-based approach to cover all that the practicing NP needs to know about the assessment, evaluation, diagnosis and evidence-based management of pediatric neck masses. Adapted from the Society of Otolaryngology Head-Neck Nurses Comprehensive Otolaryngology course that the presenter is a faculty for, she will cover pertinent information for the ENT and non-ENT NP provider.

This presentation will enable the audience to understand the palliative care patient and the assessment of the specific needs as it relates to physical, psychosocial/emotional, and spiritual symptoms. The presentation will also provide information as to how an advanced care planning discussion is initiated and carried out. This will enable the practitioner to understand a patient's goals/wishes so that a plan of care can be developed for the entire care team.

Immunizations are among our best preventive measures for reducing infectious diseases and cancers. This presentation will assist the APRN in understanding the most recent updates in immunization recommendations. It will also help the NP make the best patient-centered vaccine recommendations to improve the patient's health and well-being. In addition, strategies for improving vaccine rates, providing shared clinical decision-making and having meaningful discussions with vaccine-hesitant individuals.

This presentation will examine the assessment and management of oncological patients presenting with infectious concerns and address initial assessment, imaging, laboratory studies, antimicrobial management, and the role of specialty consults.

An essential function of nurse practitioners is reading and appraising emerging evidence to make advanced clinical decisions. A critical component of evidence interpretation is understanding reported statistics. Modern statistics are shifting away from p-values/statistical significance towards effect size, which are measures that quantify the magnitude of effect observed in a study. This session will take a fun and practical approach to interpreting reports of effect size and their confidence intervals across a variety of clinical topics. Participants will be equipped to rapidly and accurately interpret articles' major findings, from individual studies to meta-analyses with an emphasis on clinical implications.

Individual decision-making regarding immunization of their children is a complex process and it is dependent on emotional, cultural, social, religious, and political factors. The growing concern of vaccine hesitancy and rejection has led to the development of different tools and strategies for advanced care providers to start effective vaccine communication with parents to improve vaccination rates and reduce serious vaccine-preventable outbreaks. Every parent is different, and not all methods of communication are effective. Advanced providers require methods training on parenteral attitudes and communication that work to reassure parents. Nurse practitioners promote partnerships with parents, and this positions them in an ideal environment to make sure parents understand the information, clarify, and reaffirm parent's concerns, correct beliefs about immunization, discuss benefits of vaccines and modify misconceptions.

This presentation will provide a concise review and update on empiric "bugs and drugs" commonly utilized in emergency care. We will briefly review the classes of medications, their common side effects, and interactions. Using a body system approach, we will cover current recommendations for appropriate empiric agents for conditions including HEENT infections, community and hospital-acquired pneumonia, skin and soft tissue infections, sexually transmitted and urinary tract infections. We will also discuss chemical prophylaxis, sepsis, and viral infections, including influenza, COVID-19, and herpes zoster. Throughout the presentation, we will emphasize the importance of antimicrobial stewardship.

In 2023 the American Joint Replacement Registry reported 3,149,042 primary and revision hip and knee arthroplasty procedures performed from 2012-2022, with the majority of cases being primary knee (51.0%) and primary hip (33.4%) arthroplasty in the United States. These numbers will continue to grow exponentially over the next couple of decades as the population ages. Prevalence of PJI out to 2 years following hip replacement is 1.63% (Ong et al. JoA 2009) and following knee replacement is 1.55% (Kurtz et al. CORR 2010). Both procedures likely have a prevalence over 2% at 10 years. Periprosthetic joint infections of the hip and knee are caused by a variety of microorganisms and can be influenced by numerous factors throughout the continuum of care. These bacteria may be introduced at the time of surgery, through spread from another site, or from recurrence of a previously septic joint. PJI has a profound physical, social, and emotional impact on affected patients and significantly increases healthcare expenditures, patient morbidity, and overall mortality.

This presentation will provide a comprehensive overview of recent advancements in diagnosing and treating eating disorders among children and adolescents. Attendees will explore updated diagnostic criteria (specifically the newly added DSM-5 ARFID diagnosis), including nuanced distinctions in symptomatology, as well as recent updates in eating disorder etiology including genetic, psychological, and environmental factors. The session highlights emerging trends in evidence-based treatments, encompassing both pharmacologic and non-pharmacologic options. The discussion will focus on the unique developmental needs and challenges of young patients. Case studies and clinical vignettes will illustrate practical applications of these updates, emphasizing early intervention approaches and multidisciplinary treatment models. Participants will leave equipped with current knowledge essential for improving diagnostic accuracy, enhancing therapeutic outcomes, and fostering collaborative care practices in pediatric eating disorder management. This presentation aims to empower healthcare professionals, educators, and caregivers with actionable insights to better support the mental and physical health of children and adolescents facing these complex disorders. This presentation will be suited for both psychiatric and primary care NPs working with or interested in working with child and adolescent populations.

We all see and treat nausea, vomiting, diarrhea and chronic constipation on a daily basis. The evaluation and treatment algorithms are changing. Join us for a case based, practical, very interactive deep dive into what we need to know about these conditions in 2025

NPs use various clinical algorithms and risk calculators in their clinical practice. Some of these algorithms and risk scores use race or race-based corrections, bringing bias in decision-making and care delivery. Race-based corrections in glomerular filtration rate and spirometry are well-known examples. As a result of race-based decision-making, attention and healthcare resources may be directed more to people from certain races, adding to health inequities. Additionally, medical technology and equipment calibrated without considering the variations in skin color fail to detect abnormalities in people with diverse skin colors, such as pulse oximeter in black patients. Race is a socio-political construct, not a biological factor. Race-based care invites health inequities. There is wide recognition of health inequities related to race-based medicine, and efforts are underway to correct commonly used decision-making tools. It might take time to eliminate race factors from currently used laboratory tests. However, race significantly affects people and their health. So, healthcare professionals need to use race for enhanced screening and preventive care as opposed to race-based diagnosis. This presentation will distinguish between race-based care and race-conscious care and guide attendees to provide equitable healthcare based on social determinants.

This presentation serves to review current statistical data of the incidence and prevalence of burnout amongst primary care providers, specifically advance practice nurses, and its' implications to the health and wellness of the provider as well as impact to patient care quality and safety outcomes. The presentation will provide burnout assessment tools that can be utilized by individuals and/or the health care systems to evaluate the organizational burnout climate. It will review common signs and symptoms of burnout to aid in identifying burnout and occupational stress in colleagues and other staff members. Lastly, the presentation will serve to provide actionable recommendations for individual and systems or organizational interventions to promote burnout prevention, early identification, and reduction strategies.

This presentation will review the typical and atypical dermatological manifestations of sexually transmitted infections. The variations in skin of color will be highlighted. The attendees should come away with a better understanding of the necessary physical assessment skills and knowledge of variations in appearance of sexually transmitted infection-associated skin conditions.

This one-hour platform presentation provides an overview of headache disorders seen less frequently in primary care. Through use of case-based learning, participants are introduced to typical patient presentation, the epidemiology, pathophysiology, and diagnostic criteria for tension-type headache, trigeminal autonomic cephalalgias (specific emphasis on cluster headache), benign exertional headache, and high and low headache pressure syndromes. The overlap in presentation by secondary headache disorders is addressed. Medication management, lifestyle changes, as well as procedural interventions, and the use of diagnostic testing is reviewed. Criteria for referral and the role of the primary care clinician in follow up is identified.

Nurse practitioners are not immune to misinformation emerging from popular media narratives surrounding human trafficking. Implicit bias and stigma in the absence of evidence-informed care contributes to clinical environments in which 60-87% of patients seeking healthcare while being trafficked remain unidentified and without vital connections to care resources. This presentation will examine common myths about human trafficking often shared by well-intentioned but ill-informed sources. Political rhetoric and media sensationalism can cloud the perceptions of health care providers encounter in their personal realms with impacts for the professional realm. The truth is that patients experiencing trafficking present across the care continuum and all care providers must be prepared to respond. Nurse practitioners will be empowered with the latest emerging trends and best available evidence to implement core competencies for trafficking response across health systems to include individual clinicians, academic institutions, research entities, and clinical care arenas.

Cancer is the second cause of death in the US next to heart disease. Cancer screening provides an opportunity to detect and diagnosis cancer at an early stage and result in the most optimal prognosis. Regardless of the focus of the NPs clinical practice, NPs need to be knowledgeable of the most common cancers, tools for detection and treatment, as well as strategies to promote primary, secondary, and tertiary prevention. Social determinants of health limit access to care. Often primary prevention and cancer screening is a luxury. Opportunities for cancer screening may present themselves when an individual is enrolled in school, hospitalized or a clinic setting.

This session will describe common cyanotic congenital heart lesions and discuss current therapies for them. We will also discuss long term issues seen in these patients and contemporary trends in care. This session should solidify knowledge of cyanotic cardiac malformations and their treatment.

This presentation will explore the implementation of an Adverse Childhood Experiences (ACEs) screening protocol tailored for active-duty soldiers in a Family Medicine setting. Led by a board-certified Family Nurse Practitioner with over 27 years of military service, this session will provide a comprehensive overview of ACEs, their impact on the physical and mental health of military personnel, and the importance of early identification through structured screening. Attendees will learn about the development and execution of the ACEs screening protocol, with a focus on overcoming challenges such as staff knowledge gaps, documentation inconsistencies, and the unique needs of the military population. Through real-world examples and data-driven insights from a completed Doctor of Nursing Practice (DNP) project, the presentation will highlight strategies for improving patient outcomes and enhancing mental health referrals. Nurse practitioners attending this session will leave equipped with practical tools for implementing ACEs screening in their own practice, methods for evaluating the success of the protocol, and insights into the role of leadership in driving successful healthcare interventions.

This presentation will review recent cases of infants and children who presented to their primary care office or to the hospital with symptoms commonly seen in this age group. In each of these cases, the proper diagnosis was missed on the initial visit. In fact, these diagnoses can be frequently missed in children. This will be an interactive session with a case presentation format. Patient data will be introduced, and the audience will be asked to manage the patient. Will the audience correctly identify the severity of the illness and proper diagnosis? Symptoms will include nausea, near syncope, syncope, and lethargy. The red flags for providers will be identified. Finally, there will be a discussion about diagnosis and treatment options.

In a recent Pediatric Review, 8.9% of US children or 1 out of 9, aged 3-17 years of age are diagnosed with ADHD and the prevalence rate increases with advancing age. As clinicians, we are screening, managing medications, and coordinating referrals for specialty care for patients with ADHD. The American Academy of Pediatricians supports schools and pediatricians working together to support our patients with ADHD. This presentation will provide an overview of a nurse practitioner-led program focused on educating elementary school teachers to enhance the social environment for students with ADHD. This education includes information on symptoms of ADHD, potential triggers for behavior issues, viewing the ADHD diagnosis through the lens of the patient, and evidence-based interventions that can help students with ADHD succeed academically and socially. By collaborating with nurse practitioners, teachers can develop individualized plans to support students with ADHD, promote positive behavior, and improve academic outcomes. The partnership between nurse practitioners and educators is essential to improve the educational experience and overall well-being of pediatric patients with ADHD.

Whether you are a new Nurse Practitioner or a seasoned professional, sharing your clinical expertise is important! This session will provide a primer on the key components of writing a publishable manuscript and the skills needed to become a peer reviewer. Resources for honing your skills, tips for successful manuscript submission, and components of effective peer review will be presented and discussed.

Alcohol and other drug use among our nation's youth remains a major public health problem. Adolescent use of illicit substances imposes an enormous burden on individuals, families, and communities. Each use of drugs evokes rapid positive reinforcement, either as a result of the rush (euphoria induced by the drug), alleviation of disturbed effects, alleviation of withdrawal symptoms, or a combination of all of the above. One of the adverse outcomes of adolescent substance use is the increased risk of addiction in those who start smoking, drinking, and taking drugs before they are 18 years old. Some adolescents advance to levels of use and consequences that meet criteria for substance use disorders (SUDs) and are at high risk for its continuation in adulthood. This presentation aims to increase HCP's knowledge regarding SUD's incidence, prevalence, and impact on adolescents. The incidence and prevalence of SUD will be discussed. The impact of adolescent SUD is reviewed. Commonly used substances will also be reviewed. This substance use is associated with a greater likelihood of developing substance dependence or disorders as an adult. This reinforces the important role of the HCP in being knowledgeable about and comfortably screening for substance use disorders in adolescents.

Ear, nose and throat complaints are very common presentations in primary care practices, making up for roughly 10% of all complaints. These commonly include ear pain, hearing loss, vertigo, allergies and skin lesions. Primary care NPs should be able to diagnose and manage many of these problems. This presentation will focus on managing chronic and acute primary care ENT complaints including ear pain, tinnitus, vertigo, allergies and sinusitis and lymphadenopathy. This presentation will assist NPs to improve assessment skills and determine when imaging is necessary and how to use subjective and objective patient information to increase diagnostic accuracy for improved patient treatment. It can reduce unnecessary referrals to subspecialty. The presentation will use evidence-based treatment options and incorporate case studies applicable to primary care and urgent care settings.

Endometriosis affects 10% of U.S. women, yet the time to diagnosis is on average 7 years from symptom presentation. Symptoms are frequently underrecognized or misattributed to other disease processes, such as IBS. Women from underserved communities are disproportionately affected by this failure to properly diagnose. In the meantime, the health consequences are frequently debilitating. This presentation aims to increase awareness of the latest research in endometriosis in terms of disease process, identification of those affected through thoughtful assessment and work-up, and education on current treatment options. Attendees will leave the presentation better equipped to consider endometriosis on their differential diagnosis for future and existing patients, improving the quality of life for those suffering from this "silent disease".

Alzheimer's disease and age-related dementia (ADRD) and diabetes mellitus co-occur more frequently in older adults than would be expected by chance alone. Further, the co-prevalence of ADRD and diabetes is expected to increase in the United States over the next 30 years contributing to higher health care costs and placing additional burden on the nurse practitioners that care for these patients. This presentation will review key aspects of identifying and managing cognitive decline in older adults with diabetes. An overview of the problem and a deep understanding of appropriate assessment and treatment strategies will be reviewed; including mitigation of hypoglycemia, deprescribing medications known to cause hypoglycemia, and use of clinical guideline directed diabetes medications (GLP1R agonists and SGLT2 inhibitors). Case studies will also be reviewed to support learning and guide appropriate referrals when necessary.

This session will provide a review of common and newer medications used or encountered in emergency care settings. Using case studies, clinical vignettes, and a body system approach, we will review select medications. This review will cover mechanisms of actions, indications, side effects, interactions, considerations for monitoring, related guidelines, and supporting evidence. By the end of this session, emergency nurse practitioners will have a renewed understanding of common medications used to manage both acute and chronic conditions.

Immunizations are the most effective intervention to prevent illness in infants and children worldwide, yet we are seeing a growing number of parents choose not to immunize their children. This presentation will review current immunization rates of children and adolescents in the U.S. and worldwide to inform the NP provider of the importance of getting every child fully vaccinated. The updated ACIP/CDC 2025 recommended child and adolescent immunizations will be discussed and strategies for encouraging parents to get their children vaccinated will be examined. Resources for practice will be shared to enable the NP to incorporate multiple methods for encouraging families to fully immunize their children.

This presentation will focus on common ear complaints seen in the ER, Urgent Care, and Primary Care setting (including pediatrics). Otalgia in the absence of otitis externa is frequently misdiagnosed as middle ear fluid. We will go over the most common cause of otalgia presenting to the UC/ER - TMD exacerbation- with diagnostic video and treatment algorithm. Sudden hearing loss occurs 66,000/year in US. Determining conductive versus sensorineural loss is key to avoid risking permanent hearing loss. Participants will learn best diagnostic practices leading to best treatment and referral patterns. We will go over most common Tympanic Membrane presentations (myringosclerosis, TM perforations, retracted TM, Cholesteatomata) using HD images and videos. Techniques such as the valsalva maneuver, tuning fork, pneumatic otoscope, and tympanometry will be presented with HD videos to help increase diagnostic accuracy to >90%. We will discuss the need to confirm the resolution of pediatric serous otitis media by 3 months (and best techniques to do this). Children who have persistent SOM are at risk of speech, language, and developmental delay. We will also discuss another very common cause of ear pressure and fullness (early stages of Ménière's disease) which often presents to ER and Urgent Care - and best treatments.

The presentation will discuss the outpatient treatment of both a breast abscess and breast pain. We will go over etiology, epidemiology, history & physical, clinical features, diagnosis, treatment options, prognosis, complications, and when to refer to specialty.

This presentation will cover military sexual trauma and the collaborative care approach. NPs provide care to sexual assault trauma patients and some of these NPs work at a military treatment facility and the VA. Attendees will understand how to provide trauma informed care along with the collaborative team that cares for the victims.

The goal of this presentation is to update APPs on the changes or additions to the current body of science in gastroenterology and hepatology. This will include optimizing identification of disease diagnosis, evaluation, and management/treatment.

The current state of IBD care in a community setting is fragmented and involves multiple systems and providers, difficulty in coordinating and managing care between providers and specialties, high cost and low reimbursement and highly variable practice patterns. In turn, this can lead to low-value care, poor patient experience and inferior outcomes.

The opioid epidemic has influenced opioid prescribing patterns among nurse practitioners practicing in both inpatient and outpatient settings. For some adult patients, opioids may be included as part of a multimodal approach to pain management, however healthcare literacy, comorbidities, medication interactions, medication adherence, and unintentional overdose can compromise patient safety and increase their risk for death. This presentation will review the pharmacodynamics and pharmacokinetics of both opioids and naloxone and provide nurse practitioners with updates on naloxone prescribing practices, including resources for making naloxone accessible and affordable to patients. It will emphasize safe naloxone administration practices in inpatient and outpatient environments and provide an overview of educational and community resources for patients and caregivers.

The purpose of this presentation is to demonstrate the expanded role of Point-of-Care Ultrasound (POCUS) in primary and urgent care settings by Advanced Practice Registered Nurses (APRNs) through various case presentations. Point-of-Care Ultrasound (POCUS) is a rapidly growing modality that enhances diagnostic accuracy and patient care. While traditionally used in emergency settings, POCUS is now increasingly recognized for its value in primary and urgent care. This presentation aims to equip APRNs with the knowledge and skills to incorporate ultrasound into their practice, improving diagnostic capabilities and patient outcomes. APRNs can utilize POCUS to differentiate between common dermatological conditions such as necrotizing fasciitis, cellulitis, abscesses, and foreign bodies. Additionally, ultrasound is effective for diagnosing musculoskeletal issues like Achilles tendon ruptures and joint effusions. In pulmonary cases, POCUS assists in identifying pneumonia, pleural effusions, and pneumothorax, enhancing bedside diagnostic efficiency and reducing the need for immediate radiologic interventions. Handheld ultrasound devices are revolutionizing healthcare by offering portability and ease of use. These devices outperform traditional stethoscopes in many diagnostic scenarios, providing real-time, visual insights into patient conditions. This presentation will highlight how handheld ultrasound devices can be seamlessly integrated into APRN practice, offering superior diagnostic capabilities and improving patient care.

Nurse practitioners in every specialty are faced with patients dealing with pain. Between the fear of opioids and patients doing their own research on treatment options, the NP needs to be aware of the more novel agents that are being used for pain including low dose naltrexone and cannabis. When an opioid may be indicated, Buprenorphine is a newer option that can be effective and potentially safer. For many of us, these agents were not even available when we completed our NP training. This presentation will review the use of each drug, mechanism of action, case studies and treatment considerations so the NP can be confident in providing up to date and safe care.

Weight gain, body composition changes, and emerging or worsening cardiometabolic risk factors affect women in the menopausal transition. If these issues are not managed successfully, obesity may develop or worsen. Menopause and the menopausal transition contribute to hormonal and body composition changes that increase a woman's cardiometabolic risk and have a detrimental effect on many aspects of her health and quality of life. Women with obesity have even greater risks that need to be understood and mitigated. In addition to the time spent in the menopausal transition, many women spend 40% or more of their lives in a postmenopausal state, making it important for clinicians to understand this complex state. As women enter their 60s and 70s, adiposity-related health issues emerge or worsen, yet are often not recognized or effectively addressed. You will learn about the health risks at various points of the menopausal state so that you can effectively intervene. This presentation will provide you with a roadmap of the entire spectrum of menopause and help you "connect the dots" to improve outcomes.

This presentation aims to equip nurse practitioners with essential knowledge and skills to effectively care for Asian American minority populations by focusing on their unique health conditions. Asian Americans are among the fastest-growing populations, presenting distinct health patterns and risks that require specialized attention. Attendees will gain an understanding of the specific health conditions prevalent among Asian American minority populations, recognizing patterns and health risks unique to this group. The presentation will explore and discuss effective management strategies tailored to these unique health conditions within the primary care setting, emphasizing culturally sensitive approaches and evidence-based practices. The session will also delve into comprehensive treatment protocols and interventions specifically designed for these health conditions, covering medical and holistic approaches to ensure inclusive and effective care plans. By the end of the presentation, nurse practitioners will be better prepared to deliver culturally competent care, improve health outcomes, and reduce disparities within Asian American minority communities.

Functional medicine is a tailored, whole person approach to well-being and health care. This approach builds on scientific and nursing process foundations for humanistic and patient driven interventions. This presentation will discuss what functional medicine is, the expected competencies of providing functional medicine and what processes need to be undertaken to integrate functional medicine into your practice.

Cervical cancer prevention has changed significantly in recent years with less frequent screening and with the approval of HPV primary screening every 5 years, with a reflex Pap done only if the HPV test is positive. Additionally, cotesting with Pap and HPV every 5 years or Pap alone every 3 years remains an option. This session will review the appropriate use of Pap testing, the rationale for HPV testing along with the Pap (co-testing) in women 30 and older and the use of HPV testing as a primary screen (stand-alone test) in women 25 and older by two of the FDA approved HPV tests. There will be a discussion of the American Cancer Society Guidelines for screening and a review of the 2019 ASCCP Risk-Based Management Consensus Guidelines for management of abnormal screening and subsequent follow-up with case studies. These guidelines are a shift from results-based to risk-based management relative to the risk of an existing CIN 3 (pre-cancer).

Sleep is a period of intense brain growth and restoration. Quality sleep is an important part of physiologic, emotional, and neurocognitive development. Individual variability in sleep need is influenced by behavioral, medical, environmental, and cultural factors. The consequences of poor sleep results in chronic health conditions, mood dysregulation, school failure, obesity, and an increase in risk taking behaviors. Up to 50% of children will experience a sleep problem that will be brought to the primary care provider's attention. This session will provide an overview of the development of the sleep-wake cycle, how achievement of developmental milestones can affect the sleep-wake cycle, the effect of sleep deprivation on the prefrontal cortex, executive functioning, and the elements necessary for developing and supporting adequate quality and quantity of sleep throughout childhood and adolescence. Social determinants of health, cultural practices, and environmental factors that affect a child's ability to achieve adequate sleep will be reviewed as these elements play a part in how sleep issues are defined as problems. The history for and an assessment of sleep concerns to rule out medical sleep disorders will be reviewed. During this session, the currently available pharmaceutical interventions for pediatric sleep issues will be reviewed.

This session will be case based and will be a deep dive into complex pain treatment in the inpatient setting. Whether you practice inpatient or outpatient pain management, you will have lots to take away. How to transition from oral to IV pain medications, including PCA pumps. How to calculate equianalgesic dosing and opioid rotate appropriately. What to do with patients on chronic opioids that suddenly have acute pain needs. This session will help the provider feel more competent in pain care delivery.

The focus of this presentation will be on the challenge of accurately diagnosing and treating the pediatric patient with a toxidrome. The advanced practice provider is faced with the challenge of identifying and differentiating those poisonings that are benign from those that have the potential for life-threatening complications. Discussion will include the synthesis of evidence-based knowledge to accurately assess, diagnose, and treat the poisoned child. Discussion will also include a focus on the recognition of the pearls and pitfalls associated with pediatric poisonings. Clinical case studies of the most commonly encountered toxidromes will be included in this presentation to integrate knowledge with clinical practice. To ensure quality of care, evidence-based practice interventions and clinical practice guidelines that promote patient quality and safety in this high-volume, high-risk pediatric clinical condition will be discussed. This presentation will conclude with a discussion of evidence-based recommendations for interventions designed for the prevention of pediatric poisonings.

Healthcare inequality continues to exist around the world. One solution is connecting people to care via telehealth. Telehealth can overcome barriers to healthcare access and improve outcomes when implemented with health equity in mind. Without attention to digital equity and existing health disparities, telehealth may exacerbate rather than enhance health equity. It has been suggested that the digital divide is now a social determinant of health and that digital skills and connectivity are "super social determinants of health." Digital literacy, the digital divide, health literacy, cultural competency, and accessibility are essential considerations for all telehealth providers. Yet, many are not familiar with these concepts. Ensuring technology is implemented to allow for accessibility features, providing patient education, and telehealth provider education are essential to developing and sustaining telehealth programs that promote rather than limit health equity. This presentation will highlight digital inequities and essential methods to overcome them. With telehealth an integral part of healthcare moving forward, all healthcare providers must be familiar with these concepts to ensure inclusive, accessible healthcare for all. A focus on cultural competency will illuminate essential skills necessary when conducting care across distance to ensure quality, patient-centered, inclusive care is provided, and successful outcomes are achieved.

Oral health is a critical component of overall well-being for both men and women and has been strongly linked to outcomes and management of chronic diseases. Hormones influence the health of women, impacting their risk for chronic disease as well as periodontitis and caries. For women, hormonal changes throughout their lives can significantly influence oral health, often leading to issues like gingivitis, periodontitis, and dry mouth. The oral pH and gut microbiome need to be considered in women as there are differences between them and men. Poor oral health can worsen conditions such as diabetes, cardiovascular disease, and respiratory infections, and these chronic conditions can worsen oral health. Moreover, medications frequently prescribed for chronic disease management, including hormone replacement therapy, antihypertensives, antidepressants, and antidiabetics, can have adverse effects on oral health, contributing to dry mouth, gum inflammation, and oral infections, among other adverse effects. The impact of this causality dilemma on patient health is crucial for all nurse practitioners to be aware of and consider in their practice, whether in the hospital or clinic. Understanding these connections between oral and women's health is vital for healthcare providers to offer comprehensive care and improve patient outcomes, particularly for chronic diseases.

Adolescence is a time of significant development, both physically and emotionally. Research suggests a link between mental health challenges and increased risk for engaging in sexual behaviors that can lead to negative consequences. This presentation will explore how healthcare providers can approach adolescents who are sexually active and experiencing mental health concerns. We will use four case studies to illustrate best practices in screening, testing, and treatment for this population. The cases will represent diverse identities, including a heterosexual female, a heterosexual male, a homosexual male with a specific sexual interest (hematolagnia), and a non-binary individual assigned female at birth whose partners are female.

Postpartum is not just the first 6-8 weeks after birth. For people who give birth, postpartum is forever. That is to say that birthing people with experience the consequences of pregnancy and birth for the rest of their lives. This presentation will provide a brief overview of common causes of morbidity and mortality related to pregnancy and will explore three key areas in which the primary care provider can play a crucial role in addressing maternal morbidity: cardiovascular health, diabetes, and maternal mental health. By addressing these three critical areas, primary care providers can play a vital role in identifying and managing maternal morbidity, ultimately improving the health and well-being of mothers and their families.

Ehlers-Danlos syndromes (EDS) are a heterogeneous group of inheritable connective tissue disorders characterized by skin hyperextensibility, joint hypermobility and cutaneous fragility with delayed wound healing. Of the 13 subtypes of Ehlers-Danlos Syndromes identified in the 2017 international classification of Eds, 12 have a recognized, associated genetic mutation. However, hypermobility EDS (hEDS) currently has no identifiable gene. Therefore, patients with hEDS are identified through clinical diagnosis guidelines and criteria. Ehlers-Danlos Syndrome remains a mystery to even specialty clinicians, so much of this lecture will focus on the diagnostic criteria and overview of hEDS symptoms, comorbidities, current treatment options, and the clinical criteria currently guiding the standard of care. Early diagnosis of hEDS is of utmost importance to optimize the symptomatic management of patients and to prevent avoidable complications. Optimally patients should be treated and monitored by multidisciplinary teams in specialized centers. However, the reality is that much of the preliminary diagnosis and treatment will begin in primary care.

This session is to enhance clinical practice in cardiovascular/cardiometabolic health of women across the lifespan. Women's cardiovascular rates are increasing among younger women <55 years as well as an increase of suboptimal cardiovascular health during pregnancy. There is increase in metabolic syndrome leading to prevalence of dyslipidemias. Missed or delayed diagnosis with undertreatment of lipids contributes to cardiovascular disease. Younger women are less likely to be treated less and to achieving therapeutic targets.  Previous guidelines acknowledge sex-specific risk enhancing factors for lipid management in women for Cardiovascular prevention, however there is a continued need for sex-specific guidelines for evaluation and management of lipids. Lipids are impacted during normal hormonal changes throughout a woman's life cycle- during adolescence, pre-pregnancy, pregnancy, pre- and perimenopause, menopause, and at older ages. Women need to understand their personalized cholesterol goals and ally with their clinicians to ensure appropriate and aggressive therapies are made available to female patients. There will be focus on management of primary prevention of cardiovascular disease by examining sex-specific cardiovascular risk factors at each stage and pay special attention to statin use, statin side effects and non-statin therapies. Future research should focus on increasing enrollment of women in lipid trials.

Beyond the well-known hormones of female reproduction, estrogen, progesterone, and testosterone, several other hormones play pivotal roles in reproduction and metabolism. Understanding these hormones and how they interact provides valuable insights into conditions like obesity, PCOS, and metabolic syndrome. It offers providers a better understanding of the hormonal pathways beyond the basics. This should lead to improved diagnosis and treatment and a more holistic understanding of patients' unique needs. Kisspeptin, leptin, neurokinin, and dynorphin are critical in regulating reproductive functions and metabolic processes. Kisspeptin is essential for the initiation of puberty and the regulation of reproductive hormones. Leptin, known for its role in energy balance, also impacts reproductive health by signaling nutritional status to the reproductive system. Neurokinin and dynorphin are involved in minute hormone releases in response to feedback from the gut and play roles in stress and appetite regulation.

Cirrhosis represents an advanced stage of liver disease characterized by extensive fibrosis and impaired liver function. Given that primary care providers often serve as the initial point of contact for patients with liver conditions, it is essential for them to possess comprehensive knowledge of early recognition, management, and referral criteria for cirrhosis. This presentation aims to equip primary care providers with essential knowledge and practical tools for effectively managing this complex condition. Key topics covered include an in-depth exploration of cirrhosis pathophysiology, common etiologies, and early signs and symptoms to facilitate prompt detection. Diagnostic approaches and the management of complications will also be discussed, emphasizing the importance of lifestyle adjustments, pharmacological interventions, and regular surveillance for hepatocellular carcinoma (HCC). Additionally, the presentation will outline referral guidelines for specialized care, including indications for liver transplantation. By the conclusion of this session, participants will possess a comprehensive understanding of cirrhosis, enabling them to identify high-risk patients, initiate timely interventions, and collaborate effectively with hepatology specialists to optimize patient outcomes.

Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a debilitating disease affecting an estimated 5-8 million women in the US and millions worldwide. Typically, multiple providers are seen before a correct diagnosis is made, with 3-7-year delays. Pathophysiology, subtype distinction, financial and symptom burden, and differential diagnosis will be examined. Evidence-based pharmacological management and new treatment options will be discussed.

Local anesthetics are administered daily for many procedures in various clinical settings for patients across the lifespan; however, the complication of local anesthetic system toxicity (LAST) is often missing or briefly discussed in training programs for clinicians. It is crucial for any provider administering local anesthetic to be knowledgeable of risk factors and early recognition, including common central nervous system and cardiovascular manifestations of LAST. Additionally, the provider should be knowledgeable about the emergent management of LAST reviewing the American Society of Regional Anesthesia and Pain Medicine checklist, pharmacologic interventions and deviations from routine advanced resuscitative measures. Upon completion of this presentation, the nurse practitioner should also be able to identify prevention strategies that can be implemented into clinical practice.

This presentation will provide a case study for both Erectile Dysfunction and Testosterone Deficiency. In the presentation I will review the pathophysiology of Erectile Dysfunction (ED) and Testosterone Deficiency (TD). Discuss the common causes of ED and TD. Review the current medical therapy for the treatment of ED and TD. Lastly, identify the extensive treatment options for ED and TD that can be offered by Primary Care and Specialty Care Providers. Each case study will provide the basis for the type of patients that are commonly seen in clinical practice and escalating treatment options.

Patients with Serious Illness and their family go through extensive treatment journey. In this journey, some of the important aspects remains unknown and missed that includes patients' values and goals. The presentation will include the importance of providing patient-centered care that focuses on their values and goals. The important topic will include. Providing details on Advance Care Planning, Advanced Directives, Goals of care and EOL care planning. Serious illness and difficult communication barriers and benefits. Strategies for effective communication using the Serious Illness Communication guide, following non-verbal and verbal clues.

Pharmacogenetics is the impact of genetic variants on an individual's response to medications or pharmacologic agents. In some situations, genetics dictate pharmacologic interventions, as there are medications that target the pathology of genetic diseases. Examples of this include CFTR-modifying drugs for Cystic Fibrosis or ion channel-modifying drugs for specific forms of genetic epilepsy. In contrast, individuals with the same disease, with or without a genetic component, may respond differently to medications due to their genetics. Different polymorphisms, or variants in specific genes, can impact an individual's response to specific medications, leading to toxicities or lack of therapeutic responses. Genetic testing can provide another data point in the pharmacologic management of a patient. We will provide examples of patient cases to illustrate these concepts.

Nurse practitioners (NPs) are pivotal in healthcare delivery and patient outcomes. Incorporating clinical practice guidelines (CPGs) into their practice is a strategic approach to achieving this goal. CPGs are systematically developed care recommendations that assist clinicians and patients in making informed decisions about appropriate healthcare for specific clinical circumstances. By adhering to evidence-based CPGs, NPs can ensure standardized care, reduce variability in treatments, enhance the quality of patient care, and measures outcomes. The integration of CPGs enables NPs to stay abreast of the latest advancements and best practices in healthcare, facilitating early diagnosis and timely intervention, which are crucial for improving patient outcomes. Using CPGs supports NPs in providing care consistent with current research, reducing the risk of errors and adverse events. The adoption of CPGs empowers NPs to engage in patient education, helping patients understand their conditions and the rationale of treatment plans. This patient-centered approach fosters adherence to prescribed therapies and encourages active patient participation. NPs can utilize CPGs to guide the development of individualized patient unique care plans, further improving health outcomes. In summary, integrating CPGs by NPs is a vital strategy for enhancing caregiver delivery and optimizing patient outcomes through evidence-based, standardized, and patient-centered care.

Suicide may be a difficult public health problem to tackle but given the impact it has on the lives of people worldwide, we as clinicians should have a thorough understanding of the risk factors that are commonly observed and the unique ways men may present clinically. Suicide is a major cause of death in men in the United States and abroad. Though more women attempt suicide, more men's attempts end in death. It would seem important to know if the tools we currently use to screen for suicidality are appropriate for detecting those at risk. Reassessing how males may present with mental illness and if that is accurately captured in screening tools is important lest the opportunity to intervene and prevent a suicide attempt is missed. Mental health problems like depression play a major role in this issue but knowing how men typically present with depressive symptoms that predispose them to suicide attempts is a major key in screening and intervening when appropriate. The traditional screening tools for depression may not detect risk factors more common in men. Looking at how men's presentations may differ could help impact detection and help providers better address concerns as they arise.

Atopic dermatitis is a common chronic skin condition with relapsing and recurring exacerbations of variable severity and polymorphic presentations. A plethora of pharmacotherapeutics are available for clinicians to choose from to manage disease manifestations. Unfortunately, this disease and the medications used to treat the chronic symptoms and exacerbations can have unforeseen consequences. Nurse practitioners must rely on their clinical acumen and understanding of pharmacology to mitigate risk, identify complications, and manage adverse events. This presentation will review an ocular emergency case study involving severe atopic dermatitis and anxiety, leading to ocular complications and ultimately intraocular lens dislocation. The presentation will explore the impact of chronic dermatologic conditions on mental health, discuss how health inequities contribute to morbidity, explore atopic dermatitis therapeutic options, and review special considerations for prescribers. Comprehensive, well focused assessments are key to accurate diagnosis and early intervention aimed to limit the burden of disease. Additionally, patients must be followed closely to ensure response and tolerance of treatment and minimize associated side effects.

In this presentation, attendees will gain insights into navigating the care of uninsured patients. The session will cover key areas such as relevant policies, health consequences of being uninsured, and the connection between social determinants of health and insurance coverage. Additionally, the role of Nurse Practitioners in addressing these issues will be explored.

The presentation will review several case studies of BPH patient scenarios. The presentation will review the pathophysiology and development of BPH. Will define BPH and discuss the prevalence. Review the common urinary symptoms that are associated with BPH. Discuss the screening questionnaires used to evaluate BPH. Review the current medical treatment and recommended pharmacological management of BPH. Lastly, discuss the surgical management for BPH to include minimally invasive procedures and recent emerging procedures and techniques for BPH.

This presentation will review the path to Full Practice Authority. Presenters will review the current state of Full Practice Authority in the United States and the history of state regulation in the United States. The current patchwork of practice regulations will be discussed, including the national implications for practice. Two state case studies will be reviewed to share lessons learned on achieving full practice authority - one state has been green for over a decade while the other state remains red. Opposition to full practice authority will be identified. The presentation will reveal how this opposition can manifest once full practice authority is achieved and how this impacts patient care.

These objectives aim to prepare Nurse Practitioners to handle diverse and potentially volatile situations encountered in their professional environments, promoting their safety and effectiveness in patient care.

The primary goal of this presentation is to increase the clinically knowledge of the provider, on the ease and utility of these protocols. This information may increase the ability of the provider to offer pain reduction treatments that do not increase the possibility of opioid dependency or abuse. This presentation gives a review of the origins of auricular therapy and the possible mechanisms of action. Further detail includes: the medical diagnosis that can be treated with auricular therapy, several of the most common protocols, current research supporting the use of this treatment modality, precautions and information on the cost of auricular therapy. This presentation includes several case presentations which helps in understanding the ease of using this valuable skill and the importance of considering the use of this treatment in treating patients with pain.

According to the Centers for Disease Control and Prevention (CDC), genetic tests are now available to diagnose individuals with gene mutations that predispose them to an increased risk for certain diseases, including diabetes, heart disease, and a variety of cancers. Two of the most common tested variants are the BRCA1 and BRCA2 genes, with the most prevalent BRCA-related malignancies in men being prostate and breast. Nurse practitioners play an integral role in the early detection and screening for such malignancies. Through prompt identification of risk factors, nurse practitioners can offer men opportunities for genetic testing and offer individuals with such mutations regular cancer screenings at an earlier age.

The healthcare sector has become one of the most targeted industries for cyberattacks, with a dramatic rise in breaches since 2020. This presentation will provide Nurse Practitioners (NPs) with a comprehensive understanding of the landscape of healthcare cybersecurity, focusing on key aspects such as incidence, contributing factors, and solutions. The session will explore the increasing prevalence of ransomware attacks, phishing schemes, unauthorized access, and third-party vulnerabilities. Participants will gain insight into the root causes of these breaches, including reliance on third-party vendors, insufficient employee training, and inadequate technical safeguards. Real-world examples will illustrate the impacts of these breaches from compromised patient safety to significant financial penalties and reputational damage for healthcare organizations. Regulatory frameworks such as HIPAA, the HITECH Act, and emerging federal cybersecurity performance goals will be examined to highlight compliance requirements and legal implications. The presentation will provide recommendations on prevention and mitigation strategies, as well as the critical role of human factors, such as staff training and cultivating a culture of cyber awareness. Emerging technologies like AI-powered threat detection and secure telehealth platforms will be discussed as part of a forward-looking approach to protecting healthcare data. Nurse Practitioners will leave this session equipped with actionable strategies to minimize cybersecurity risks, safeguard patient data, and ensure compliance with evolving regulatory standards in an increasingly digital healthcare landscape.

After the FDA required long-term cardiovascular outcomes trials (CVOTs) for all new diabetes agents in 2009 to ensure safety, the results of CVOTs demonstrated positive outcomes that favored heart and kidney protection in additional to glucose lowering. These unexpected results have led to new indications for many of these newly approved agents, and several of them can now be used for patients who do not have type 2 diabetes. Another unexpected trend for many of the newer agents typically used for type 2 diabetes is that practitioners other than endocrinology or primary care are prescribing them. These changes reflect a needed shift in focus away from a traditional gluco-centric view for people with diabetes. Due to the bidirectional relationship that diabetes shows with cardiovascular risks and/or disease and chronic kidney disease, treatment guidelines are endorsing a more outcome-oriented approach to diabetes management. Therefore, this session will review the evidence for sodium glucose co-transporter inhibitors (SGLT2is) and their positive influence on reduced hospitalization and deaths attributed to heart failure as well as reduced nephropathy. In addition, the evidence favoring GLP-1s for the reduction in macrovascular and renal complications will be discussed.

This presentation reviews and explores the intricate pathophysiology of obesity, highlighting genetic, hormonal, and environmental factors that contribute to its development. Central to obesity's pathogenesis is dysregulation in energy balance, involving key hormones such as leptin and insulin, along with the endocrine properties of adipose tissue. For the NP practicing in primary care, practical applications in managing obesity will be critically analyzed, including lifestyle interventions, behavioral modification and support, pharmacotherapy, and surgical options. Lifestyle modifications, particularly diet and physical activity, remain foundational, but their long-term efficacy is often limited by physiological adaptations. Pharmacological treatments offer adjunctive benefits, targeting appetite regulation and metabolic pathways. Metabolic and bariatric surgery provides significant and sustained weight loss for severe obesity, though it is associated with potential complications. This intersection of pathophysiological insights and practical treatment strategies underscores the need for a multifaceted approach to obesity management in the primary care setting. Personalized medicine, integrating genetic, epigenetic, and environmental data, holds promise for optimizing therapeutic outcomes. Barriers to obesity management in primary care will be discussed. Case studies will link manifestations of disease pathology with clinical assessment and evidence-based treatment options to reduce obesity’s disease burden and improve health.

This presentation will provide updates and recommendations for cancer pain management according to the most recent NCCN guidelines.

Stigma and stereotypes continue to cast long shadows over the field of mental health, creating barriers that hinder patient engagement, equitable access to care, and positive outcomes. Nurse practitioners play a pivotal role in breaking down these barriers and promoting a culture of inclusivity, respect, and compassion. This session will delve into the impact of stigma and stereotypes on mental health care, exploring how they shape patient experiences and contribute to disparities in treatment. Learners will gain practical strategies to identify and address implicit biases, enabling them to create more inclusive clinical environments. Additionally, the session will emphasize the importance of adopting person-centered language, equipping participants with actionable tools to enhance respectful and effective communication with patients. Through evidence-based insights and real-world examples, this presentation will empower nurse practitioners to address stigma and stereotypes, ultimately improving the quality of care and fostering stronger provider-patient relationships.

Chronic cough is a common patient presentation. Chronic conditions such as asthma, gastric esophageal reflux disorder (GERD), and postnasal drip can exacerbate symptoms causing an upper airway cough syndrome. Nurse practitioners need to recognize these conditions and manage them medically to provide the patient with relief of symptoms.

Effective pain management requires a shift in perspective—from seeking a quick fix to embracing a comprehensive, multimodal approach. This presentation explores the reality that pain relief is a process, grounded in both science and individualized care. This includes the importance of patient expectations, measurable outcomes beyond pain scores, and the clinical significance of pain improvement. Attendees will gain insight into the nuanced use of over the counter analgesics, prescription medications, and topical agents, including their risks, mechanisms of action, and patient conversation points. A practical review of opioid use—including selection, risk assessment, rotation, and safety strategies—will be included, along with a discussion of special considerations like opioid-induced constipation, the role of PAMORAs, and naloxone prescribing. This is a real-world, evidence-based guide to pharmacologic pain management, with case studies, clinical pearls, and safety tips. Whether you’re new to pain management or looking to care for these patients in primary care or practices that focus on other specialties, you’ll leave with tools to create more meaningful, measurable treatment plans that align with what truly matters to patients—their function, sleep, and quality of life.

Emergency Nurse Practitioners (ENPs) play a vital role in providing prompt, safe, and skilled care in rural and agricultural communities where access to healthcare is often limited. Community ENPs and ENPs working in transport roles and at non-rural receiving hospitals must understand injuries and illnesses associated with environmental, occupational, and recreational activities common to rural and agricultural communities to anticipate and guide specialized assessment and care delivery. Risks such as farm-related accidents and environmental exposures require expert knowledge and skills to achieve best clinical outcomes. By comprehending the intricacies of these risks and ENPs can enhance their diagnostic capabilities and medical decision skills and improve patient outcomes.

Productivity metrics form the foundation of many healthcare payment systems in the United States. Productivity measures outputs (labor, supplies, and complexity of care) against inputs (potential revenue) through complex measurements to reflect health system performance (American Association of Professional Coders [AAPC], 2022). It uses the Resource-Based Relative Value Scale created by Medicare to calculate the reimbursement mechanism for each service and procedure (AAPC, 2022). The Veterans Health Administration and the Military Health System both use workload RVUs (wRVUs), which account for time, skill, cognitive judgment, and effort related to patient risk. However, there are unique differences between both organizations. This course will compare the two and provide insight into key takeaways NPs from both organizations can use to improve their metrics within their respective agencies.

The presentation will include a discussion of the major physiological changes in pregnancy, a brief history of legislation related to pregnant or childbearing workers, an update on the current legal environment concerning work accommodations in pregnancy and guidance related to appropriate and reasonable accommodations.

Join for a transformative session on the Enhanced Recovery Program (ERP), a comprehensive and multidisciplinary approach to perioperative care that significantly enhances the functional recovery of surgical patients. Discover how the ERP can revolutionize thoracic oncology surgical care and improve patient outcomes. Don't miss this opportunity to learn about the remarkable benefits of implementing ERP in your practice!

Dry eye disease (DED) is one of the most common ocular conditions patients report to their health providers. It is a multifactorial condition of the ocular surface characterized by a loss of homeostasis in the tear film, accompanied by various ocular symptoms. Key factors contributing to DED include tear film instability, hyperosmolarity, inflammation and damage to the ocular surface, and neurosensory abnormalities. Even patients who do not report symptoms but show signs of DED may require treatment before undergoing ocular surgery. Patients with DED often experience discomfort, with complaints such as stinging, burning, or tearing in their eyes. These symptoms can significantly impact their daily lives. Neurotrophic conditions—including diabetes, herpes simplex, or zoster ophthalmicus, post-refractive laser procedures and other trigeminal nerve diseases can lead to decreased reflex-induced lacrimal secretion and a reduced blink rate resulting in increased tear evaporation, contributing to dryness in the cornea. In this presentation, the authors will discuss the common causes of dry eye, the diseases and conditions that can lead to dry eye, available treatment options, and effective management strategies.

This session will address the newest barriers to care for the transgender population in light of the most recent Executive Orders banning transgender care. Creating an inclusive and safe place for the LGBTQIA+ community is imperative for clinicians caring for the population. There are unique challenges and inherent discrimination that many LGBTQIA+ patients face in healthcare and as such tend to avoid seeking health care until absolutely necessary

This unique presentation introduces the viewers to the NP development and various aspects of current state of NP role in Japan. Since the first NP graduate program launched in Oita, Japan in 2008, the progress for the NP role establishment continued to face barriers from both within nursing and other healthcare groups, primarily physician organizations. This presentation includes information regarding the social and demographic challenges in Japan which highlights the need for an innovative new healthcare model to meet the future needs of Japan both in rural and urban areas, and both in healthcare institutions and within community settings. Discussions would also share results from an unpublished qualitative research that the presenter and a Japanese colleague, a nurse faculty conducted to reveal additional insight which points to an action needed. Advancing the NP role in Japan requires highly engaged collaboration between the general nursing organizations, NP organizations, and other organizations that represent various health care professionals including physicians. Collaboration is critically and urgently needed to move the needle toward attaining the full recognition of the NP ROLE at the national level.