Effectiveness of an Algorithmic Approach to Ventilator Withdrawal at the End of Life: A Stepped Wedge Cluster Randomized Trial.

Background: The transition to spontaneous breathing puts patients who are undergoing ventilator withdrawal at high risk for developing respiratory distress. A patient-centered algorithmic approach could standardize this process and meet unique patient needs because a single approach (weaning vs. one-step extubation) does not capture the needs of a heterogenous population undergoing this palliative procedure. Objectives: (1) Demonstrate that the algorithmic approach can be effective to ensure greater patient respiratory comfort compared to usual care; (2) determine differences in opioid or benzodiazepine use; (3) predict factors associated with duration of survival. Design/Settings/Measures: A stepped-wedge cluster randomized design at five sites was used. Sites crossed over to the algorithm in random order after usual care data were obtained. Patient comfort was measured with the Respiratory Distress Observation Scale© (RDOS) at baseline, at ventilator off, and every 15-minutes for an hour. Parenteral morphine and lorazepam equivalents from the onset of the process until patient death were calculated. Results: Usual care data n = 120, algorithm data n = 48. Gender and race were evenly distributed. All patients in the usual care arm underwent a one-step ventilator cessation; 58% of patients in the algorithm arm were weaned over an average of 18 ± 27 minutes as prescribed in the algorithm. Patients had significantly less respiratory distress in the intervention arm (F = 10.41, p = 0.0013, effective size [es] = 0.49). More opioids (t = -2.30, p = 0.023) and benzodiazepines (t = -2.08, p = 0.040) were given in the control arm. Conclusions: The algorithm was effective in ensuring patient respiratory comfort. Surprisingly, more medication was given in the usual care arm; however, less may be needed when distress is objectively measured (RDOS), and treatment is initiated as soon as distress develops as in the algorithm. Clinical Trial Registration number: NCT03121391.

Development of an HIV/STI and partner violence health promotion intervention for abused US Virgin Islands women.

Women in the US Virgin Islands (USVI) experience intimate partner violence (IPV) and human immunodeficiency virus (HIV) at disproportionate rates compared to women on the US mainland. Women in violent relationships report experiencing controlling behaviours that decrease their ability to negotiate for sex using condoms or to prevent unwanted pregnancies. Though several evidence-based interventions exist to prevent either IPV or HIV, few address them through an integrated health promotion approach or attend to particular USVI cultural mores. This article describes the systematic development of a theory based, culturally tailored, integrated health promotion intervention that addresses IPV and HIV among USVI women experiencing abuse. The process included: (i) identifying and integrating evidence-based health promotion interventions, (ii) conducting formative research using focus groups, (iii) synthesizing focus group data to inform intervention development and (iv) developing a culturally and linguistically appropriate intervention specific to the needs and concerns of USVI women. The Empowered Sisters Project: Making Choices Reducing Risks (ESP) was developed through this research. ESP is a three-session health promotion curriculum focussed on enhancing sexual health and safety among women experiencing abuse. The ESP intervention components included promoting condom use, increasing IPV and HIV knowledge and developing a personalized safety plan. Health professionals facilitated individual intervention sessions using culturally tailored visual media and scripts. This program focussed on experiences of women living in the USVI and has implications for utility across the Caribbean diaspora.

Multiple Dimensions and Correlates of Fatigue in Individuals on Hemodialysis.

This study examined the severity, pattern, and correlates of fatigue among adults undergoing hemodialysis. Measures included the Piper Fatigue Scale (PFS-12), Patient-Reported Outcomes Measurement Information System (PROMIS) - Fatigue, Charlson Comorbidity Index, and Six-Minute Walk Test (6MWT). Patients were excluded if mobility or cardiovascular issues prevented conducting the 6MWT. Participants were 86 cognitively intact adults (M = 61.7 years, SD = 13.81), predominantly male (58.1%), and African American (48.8%), with 80% reporting fatigue in the week prior to hemodialysis. Significant increases were noted in sensory and cognitive fatigue from pre- to post-dialysis, while the 6MWT distance decreased significantly pre- to post-dialysis. Factors significantly associated with pre-dialysis fatigue included low hemoglobin, younger age, and living with someone else, while comorbidities and dialysis inadequacy were trending to significant associations with fatigue.

Association of Psychosocial Symptoms, Blood Pressure, and Menopausal Status in African-American Women.

African-American women have disproportionate rates of hypertension that can be further complicated as they transition through menopause. Stress, coupled with depression and hypertension in perimenopausal African-American women has not been fully explored. This study examines the associations of stress, depression, and social support on systolic blood pressure (SBP) among a sample of 184 perimenopausal African-American women. We used descriptive statistics, Pearson's correlation, and logistic regression to analyze data stratified by menopausal status (perimenopausal or menopausal) and SBP status (<130 mmHg vs. >130 mmHg). Women classified as menopausal reported higher levels of stress and depressive symptoms, and lower levels of social support. Age, body mass index (BMI), health insurance, and perceived health status were significant predictors of SBP in menopausal women. Stress, depression, and social support did not play a role in SBP. It is necessary that future research focus on reducing cardiovascular risk include addressing menopausal health.

Comparison of EMLA and Diclofenac on Reduction of Pain and Phlebitis Caused by Peripheral IV Catheter: A Randomized-Controlled Trial Study.

Peripheral venous catheters (PVC) are often used to provide hydration, medications, and blood products when the length of therapy is expected to be less than 1 week. Pain and phlebitis are frequent complications of PVC. Diclofenac and EMLA have been used to minimize these adverse effects; however, conflicting results have been reported regarding which has better outcomes. This double-blind, randomized controlled trial was conducted to compare the efficacy of EMLA and Diclofenac (TDP) in attenuating PVC pain and phlebitis. The inpatient setting was chosen because of the higher frequency of PVC insertions, allowing for a sufficient sample size. One hundred fifty-four subjects were randomly assigned to three groups: EMLA patch (n = 61), a TDP patch (n = 50), or a patch with lubricant gel (n = 46) as a placebo. The pain was measured by Visual Analogue Scale (VAS). Phlebitis was examined based on Boxter criteria in intervals of 6, 12, 18, 24, and 48 hours after PVC insertion. The mean score of VAS was 41.86 ± 22.49 for the control, 39.40 ± 21.60 for TDP, and 38.77 ± 23.28 for the EMLA group, with no significant differences in pain severity between the three groups. The rate of phlebitis in the group with EMLA was significantly higher than the other two groups at 6, 12, and 18 hours (p = 0.02, p = 0.003 and p = 0.04, respectively). In all interval times, the rate of phlebitis in the TDP group was significantly lower than the other groups. Compared with men, women experienced higher rate of phlebitis and intensity of PVC pain. EMLA and TDP had similar analgesic effects, but phlebitis was less frequently observed with TDP, suggesting TDP as a potential medication for reducing pain and phlebitis before PVC insertion.

Trajectory of Dyspnea and Respiratory Distress among Patients in the Last Month of Life.

BACKGROUND: The trajectory of dyspnea has been reported among patients approaching the end of life. However, patients near death have been dropped from longitudinal studies or excluded altogether because of an inability to self-report; proxy estimates have been reported. It is not known whether dyspnea or respiratory distress remains stable, escalates, or abates as patients reach last days. OBJECTIVE: Determine trajectory of dyspnea (self-reported) and respiratory distress (observed) among patients who were approaching death. DESIGN: A prospective, repeated-measures study of dyspnea/respiratory distress among a sample of hospice patients was done. Measures were collected at each patient encounter from hospice enrollment until patient death. MEASUREMENTS: Dyspnea was measured in response to "Are you short of breath?" and using the numeric rating scale anchored at 0 and 10. Nurses measured respiratory distress with the Respiratory Distress Observation Scale (RDOS). Patient consciousness (Reaction Level Scale), nearness to death (Palliative Performance Scale), diagnoses, and demographics were recorded. Data for the 30-day interval before death were analyzed. RESULTS: The sample was 91 patients who were female (58%) and Caucasian (83%) with dementia (32%), heart failure (26%), and cancer (13%). RDOS increased significantly from mild distress 30 days before death to moderate/severe distress on the day of death (F = 10.8, p < 0.0001). Distress was strongly correlated with nearness to death (r = -0.97, p < 0.0001) and consciousness (r = 0.97, p < 0.0001). CONCLUSIONS: Respiratory distress escalated in the last days. Inability to self-report raises care concerns about under-recognition and under-treatment of respiratory distress.

Risk For Postpartum Depression Among Immigrant Arabic Women in the United States: A Feasibility Study.

INTRODUCTION: Postpartum depression (PPD) affects approximately 14% of women in the United States and 10% to 37% of Arabic women in the Middle East. Evidence suggests that immigrant women experience higher rates, but information on PPD among immigrant women of Arabic descent in the United States is nonexistent. METHODS: A cross-sectional descriptive feasibility study was conducted to assess the practicality of implementing a larger proposed research study to examine predictors of PPD in US immigrant women of Arabic descent residing in Dearborn, Michigan. Fifty women were recruited from an Arab community center and completed demographic data, the Arabic version of the Edinburgh Postpartum Depression Scale (EPDS), and the Postpartum Depression Predictors Inventory-Revised (PDPI-R). RESULTS: Among participants, 36% were considered at high risk for developing PPD. Lack of social support, antenatal anxiety, antenatal depression, maternity blues (feeling depressed during the first 4 weeks postpartum), and life stress were significantly related to risk for PPD. Multiple regression analysis revealed that social support (t = -3.77, P < .0001) and maternity blues (t = 2.19, P = .03) were the only significant predictors for postpartum depressive symptoms. DISCUSSION: Findings of this study describe the prevalence of PPD in a sample of US immigrant women of Arabic descent and support the feasibility of a larger and more in-depth understanding of their immigration and acculturation experiences. Study participants reported high risk for PPD. Maternity blues and lack of social support were significant predictors to the risk for PPD. Future research tailored to this minority group is recommended.

Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies.

BACKGROUND: Hypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach. OBJECTIVE: Our goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support. METHODS: We conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined. RESULTS: A total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change -12.6, SD 24.0 vs mean change -11.3, SD 25.5 mm Hg, P=.78), and DBP (mean change -4.9, SD 13.1 mm Hg vs mean change -3.3, SD 14.3 mm Hg, P=.54). Control and BPMED participants had slight improvements to medication adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with no significant differences found between groups (P=.92). On linear regression analysis, baseline SBP was the only predictor of SBP change; participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up (ß=-0.63, P<.001). In total, 94% (51/54) of BPMED participants agreed/strongly agreed that they were satisfied with the program, regardless of pilot setting. CONCLUSIONS: Use of text message reminders to improve medication adherence is a feasible and acceptable approach among African Americans with uncontrolled HTN. Although differences in actual medication adherence and blood pressure between BPMED and usual care controls were not significant, patterns of improvement in the BPMED condition suggest that text message medication reminders may have an effect and fully powered investigations with longer-term follow-up are warranted. TRIAL REGISTRATION: Clinicaltrials.gov NCT01465217; https://clinicaltrials.gov/ct2/show/NCT01465217 (Archived by WebCite at http://www.webcitation.org/6V0tto0lZ).

Beauty for Ashes: A Church-Based Diabetes Care Program.

The pilot study described here was a test of interventions designed to enhance long-term disease management of African-Americans with type 2 diabetes in faith-based organizations. A quasi-experimental design based on 46 participants was used comparing three interventions: guided imagery, group counseling, and routine care. Unexpectedly, the number of self-reported hypoglycemic episodes significantly increased in the Rational Emotive Behavioral Therapy (REBT) group, depressive symptoms significantly increased in the guided imagery group, and the mean hemoglobin A1c values did not significantly differ for any group. In future research, the authors will incorporate an interim step investigating the theory of integration (Hernandez, Antone, & Cornelius, 1999) to increase the explanatory power in assessing treatment effects of African-Americans in faith-based organizations.

A Church-Based Diabetes Care Survey in St. Thomas, U.S. Virgin Islands.

Forty-eight (N = 48) African-Caribbeans participated in a church-based diabetes care survey in St. Thomas, U.S. Virgin Islands. The purpose of this pilot study was to determine whether integration was a significant predictor of depressive symptoms and glycemic control in persons with type 2 diabetes among African-Caribbeans in faith-based organizations (FBO), controlling for demographic variables. Data were collected on measures of integration of diabetes, acceptance, depressive symptoms, number of hypoglycemic episodes, hemoglobin Alc, and demographic characteristics. The majority of subjects were female. Acceptance and depression were negatively correlated, and acceptance and integration were positively correlated. Depression and number of mild hypoglycemic episodes were also positively correlated. Surprisingly, integration was not significantly related to hemoglobin Alc, number of hypoglycemic episodes, and depressive symptoms. Implications of these findings are presented.

Self-Efficacy and Blood Pressure Self-Care Behaviors in Patients on Chronic Hemodialysis.

This study examined the effects of an educative, self-regulation intervention on blood pressure self-efficacy, self-care outcomes, and blood pressure control in adults receiving hemodialysis. Simple randomization was done at the hemodialysis unit level. One hundred eighteen participants were randomized to usual care ( n = 59) or intervention group ( n = 59). The intervention group received blood pressure education sessions and 12 weeks of individual counseling on self-regulation of blood pressure, fluid, and salt intake. There was no significant increase in self-efficacy scores within ( F = .55, p = .46) or between groups at 12 weeks ( F = 2.76, p = .10). Although the intervention was not successful, results from the total sample ( N = 118) revealed that self-efficacy was significantly related to a number of self-care outcomes including decreased salt intake, lower interdialytic weight gain, increased adherence to blood pressure medications, and fewer missed hemodialysis appointments. Increased blood pressure self-efficacy was also associated with lower diastolic blood pressure.

Violence and abuse of internally displaced women survivors of the 2010 Haiti earthquake.

OBJECTIVES: Limited research following disasters suggests that internally displaced women are disproportionately vulnerable to violence and abuse. An interdisciplinary collaborative of researchers and practitioners in Haiti, the US Virgin Islands, and the US Mainland investigated gender-based violence (GBV) pre- and post-earthquake and health outcomes among Haitian women living in tent cities/camps following the 2010 earthquake. METHODS: A comparative descriptive correlational design using culturally sensitive and language appropriate computer-assisted interviews of 208 internally displaced women 2011-2013. RESULTS: Found high rates of violence and abuse both before (71.2 %) and after (75 %) p = 0.266, the earthquake primarily perpetrated by boy friends or husbands. Significantly more mental and physical health problems were reported by abused than non-abused women. The majority (60-78 %) of abused women did not report personal or community tolerance for violence and abuse, but acknowledged a community context of limited involvement. CONCLUSIONS: Coordinated planning and implementation of needed interventions are essential to provide a balanced approach to the care of displaced women after natural disasters with sensitivity to the abusive experiences of many women both before and after the disasters.

A Two-Group Trial of a Terminal Ventilator Withdrawal Algorithm: Pilot Testing.

BACKGROUND: Terminal ventilator withdrawal entails cessation of mechanical ventilation to allow a natural death. There is little empirical evidence to guide the conduct of this procedure. If the process is not well conducted, patients undergoing terminal ventilator withdrawal are at high risk for experiencing significant respiratory distress. OBJECTIVES: Our aim was to (1) establish the feasibility of a nurse-led algorithmic approach; (2) determine differences in patient comfort between groups; and (3) determine differences in the use of opioids and benzodiazepines. METHODS: A prospective, two-group, repeated measures, observation design was used with nurses from one medical intensive care unit (MICU) conducting the algorithm and nurses from a second MICU providing unstandardized usual care. Patient respiratory comfort/distress was measured with the Respiratory Distress Observation Scale (RDOS). RESULTS: Nurses and respiratory therapists were trained to follow the algorithm in one-hour educational sessions; fidelity to the algorithm was subsequently confirmed. Fourteen patients evenly distributed by ethnicity and gender were enrolled, eight in the control MICU and six in the intervention unit. No significant differences in age, consciousness, illness severity, or baseline RDOS were found. All control patients underwent a one-step terminal extubation process. There were no incidences of post-extubation stridor in the intervention group, whereas three (38%) control patients experienced stridor. Patients in the intervention group had greater respiratory comfort compared with control patients (p<0.05). Differences in medication use were found with lorazepam favored in the control unit; morphine is recommended in the algorithm. CONCLUSIONS: Feasibility and proof of concept for the nurse-led algorithm were established.

An examination of eating behaviors, physical activity, and obesity in african american adolescents: gender, socioeconomic status, and residential status differences.

BACKGROUND: African American adolescents experience higher rates of obesity and have an increased risk of obesity-related diseases than do White American adolescents. Despite culturally sensitive obesity preventive interventions, obesity rates are increasing within the African American adolescent population. Current obesity interventions do not usually address the heterogeneity (e.g., socioeconomic status [SES], gender, and residential status differences) within the African American adolescent community that can affect the efficacy of these interventions. PURPOSE: To examine the gender, SES, and residential status differences related to obesity and weight behaviors in African American adolescents. METHODS: A descriptive correlational study was conducted with 15- to 17-year-old African American adolescents (n = 145) from community clinics, youth organizations, churches, and social networks in metropolitan and inner-city Detroit. Data were collected through use of survey methods and analyzed with use of descriptive statistics, independent sample t tests, and multiple regression equations. RESULTS: Female adolescents consumed foods higher in fat and calories (t = -2.36, p = .019) and had more body fat (t = -9.37, p = .000) than did males. Adolescents of lower SES consumed food higher in fat and calories (t = -2.23, p = .027) and had higher body mass (t = -2.57, p = .011) than did adolescents of higher SES. Inner-city African American adolescents had higher levels of physical activity (t = -2.39, p = .018) and higher body mass (t = 2.24, p = .027) than did suburban African American adolescent counterparts. Gender, SES, and residential status were statistically significant predictors of eating behaviors, physical activity, body mass index, and body fat. CONCLUSIONS: The initial findings from the study will assist in better understanding the obesity epidemic that affects African American adolescents in disparate proportions. IMPLICATIONS: Further examination of the study variables is essential to serve as a basis for developmentally appropriate and culturally relevant targeted interventions with this population. Health care providers and obesity researchers who work with youth can use the initial findings from this study to advocate for healthy lifestyles while reducing the obesity disparity within the African American adolescent population.

The Association of Afro-Caribbean Immigrants' Feelings of Disconnection from the Community with the Metabolic Syndrome.

Many immigrants can feel like outsiders in their adopted country. The objective of this study was to determine if psychosocial stress associated with feelings of disconnection from the community is associated with the metabolic syndrome (Met-S) among Afro-Caribbean immigrants. The frequency of the Met-S, based on International Diabetes Federation criteria, was determined for a population-based sample of 406 English-speaking Afro-Caribbean immigrants ages twenty and older in the Virgin Islands of the United States (USVI). Feelings of disconnection were assess with Roger's Life Attitude Inventory. Logistic regression analyses showed that a high level of disconnection was significantly associated with the Met-S [Odds Ratio = 1.64 (95% CI 1.10-2.44)] after adjusting for conventional risk factors and for body mass index. Afro-Caribbean immigrants in the USVI who express a high level of disconnection from the community have an increased risk for the Met-S.

Sociocultural Influences on Weight-Related Behaviors in African American Adolescents.

The purpose of this study was to examine the sociocultural factors related to weight behaviors in African American adolescents utilizing a social ecological approach. A descriptive correlational design included a sample of 145 African American adolescents. Perceived familial socialization, ethnic identity, physical activity, and eating behavior patterns were measured. Data were analyzed using descriptive statistics, Pearson product-moment correlations, and multiple regression equations. Perceived maternal socialization was significantly related to adolescent eating behaviors and physical activity whereas perceived paternal socialization was significantly related only to their physical activity. The adolescents' ethnic identity was not significantly related to their eating behaviors or physical activity. Health care providers who work with adolescents and their families can use the initial findings from this study to encourage healthy weight-related behaviors while reducing the obesity epidemic within the African American adolescent population in a developmentally appropriate and culturally sensitive manner.

Cross-cultural differences and sexual risk behavior of emerging adults.

PURPOSE: The authors examined population-specific risk factors that increase emerging adults' risk of acquiring sexually transmitted infections (STIs), including the human papillomavirus (HPV). DESIGN AND METHOD: A cross-sectional sample of 335 diverse, emerging adults ages 18 to 24 years was recruited from a health center at a large university in the Southeastern United States. The mean age was 20.6 ± 1.9 years, majority were females (74.0%), and 61.0% were Hispanic. RESULTS: Findings revealed inconsistent condom use, reasons for not using condoms, and a need for more culturally specific intervention strategies. DISCUSSION AND CONCLUSIONS: Healthcare providers should identify culturally specific reasons for inconsistent condom use, examine cultural and geographic differences in sexual risk behaviors among groups and communities, and modify communication, educational programs, and interventions accordingly. IMPLICATIONS FOR PRACTICE: By adopting a multicultural approach to the control of STIs, nurses can address specific cultural attitudes and behaviors that may influence exposure to STIs, including HPV.

Obesity in urban women: associations with sleep and sleepiness, fatigue and activity.

BACKGROUND: African-American women (AAW) have the highest prevalence of obesity and therefore are at greater risk for obesity-related symptoms and diseases. Obese individuals frequently report poorer sleep quality, more daytime sleepiness, more severe fatigue, and higher physical inactivity than normal weight individuals. The relationships among these variables have not been well-characterized in obese, urban-dwelling, AAW. METHODS: This descriptive, correlational study examined the relationships among sleep quality, daytime sleepiness, fatigue, level of physical activity, and body mass index (BMI) in AAW living in an urban setting. A convenience sample of 69 young adult women with a BMI of greater than 30 kg/m(2) completed measures of sleep quality, sleepiness, fatigue severity, sense of community, and physical activity. Further analysis was done to determine if any of the study variables predicted level of physical activity. FINDINGS: There was a strong and significant correlation between BMI and overall fatigue severity and a significant, negative correlation between BMI and physical activity performance. BMI was significantly correlated with sleep latency but not global sleep quality. There were significant relationships between fatigue severity and poorer global sleep quality and daytime sleepiness. Multiple regression analysis showed BMI and age accounted for a significant amount of the variance in physical activity. CONCLUSIONS: Higher BMI was associated with significant fatigue. Fatigue severity was associated with poorer global sleep quality, daytime sleepiness, and a sense of community. Higher BMI may be a barrier to having an active lifestyle.

A pilot study of the feasibility and outcomes of yoga for lung cancer survivors.

PURPOSE/OBJECTIVES: To determine the feasibility of a standardized yoga intervention for survivors of non-small cell lung cancer (NSCLC) and, effects on sleep, mood, salivary cortisol levels, and quality of life (QOL). DESIGN: This 14-week, one-group, repeated-measures study included a three-week preintervention phase, eight weeks of yoga classes (40 minutes once per week) and home practice, and a three-week postintervention phase. Follow-up occurred at three and six months poststudy. SETTING: A community-based cancer support center in the midwestern United States. SAMPLE: 7 adults who had completed initial treatment for stages I-IIIa NSCLC. METHODS: A standardized yoga protocol was developed prior to the study by experts in the field. Breathing ease was monitored before, during, and after classes to assess feasibility of movement without compromising respiratory status while doing yoga. Data analysis included descriptive statistics, repeated-measures analysis of variance, and salivary cortisol analysis. MAIN RESEARCH VARIABLES: Sleep quality, mood, salivary cortisol, and QOL were assessed using the Pittsburgh Sleep Quality Index, Profile of Mood States-Brief, a cortisol measurement, and the Medical Outcomes Survey SF-36®, respectively. Breathing ease was assessed using a dyspnea numeric rating scale as well as observation of participants. FINDINGS: Participants with varying stages of disease and length of survivorship were able to perform yoga without respiratory distress. Class attendance exceeded 95%, and all practiced at home. Mood, sleep efficiency, and QOL significantly improved; salivary cortisol levels decreased over time. CONCLUSIONS: Yoga was feasible for NSCLC survivors without further compromising breathing with movement. Potential benefits were identified, supporting the need for future clinical trials with larger samples stratified by cancer stage, treatment, and length of survivorship. IMPLICATIONS FOR NURSING: Nurses and healthcare providers should consider yoga as a mind-body practice to manage stress, improve mood and sleep, and potentially enhance QOL for NSCLC survivors.

Factors Associated with African-American Women's Decisions to Participate in Genetic Research.

The purpose of this study was to determine the factors that are associated with African-American (AA) women's decisions to participate in genetic research. Using a descriptive correlational design, a convenience sample of African-American women (age ≥ 40) was recruited from various locations in the Midwest. During semi-structured interviews, demographics, psychological factors, knowledge of and attitudes toward genetics were collected. Of the 98 women (mean age 53), 66% indicated that they were unwilling to participate, despite having positive attitudes. Correlations were found between genetic knowledge and attitudes toward genetics (r = .35, p = .001), and decision-making to participate and attitudes toward genetics (r = .40, p = .001). Data revealed decisions were largely associated with their lack of knowledge and resulting perceptions. Efforts should be made to inform African-American women about the benefits of the new science through planned, culturally specific, and sensitive interventions that incorporate genetic and health literacy programs.