The effects of symptomatic seroma on lymphedema symptoms following breast cancer treatment.

It has been speculated that symptomatic seroma, or seroma requiring needle aspiration, is one of the risk factors for lymphedema symptoms following breast cancer treatment. These symptoms exert tremendous impact on patients' quality of life and include arm swelling, chest/breast swelling, heaviness, tightness, firmness, pain, numbness, stiffness, or impaired limb mobility. Our aim was to explore if symptomatic seroma affects lymphedema symptoms following breast cancer treatment. Data were collected from 130 patients using a Demographic and Medical Information interview tool, Lymphedema and Breast Cancer Questionnaire, and review of medical record. Arm swelling was verified by Sequential Circumferential Arm Measurements and Bioelectrical Impedance Spectroscopy. Data analysis included descriptive statistics, Chi-squared tests, regression, exploratory factor analysis and exploratory structural equation modeling. Thirty-five patients (27%) developed symptomatic seroma. Locations of seroma included axilla, breast, and upper chest. Significantly, more women with seroma experienced more lymphedema symptoms. A well-fit exploratory structural equation model [X2(79) = 92.15, p = 0.148; CFI = 0.97; TLI = 0.96] revealed a significant unique effect of seroma on lymphedema symptoms of arm swelling, chest/breast swelling, tenderness, and blistering (beta = 0.48, p < 0.01). Patients who developed symptomatic seroma had 7.78 and 10.64 times the odds of developing arm swelling and chest/breast swelling versus those who did not, respectively (p < 0.001). Symptomatic seroma is associated with increased risk of developing lymphedema symptoms following breast cancer treatment. Patients who develop symptomatic seroma should be considered at higher risk for lymphedema symptoms and receive lymphedema risk reduction interventions.

Nondisplaced shearing-type talar body fractures.

The majority of talar body fractures represent avulsive injuries or are associated with obvious displacement or dislocation. Minimally displaced, nonavulsive fractures of the talar body are rare and can be difficult to recognize. Delay in diagnosis and therapy may be associated with an increased risk of osteonecrosis, malunion, secondary osteoarthritis, and other complications. We present two cases of nondisplaced talar body fractures with delay in diagnosis and stress the importance of recognizing these fractures, given the appropriate mechanism of injury.

Community baby shower as a transcultural nursing intervention.

A community assessment was conducted by nursing students to determine the educational needs of Native American women whose infants were at risk for infant mortality. As a result, a culturally based community baby shower was provided for the women and their infants which incorporated health education. Games, prizes, and lunch were provided for the mothers upon completion of educational newborn care, immunizations, and infant safety learning activities. The intervention project based upon maintaining a Native American cultural theme was used with cake, favors, prizes, invitations, and advertisements. In addition, a recognized Native American spiritual leader was invited to begin the shower with a traditional blessing. Multiple community resources such as businesses, stores (including drug), churches, hospitals, a local nursing home, and several private individuals also contributed time, money, and baby care items for the shower. From the advertising, many women expressed interest in attending the baby shower than could be accommodated. Press releases provided exposure for the school of nursing, contributors, participants, and many members of the Native American community. A pre- and post-test survey indicated that by the end of the baby shower, all 10 key native American women participants were able to demonstrate the use of the information taught by the nursing students. The baby shower enhanced the Native American mothers' self confidence and provided them with culturally sensitive care. The welcoming atmosphere created by the students for the Native Americans was also important to the success of the project.