Abnormal Pap smear follow-up in a high-risk population.

Low-income women are at high risk of developing cervical cancer attributable not only to the higher prevalence of risk factors in this population but also to the lack of timely follow-up of abnormal Pap smears. This study evaluates the efficacy of an aggressive follow-up strategy. Women with abnormal Pap smear results after screening in a public hospital emergency department were randomly assigned to follow-up either by a case-managed approach using computerized tracking and universal colposcopy or by traditional care. The main outcome was the proportion of women receiving follow-up in 6 months. A secondary outcome was the proportion of women receiving follow-up by 6 months and diagnostic resolution in 18 months. Of 54 women in the intervention group, 65% kept at least one follow-up appointment in 6 months compared with 41% of the 54 women in the control group (P = 0.012). Half the women in the intervention group versus 19% of women in the control group had follow-up in 6 months and diagnostic resolution in 18 months (P = 0.001). After adjusting for age, initial Pap smear result, and race/ethnicity, the odds of having follow-up in 6 months were four times greater for women in the intervention group (odds ratio = 4.0; 95% confidence interval, 1.6-9.7), and the odds of having both follow-up in 6 months and diagnostic resolution in 18 months were more than six times greater (odds ratio = 6.5; 95% confidence interval, 2.4-17.8). This study demonstrates that an aggressive follow-up strategy significantly improves the rate of both initial follow-up and diagnostic resolution of abnormal Pap smears among low-income women with atypical squamous cells of undetermined significance and atypical glandular cells of undetermined significance when compared with traditional care.

Central neurilemoma (schwannoma) of the mandible.

The following case report describes the unusual occurrence of a central neurilemoma of the mandible. The lesion presented as a large bilocular, radiolucency of the mandibular body and was discovered incidentally on routine panoramic examination. It was successfully treated by enucleation and curettage. A brief review of neurilemoma is also presented.

Rhabdomyosarcoma of the infratemporal fossa.

The outlook for children suffering from this most common soft tissue sarcoma is vastly better today than it was 15 years ago, when fewer than 20 percent of its victims survived. Continuing advances in treatment should increase survival rates even more in the future.

Home visiting for a posthysterectomy population.

There are many valid indications for providing home visits to posthysterectomy clients. In-home assessment of the client's status permits immediate care or referrals and saves unnecessary acute care visits to emergency rooms and physicians' offices. Nursing interventions have identified holistic healthcare needs and prevented other problems from developing. Assisting the clients in developing their problem-solving abilities enhances the goal of return to self-care during the immediate postoperative follow-up and afterward. Finally, the vital role the clinical nurse specialists can play in the healthcare system is more clearly established for these consumers of care.

Development of a postoperative self-assessment form.

This paper describes a patient self-assessment form developed for use in a research study examining early discharge and transitional nursing follow-up care for women with abdominal hysterectomy. Transitional care nursing involves preparation for an early discharge from the hospital and nursing follow-up for convalescence at home through an 8-week recovery period. The goal of transitional care is to assist the client in regaining her preoperative level of self-care. This article will include a brief overview of the ongoing research study, a description of the role of the clinical nurse specialist (CNS) in transitional care, and the use of the self-assessment form. The form is applicable to numerous clinical settings.

Unilateral mydriasis caused by transdermal scopolamine.

Contamination of the eye after handling of a transdermal scopolamine patch may cause accidental mydriasis. A simple office test is discussed to identify this pharmacologic blockade and thereby avoid an extensive neurologic workup.

Assessment and management of cervical intraepithelial neoplasia.

Although cervical intraepithelial neoplasia (CIN) once was thought to be a clinical problem primarily for older women, data reveal an alarming rise of this condition among younger women. The gains made in decreasing the incidence of cervical cancer have been tempered by the steadily increasing incidence of its precursor state, CIN. Because of increasing evidence of the association of the human papillomavirus (HPV) with cervical cancer and CIN, this virus is of particular concern. Colposcopy is a valuable method for evaluating CIN that has been indicated on Pap, as well as for identifying HPV. Since having an abnormal Pap and undergoing colposcopic examination may be stressful, the clinician can play a significant role in helping the client cope with the process of evaluation and treatment of abnormal Paps in addition to controlling cervical cancer.