Sleep and quality of life in lung cancer patients and survivors.

BACKGROUND: Lung cancer patients and survivors are vulnerable to disturbed sleep and impaired quality of life (QOL) across the continuum of illness. Few studies have sought to identify predictors of QOL using well-validated measures of both sleep quality and QOL in this population. PURPOSE: The purpose of this study was to examine factors associated with lung cancer that are predictive of QOL in adult lung cancer patients and survivors in the outpatient setting. METHOD: Cross-sectional data collected exclusively in the outpatient setting from three lung cancer clinics in the Northeastern United States were pooled and analyzed. The pooled sample (N = 103) data included cancer type and stage, body mass index, Pittsburgh Sleep Quality Index, and Functional Assessment of Cancer Treatment-Lung information. RESULTS: Significant correlations between sleep quality, lung cancer symptom severity, and QOL were observed. Sleep quality and lung cancer symptoms were found to be statistically significant predictors of QOL. No significant differences in QOL were found based on cancer type or recruitment source. Demographic factors and cancer stage were also not predictive of overall QOL. CONCLUSIONS: Lung cancer symptoms and sleep quality were important determinants of QOL in this pooled sample of lung cancer patients and survivors. IMPLICATIONS FOR PRACTICE: Patients and survivors of lung cancer require routine screening for sleep disturbance, lung cancer symptoms, and QOL needs. Nurse practitioners can help improve QOL in this population by screening for and treating sleep disturbance and lung cancer symptoms.

Mental Health and Illness.

Circumstances forcing individuals and families to flee set the stage for disruptions in mental health and forge resilience. Individual characteristics and conditions premigration, perimigration, and postmigration influence health, mental health, care-seeking behavior, and stages of well-being and successful resettlement. Primary care providers have strategies to promote mental well-being, including focusing on resilience and social determinants of health. Integrated or collaborative care models are ideal for delivering optimum care for refugee and immigrant communities. Connecting primary and behavioral care promotes a team approach; provides comprehensive, whole-person care; and relies on participation of patients and families.

Cervical cytology in vulnerable pregnant women.

PURPOSE: To identify the prevalence of abnormal Papanicolau (Pap) smears in pregnancy in a vulnerable urban family practice, determine the percentage of abnormal Pap smears that persist into the postpartum period, and identify associated risk factors. DATA SOURCES: A retrospective chart review of all prenatal patients (N = 192) from a large urban family practice in upstate New York from 2000 to 2004. Descriptive statistic analysis was performed on demographic information, risk factors for abnormal Pap smears, and disposition of the patients. CONCLUSIONS: This study provides information on the risk factors associated with abnormal Pap smears in pregnancy in a population at high risk. A significant relationship was seen between a positive marijuana toxicology screen and an abnormal Pap smear. In addition, the younger the patient age, the higher the probability of having a positive toxicology result. As expected, human papillomavirus (HPV) was the only sexually transmitted infection associated with an abnormal Pap smear in those that had reflex testing with liquid based cytology. Patients with primary care providers were much more likely to return for cervical cancer screening within 1 year of previous testing. IMPLICATIONS FOR PRACTICE: There are many barriers to screening and prevention for cervical cancer in vulnerable populations. Newer technologies with HPV testing have helped to identify those women at highest risk for cervical cancer. Implementing strategies among healthcare providers to avoid missed opportunities for screening, assessment and education of risk factors, and offering vaccination against HPV are needed. Empowering women may begin to reduce disparities through the development of educational programs that reduce cultural and linguistic barriers to screening and awareness that socioeconomic factors may be impediments to care and adherence.

Appendicitis in pregnancy.

BACKGROUND: Our urban practice had two incidences of documented appendicitis in pregnancy in a 24-hour period with two unique outcomes that prompted an inquiry. Appendicitis in pregnancy is relatively rare, but it has significant morbidity and is a cause of maternal and infant mortality. Abdominal pain is the most common presenting symptom, and the consideration of multiple pathologic disorders should be entertained. Accurate diagnosis of appendicitis in pregnancy is the largest challenge since the signs and symptoms may vary depending on the trimester in which the patient presents. METHODS: We undertook a systematic review of English-language articles from 1975 to 2005 using the key words "appendicitis," and "pregnancy" using MEDLINE, CINAHL, and Cochrane Controlled Trials Register databases. RESULTS AND CONCLUSIONS: The accurate diagnosis of appendicitis during pregnancy requires a high level of suspicion and clinical skills, and not merely relying on the classic signs and diagnostic testing. Primary care providers play an important role in recognizing potential signs and symptoms of appendicitis in pregnancy to initiate prompt action and reduce negative maternal and fetal outcomes.