Screening and early detection among racial and ethnic minority women.

OBJECTIVES: To highlight sociocultural factors reported to influence and strategies to promote breast and cervical cancer screening and early detection behaviors of racial and ethnic minority women. DATA SOURCES: Published articles, book chapters, and reports. CONCLUSIONS: The most successful strategies for promoting screening and early detection among racial and ethnic minority women are collaborative and include approaches that are culturally sensitive and appropriate. NURSING IMPLICATIONS: Intercultural and intracultural differences in racial and ethnic minority women challenge nurses to explore strategies that focus on the health care provider, the health care delivery system, and the individual woman within the context of the woman's culture.

A comparison of mechanical strength of the femoral neck following locked intramedullary nailing using oblique versus transverse proximal screws.

OBJECTIVE: The objective of the present study was to determine whether the 130-degree oblique or transverse proximal locking technique significantly enhances or diminishes the strength of the intramedullary nail-to-bone construct in a "stancelike" loading configuration. DESIGN: Six paired fresh frozen femora were randomized to locked intramedullary nailing with either the 130-degree proximal locking technique or the transverse locking technique and tested in axial compressive loading. Torsion, shear, and impact loading were not tested. PATIENTS/PARTICIPANTS: Six paired adult fresh frozen cadavers. INTERVENTION: An unreamed eleven-millimeter by thirty-eight-centimeter intramedullary nail was placed under direct visualization in each femur. Proximal locking was randomly performed on each pair with either two transverse screws or a single oblique screw. Each femur was loaded to failure at a rate of 50.8 millimeters per minute (two inches per minute) by using an Instron tensiometer. Radiographs after nail insertion and after failure were obtained. MAIN OUTCOME MEASURES: Load to fracture and fracture pattern. RESULTS: A significant difference between load to fracture was observed across femora of different donors (p < 0.001). No significant difference was observed in paired femora from the same donor when using either 130-degree or transverse proximal locking (p > 0.05). This result was based on nonanatomical axial loading that approximated loading during stance, without hip abductor loads to help stabilize the femur. CONCLUSION: Neither technique preferentially predisposed the construct to failure for the loading pattern tested. The mode of failure was the same in all cases, with failure beginning at the nail insertion site.

Nursing Potpourri: one unit's way of sharing needed information.

The end product has been a more organized approach to communication with staff. Nursing Potpourri on Paper has replaced many notes, flyers and memos formerly posted on various boards and doors in the unit. Once the mechanism to generate it was in place, a small time commitment has been needed for production and distribution. Staff response has been positive, as evidenced by verbal comments and responses to offers in the newsletter. Some nurses save each issue. Many have contributed information or ideas. The newsletter has become a solution to some problems discussed in staff and management meetings. "We can put something about it in Nursing Potpourri" has been a frequent solution to communication needs.

Find alternatives for patients using 80 to 100 mcg estrogen OCs.

PIP: A recent survey of 120 nurse practitioners and physician assistants has revealed that most did not prescribe any high-dose oral contraceptives (OCs). Those respondents agreed with the Food and Drug Administration (FDA) mandate that OCs containing more than 50 mcg estrogen should not be produced or distributed after October 1988. Of those who indicated they prescribed high-dose OCs, all reported that practice included fewer than 5 patients. All had kept women on higher-dose OCs for the following primary reasons: to induce withdrawal bleeding and control amenorrhea; to control breakthrough bleeding; and to treat endometriosis. A patient's transition from a high-dose OC will require the practitioner's individual consideration. One should emphasize to her client the serious complications associated with high-dose OCs. Also, it is necessary to consider the side-effects and medical problems in cases in which high-dose OCs have been indicated. If one must prescribe higher-dose OCs to treat a particular medical problem, it may be time for the practitioner to reevaluate his/her role and to carefully consider whether other specialists might better handle the situation.^ieng

Physically, mentally disabled teens require special contraceptive care.

PIP: Finding the most appropriate contraceptive method for retarded or developmentally delayed young people poses a tremendous challenge to family planning nurse practitioners. Retarded young people have the same sex drive and are influenced by the same pressures affecting sexual decision making as every adolescent. The crucial difference is the retarded person's lack of appropriate information about physical and emotional changes of adolescence, sexuality, and birth control. Since retarded teenagers struggle to be accepted, they tend to be compliant and thus vulnerable to sexual exploitation. Parents are generally more concerned about sexuality in retarded daughters than sons, and many request to have their child sterilized. Mentally retarded teens usually lack the motor skills and motivation to use barrier methods consistently. Long-acting injectable contraceptives such as Depo-Provera offer the greatest protection against pregnancy and have the highest satisfaction rate among parents and caretakers of retarded young people; however, side effects can include depression and weight gain. If hormonal contraception is selected, its effects on seizure activity must be carefully evaluated. In addition, may epileptic teens may be on anticonvulsants or other medications that interfere with the effectiveness of hormonal methods. Sterilization must be approved by the courts and is difficult to obtain if a young woman demonstrates enough comprehension and competence to one day marry and have a family.^ieng

Electromyogram-gas cystometrogram: its use in the management of neurogenic bladder of spinal cord injury.

The electromyogram (emg)-gas cystometrogram was used to study spinal-cord-injured patients with indwelling catheters before trial of voiding (TOV) to remove an indwelling catheter. Twenty-four patients were studied during 27 consecutive admissions. A coaxial needle electrode was placed in the external urethral sphincter. The output of a cystometer was simultaneously recorded on the emg printout so that the relationship of the shpincter response to distention of the bladder could be observed. Of 10 patients without bladder contractions, 7 had active urethral sphincters and 6 of these failed to achieve less than 50 ml residual thereby failing the TOV. The seventh patient succeeded in the trial and on subsequent study was found to have developed bladder contractions with a coordinated bladder-sphincter synergy. The 3 patients without bladder contractions or sphincter activity succeeded in their TOV using Credé's method. Seventeen patients with bladder contractions were divided into synergic, nonsynergic and partially synergic patterns. The 3 patients with synergic patterns succeeded in their TOV. Thirteen of 14 nonsynergic or partially synergic patients failed the TOV. The 1 nonsynergic patient who succeeded had bladder contractions of 70 cm of water compared to a mean of 28 cm of water for all other patients with bladder contraction. The emg-gas cystometrogram was helpful in selecting those patients who were successful in removing the Foley catheter. Important factors governing success in the multiple effort trial of voiding were the amplitude of the detrusor contraction, the presence of detrusor-sphincter synergy and the presence of a flaccid sphincter.