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Biomedical subjects

N L Risser

Publications and source records attributed to N L Risser.

7 recordsLinked to original sources
PubMed1996

Prevention of lung cancer: the key is to stop smoking.

OBJECTIVES: To review current approaches to primary prevention of lung cancer and to screening for precarcinogenic or preclinical asymptomatic disease. DATA SOURCES: Research studies, review articles, and government reports relating to prevention of lung cancer and strategies for smoking cessation. CONCLUSIONS: Because almost 90% of lung cancer cases can be attributed to tobacco, reduction of smoking is the appropriate focus of lung cancer prevention efforts. Lung cancer chemoprevention remains an experimental approach and large scale screening for lung cancer is of limited value. IMPLICATIONS FOR NURSING PRACTICE: Nurses are in a strategic position to prevent smoking initiation and to influence successful smoking cessation through education, information on the multiple modalities to assist behavioral change, and ongoing reinforcement.

Behavior Therapy↗
PubMedDate not supplied

Adding spirometry, carbon monoxide, and pulmonary symptom results to smoking cessation counseling: a randomized trial.

Smokers are often advised to quit in a discussion of future health risks. The authors tested whether adding information about personal effects of smoking would motivate hospital outpatients to stop smoking more than advice about potential hazards would. Ninety smokers in a general screening clinic were randomized to receive education alone or education plus an additional motivational intervention that contained immediate feedback about the smoker's exhaled carbon monoxide (CO) values, spirometry results, and pulmonary symptoms. A self-report of smoking status was obtained one, four, and 12 months after the intervention. In addition, at 12 months, exhaled CO measurements were made. Smokers who received the additional motivational intervention were more than twice as likely to report quitting some time during the 12-month follow-up (40% vs. 16%, p = 0.015). At 12 months, 33% of the intervention group and 10% of the control group smokers tested had achieved CO-validated cessation (p = 0.03). Counting all patients not contacted as continuing to smoke, the percentages were 20% vs. 7% (p = 0.06). These practical feedback methods to motivate cessation deserve testing in other settings.

Carbon Monoxide↗
PubMedDate not supplied

Development of an instrument to measure patient satisfaction with nurses and nursing care in primary care settings.

An instrument that evaluated patient attitudes toward nurses and nursing care in a primary care setting is described. The tool consists of 25 items, subdivided into three subscales--1) technical-professional area, 2) interpersonal educational relationship, and 3) interpersonal trusting relationship--to which respondents indicate agreement to disagreement in five Likert-type steps. Items, developed from interviews with patients, literature review, and other similar scales, were submitted to two sequential trials and to application of criteria such as variability, representativeness of content definition, ability to discriminate between respondents, and internal consistency. Respondents for the two sequential trials were 78 and 60 patients of internists or general practitioners at a group health cooperative. Scott's homogeneity ratios and reliability coefficients as measured by Cronbach's alpha were obtained for the subscale and the total scale, and subscale intercorrelation coefficients were determined, but further testing of the scale for validity is needed.

Consumer Behavior↗
PubMedDate not supplied

The accuracy of tuberculin skin tests: self-assessment by adult outpatients.

Tuberculin skin testing is an accurate, inexpensive screening procedure for detecting tuberculosis infection. The return visit needed to interpret the reaction is inconvenient, costly, and may contribute to under-utilization of the test. Although some clinicians ask patients to read their own purified protein derivative (PPD) test results, patient accuracy and the degree of teaching needed to learn this skill are unclear. This study evaluated the accuracy with which 145 outpatients read their own Mantoux skin test (PPD) reactions and reported by postcard after brief training by nurse practitioners. A total of 89 instructed patients returned postcards and also returned for clinician readings; 46 submitted postcards without returning; 7 returned but did not complete postcards; and 3 neither returned postcards nor returned for readings. Ten of 135 postcards were uninterpretable. For 81 subjects with both interpretable tuberculin self-assessment postcards and clinician readings, overall PPD classification agreement was 88 percent; Kappaw = +0.905 (P less than .001). Compared to clinician readings, 1 of 53 patients falsely reported a positive reaction (greater than or equal to 10 mm) and 2 of 25 patients falsely reported negative PPD readings (0-4 mm). There was 100 percent agreement between postcard readings and clinician classifications in a subgroup of patients (N = 26), prospectively identified by nurse practitioners as capable of accurate tuberculin self-assessment. Inter-clinician reading agreement (N = 37) was 89 percent; Kappaw = +0.943 (P less than .001). The brief standardized teaching protocol described can enable most patients to measure and report their PPD results. Study results suggest thatpostcard reports, especially negative ones, from a subgroup of patients selected for their skill in measuring their initial PPD wheal and ability to paraphrase instructions, might be substituted for clinician readings.

Ambulatory Care↗