Evaluating the genetic risk of breast cancer.

Progress genetics has endless implication for primary care and for people at risk for hereditary breast cancer. Nurse practitioners will be increasingly challenged to order and interpret genetic tests, provide genetic counseling, and assume responsibility for protecting patient privacy. Yet primary care practitioners may not be completely prepared to provide the necessary background information. This article provides guidelines for evaluating family history risk for inherited breast cancer risk. Also discussed are implications for presymptomatic testing of the BRCA1 and BRCA2 genes for adult-onset breast and ovarian cancer.

Influence of others in motivating women to obtain breast cancer screening.

PURPOSE: The purpose of this study was to examine the importance of influence of other people in getting women to obtain breast cancer screening. DESCRIPTION OF STUDY: A descriptive study of 129 women completed the researcher-developed, Likert-type scale-Influence of Others Scale. A self-report questionnaire was used to obtain frequency of breast cancer screening behaviors (breast self-examination, clinical breast examination, and mammography). RESULTS: The Influence of Others Scale had acceptable reliability scores. Comparison of the means and t-test analyses between those who performed the recommended screening behavior with those who had not revealed that the influence of family and friends and the influence of knowing someone with breast cancer were significant for each of the three screening behaviors. Regression analyses revealed that the influence of others was highly significant to the practice of breast self-examination and less so for mammography and clinical breast examination. CLINICAL IMPLICATIONS: These findings underscore the potential importance of using specific women's social networks to reinforce breast cancer screening.

Neonatal glucose determinations obtained from an umbilical artery catheter: evaluation for accuracy using an in vitro model.

Accuracy of glucose values is crucial in the management of the critically ill neonate. Sampling for these values may be obtained from an umbilical artery catheter (UAC), but dextrose solutions infused through these catheters may contaminate samples obtained for glucose determination. An in vitro study was conducted to evaluate the effect of blood withdrawal amount and normal saline irrigation on the accuracy of glucose measurements obtained from a UAC. Methods included randomization of blood withdrawal amounts and irrigation with normal saline solution prior to obtaining the blood for glucose measurement. Two hundred and eighty glucose samples were obtained. Results revealed a significant difference between measured and baseline glucose values for all withdrawal amounts and varying flush volumes. This inability to approximate the baseline glucose values could mean that a UAC sample may not reflect the neonate's actual glucose value.

Results of a national survey of physicians' knowledge and application of prevention capabilities.

We used the Comprehensive Prevention Knowledge and Applications Survey Instrument to study health promotion and disease prevention activities of a national sample of 777 family physicians. The study demonstrated active counseling in some areas, such as smoking cessation, but lesser efforts in other aspects, including counseling about smokeless tobacco cessation, seat belt use, sunlight exposure, prevention of AIDS and other sexually transmitted diseases, and preconceptual counseling. Although respondents thought themselves prepared to counsel about prevention efforts, they reported limited success in changing patients' behavior. The physicians documented frequent application of many prevention techniques, and they noted much more frequent use of mammography than has been reported in prior studies. The survey results indicate the need for modification of medical education programs and for enhancement of ability to change behavior to reduce health risks.

The Comprehensive Prevention Knowledge and Applications Survey Instrument: its validity and reliability.

Because the instruments used to measure current practices among primary care physicians in a broad range of prevention activities are limited, we developed a study to test a tool that would evaluate current prevention knowledge and applications, including items regarding activities to prevent AIDS and other sexually transmitted diseases. The Comprehensive Prevention Knowledge and Applications Survey Instrument measures knowledge, counseling capabilities, and use of recommended applications in preventive medicine. We designed and tested a 74-item instrument. Four recognized experts in preventive medicine and public health determined its content validity. We then proceeded with reliability testing with a random sample of 315 family physicians and replicated it with an additional 432 physicians for stability reliability. Internal consistency reliability and stability reliability have both been demonstrated for this instrument.

A survey of physicians' knowledge and application of AIDS prevention capabilities.

Currently, no effective immunization prevents AIDS and no curative treatment exists for the AIDS patient. However, sufficient knowledge of the pathophysiology of this disease exists to prevent its spread. Effective application of this capability requires that health care providers secure and apply this knowledge. This study reports the results of a national survey of family physicians' knowledge and application of AIDS prevention capabilities. The Comprehensive Prevention Knowledge Applications Survey Instrument was used for the survey. It revealed that, in contrast to other prevention activities, respondents (n = 765) reported low use of practices important in AIDS prevention. For example, only 18% routinely obtain sexual histories from patients seen regularly, and, of those obtaining these histories, fewer than 20% routinely obtain information regarding high-risk activities. Over 40% do not routinely ask about homosexual activities, and almost 60% omit questions about intravenous drug use, even though the patient has symptoms suggesting AIDS in both instances. Methods of enhancing application of available capabilities may focus on expanded education and intervention activities.

Validity and reliability of a breast cancer knowledge test.

A study was made to develop and test a tool to measure a subject's knowledge about breast cancer screening in order to implement effective strategies for prevention and early detection. The Breast Cancer Knowledge Test measures a subject's knowledge about detection and screening practices. The instrument is an expansion of Stillman's Knowledge Questionnaire. A 30-item test was designed and pretested. Four nationally recognized experts in cancer control determined content validity. Reliability testing then was done with a sample of 101 women 50 years of age and older. The complete posttested 18-item instrument is reported here. Correlational analyses were done between the total scores on the Breast Cancer Knowledge test and subjects' practice of screening behaviors. Findings indicate that more knowledge of breast cancer screening is associated with use of mammography and obtaining a professional examination, but not with the practice of breast self-examination.

Leg volume changes with EPIC and posturing in dependent pregnancy edema.

This study explored the differential effects of external pneumatic intermittent compression (EPIC) and posturing on leg volume changes in healthy pregnant women with dependent leg edema. Thirty-five healthy pregnant women with severe pedal edema were randomly assigned to one of two treatment groups. The experimental group (n = 17) received EPIC for 30 minutes at 40 torr while in the left lateral recumbent position. Control women (n = 18) were similarly positioned, but received no EPIC. Both groups walked for 10 minutes following left lateral posturing. Circumference measures required for leg volume estimates were made: prior to posturing (Time 1), immediately after posturing (Time 2), and following the ambulation period (Time 3). Volume losses for the experimental group were greater than for the control group at Time 2. Although volume losses for the experimental group had reversed somewhat at Time 3, they remained greater than control group losses, which did not change from Time 2 to Time 3. Analysis of covariance revealed significant mean volume losses for both experimental and control groups, with ponderal index the only significant covariate.

Preventing coronary heart disease in high-risk families.

A preventive nursing intervention to reduce coronary heart disease (CHD) risk was tested. The sample was 19 families composed of 58 first-degreed relatives of young (age 30-55 years) victims of sudden cardiac death. Families were randomly assigned to control and experimental groups. The intervention at 3-5 months postdeath focused on assessment of health history, health behaviors, health beliefs, informing and educating about CHD risk factors, and methods for detecting and reducing these factors. The control group received mailed questionnaires and no intervention. The subject's reduction of CHD risk was measured at 7 months by changes in high risk CHD behaviors, changes in health beliefs, and adherence to screening for serum cholesterol and blood pressure determination. Analysis of covariance (covarying age and pretest scores) demonstrated no differences between groups for health beliefs; however, significant differences for health beliefs existed between the sibling subgroups. The intervention was correlated with a significant reduction in alcohol intake. Reductions in high fat meat consumption were in the desired direction. Greater percentages of subjects in the intervention group obtained blood pressure and cholesterol screening.

Genetics: implications for preventative nursing practice.

A method for identifying and evaluating susceptible families for cardiac disease risk is presented from the perspective of the role of genes in heart disease. If useful applications of genetic aggregations could be integrated into nursing practice, preventive selective interventions could be implemented. Nursing practice aimed at risk reduction in susceptible families is more efficient for reducing disease mortality.

Lipoproteins and heart disease.

Elevations of LDL and plasma cholesterol are established predictive risk factors for predisposing to early coronary heart disease. Conversely, HDL has a protective anti-atherogenic effect. The hyperlipidemias are classified according to a genetic basis (primary) and the result of other diseases (secondary). Diet is an important and modifiable determinant of the lipid concentration in plasma. Restricting saturated fat consumption, increasing intake of polyunsaturated fat and reducing dietary cholesterol are key to hyperlipidemias with elevated LDL. Weight reduction, decreased alcohol consumption, and in some individuals, restriction of simple sugar intake are the primary means for treating hyperlipidemias.

External pneumatic intermittent compression for treatment of dependent pregnancy edema.

A portable external pneumatic intermittent compression (EPIC) device has been successful in reducing peripheral edema. This study explored the effectiveness of EPIC for treating dependent pregnancy edema. In the study, 42 healthy pregnant women received EPIC for 30 minutes at 40 torr while in the left lateral recumbent position: Group One with mid-thigh boots, and Group Two with below-knee boots. Prior to compression, descriptive data were gathered, leg circumference measurements made, and surface skin temperatures recorded for three sites per leg. Vital signs were taken and pedal edema subjectively indexed. Following compression, circumferences, skin temperatures, vital signs, and edema indices were rerecorded. Three volumes were calculated for each leg using a mathematical model of leg segments as conical frustum units. Mean volume reductions for each leg were significant. The mid-thigh-length boots produced greater mean volume decreases. The volume decrease for calf, lower leg, and foot frustum units were significant. EPIC holds promise as a useful treatment for dependent pregnancy edema.