OBJECTIVES-Provide an overview of the impact of smoking after a diagnosis of lung cancer, discuss the relationship between smoking cessation and improved outcomes during the lung cancer trajectory, present information about tobacco dependence evidence-based treatments, reimbursement for these treatments, and tobacco-related resources available for patients and health care professionals, and emphasize the important role of nurses.DATA SOURCES-Published articles, reports, websites, and research studies.CONCLUSION-Tobacco use is associated with 30% of cancer deaths. Prevention of tobacco use and cessation are primary ways to prevent lung cancer. However, even after a diagnosis of lung cancer, smoking cessation is important in improving survival and quality of life. Although effective tobacco dependence treatments are available to help smokers quit smoking, persistent efforts over repeated contacts may be necessary to achieve long-term cessation.IMPLICATION FOR NURSING PRACTICE-Oncology nursing action is essential in the identification of and intervention with patients who struggle with tobacco dependence after diagnosis. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Lung cancer is one of the most common smoking-related malignancies accounting for the second most common cancer, and the leading cause of cancer death in men and women in the United States (US). Lung cancer causes more deaths than the next three most common cancers (breast, colorectal and prostate) combined. An estimated 160, 390 deaths will occur from lung cancer during 2007. It is estimated that 90% of lung cancers are related to smoking. 1 NIH Public AccessAuthor Manuscript Semin Oncol Nurs. Author manuscript; available in PMC 2009 February 1.Although the link between smoking and lung cancer is well-established, the benefits of smoking cessation after a diagnosis of lung cancer are not as widely recognized. Smoking cessation can improve survival, treatment efficacy, and improve overall quality of life 2-4 . Approximately half of all smokers have quit prior to their diagnosis 5 . Despite a diagnosis of cancer, the addictive properties of nicotine can make quitting difficult and the risk for relapse high. This article provides an overview of the impact of continued smoking after a diagnosis of lung cancer and the importance of smoking cessation. The benefits of quitting, and the important role of the oncology nurse in assisting these efforts, will be emphasized along with strategies to incorporate smoking cessation interventions into the clinical setting. Smoking Prevalence Rates and the Benefits of Ce...

With rising cure rates of childhood cancer, nurse practitioners have an increased chance of encountering a large survivor cohort in practice. A variety of late effects programs exist; however, funding is limited for these programs and is not accessible for all patients. Primary providers may increasingly act as a medical home for childhood cancer survivors (CCS). Understanding the inherent risks of cytotoxic treatment and the progressive consequences of late effects is vital to limit morbidity and mortality. Adolescent and young adult survivors (AYA) are particularly apt to make health behavior decisions that create risks for comorbidities. Developmentally appropriate experimentation with drug, alcohol, or tobacco use and increased ultraviolet ray exposure intensifies the risk for secondary malignancies and novel diseases. The paucity of evidence-based surveillance guidelines and survivor-specific health promotion programs cumulatively widen the gap in noncompliance and misinformation. This article overviews the risk profile of CCS. It explores health practices, as well as emerging health promotion techniques, within the AYA survivor population and the role nurse practitioners have in enhancing health maintenance.

Introduction: Sickle cell disease (SCD) is a chronic illness characterized by unpredictable episodes of pain, cumulative organ damage, and high-health care utilization rates. Intravenous opioids are considered a mainstay in the management of acute vaso-occlusive pain crisis (VOC). In 2007, van Beers and colleagues demonstrated that the use of patient-controlled analgesia (PCA) results in significant reductions in morphine consumption with equivalent response on measurements of pain and quality of life, and this is largely accepted by SCD providers. There remains controversy regarding the method of administration of opioids via PCA, with studies examining varying ratios of continuous to demand dosing. PCA with basal infusion plus demand dosing seems to be preferred by the hematology community whereas emerging data in other populations, demonstrate adequate pain control and reduced rates of opioid-related adverse events with the use of demand only approaches. In October 2012, as part of a quality improvement initiative at the Children's Hospital at Montefiore, we revised our pain management guidelines to exclude the routine use of basal infusions in our PCA protocol. In addition, pain management consultation was requested to assist in management of PCA, particularly as it related to the appropriate use of basal infusions when indicated and timely transition to oral analgesics. Short-term methadone during the inpatient stay with a short taper post discharge was utilized for improved and long-acting analgesia in patients that did not improve rapidly on the standard regimen. Methods: We conducted a retrospective analysis of patients with SCD < 21 years of age, admitted for VOC 3-7 times/year, comparing patient admissions in 2011 versus 2013, pre- and post-revision of the pain protocol as described above. Baseline variables evaluated include demographic and clinical characteristics outlined in Table 1. Primary outcomes include total opioid utilization during inpatient admission, total hours on intravenous PCA and length of stay (LOS). Secondary outcomes include rates of acute chest syndrome, hypoxia, exchange transfusion and transfer to the pediatric intensive care unit. Results: A total of 144 admissions were included in the analysis, 73 in 2011 and 72 in 2013. Baseline demographics and clinical characteristics were similar in both groups (Table 1). In 2011, 72/73 patient admissions were treated with PCA with basal infusion compared to only 1/72 patient in 2013. Total opioid utilization during inpatient admission, total PCA hours and LOS were significantly reduced in the 2013 group compared to the 2011 group with no significant difference in admit pain to discharge pain (Table 2). Furthermore, patients in the 2013 group demonstrated a significantly lower incidence in episodes of hypoxia and acute chest syndrome (Table 2) Conclusions: In conclusion, we demonstrate the feasibility and benefits of demand only PCA in the management of VOC pain. Superiority of the demand only PCA approach needs to be rigorously evaluated in a randomized prospective study. Table 1. Baseline demographic and clinical characteristics by admissions: 2011 (n=73) 2013 (n=72) P-value Age (years) 16.3 ± 3.5 15.4 ± 3.3 0.40 Gender M F 39 (53.4%) 34 (46.6%) 32 (44.4%) 40 (55.6%) 0.62 Race Black Multiracial 60 (82.2%) 13 (17.8%) 61 (84.7%) 11 (15.3%) 0.87 Ethnicity Non-Hispanic Hispanic 55 (75.3%) 18 (24.7%) 55 (76.4%) 17 (23.6%) 0.85 Genotype Hbg SS Hgb SC 68 (93.2%) 5 (6.8%) 59 (81.9%) 13 (18.1%) 0.18 Weight (kg) 57.3 ± 17.6 54.7 ± 19.3 0.45 Opioid tolerant Y N 9 (12.3%) 64 (87.7%) 3 (4.2%) 69 (95.8%) 0.25 Hydroxyurea Y N 44 (60.3%) 29 (39.7%) 33 (45.8%) 39 (54.2%) 0.50 Hemoglobin (g/dL) 8.7 ± 1.8 8.6 ± 1.6 0.85 HgbS % HgbF% 77.5 ± 10.410.9 ± 6.9 77.7 ± 15.16.5 ± 5.6 0.97 0.10 Table 2. Comparison of primary and secondary outcomes by admissions: 2011 (n=73) 2013 (n=72) P-value Total opioid utilization during inpatient admission* (mg IV ME/kg**) 13.3 ± 33.8 3.6 ± 3.0 0.0003 Total PCA hours 153.2 ± 103.2 80.0 ± 45.4 <0.0001 Length of stay (days) 7.5 ± 5.0 5.5 ±7.4 0.002 Change in pain score (Admit pain to discharge pain) 5.5 ± 3.1 5.7 ± 3.2 0.82 Hypoxia 21/73 (28.8%) 5/72 (6.9%) 0.0008 Acute chest syndrome 16/73 (21.9%) 2/72 (2.8%) 0.0043 *all oral and IV opioids were included **mg IV ME/kg = milligrams of intravenous morphine equivalents per kilogram Disclosures No relevant conflicts of interest to declare.

Background: Tape is the standard means of securing endotracheal tubes in the surgical environment to prevent accidental extubation. This study utilizes a mannequin model to examine the amount of force required to dislodge endotracheal tubes secured with four different varieties of commercially available tape and three different taping methods. This study also incorporates different angles of applied force and varying mannequin positions to simulate conditions often encountered in the operating room. Methods: An airway trainer mannequin was intubated using a standard cuffed endotracheal tube and secured with one of four varieties of tape and one of three taping methods in randomly assigned order. The mannequin was placed in either the supine, lateral, or prone position. The endotracheal tube was then attached to a digital force meter and constant manual force applied in one of three planes (laterally to right, vertically, or laterally to left) until the cuff was removed from the trachea. Force measurements were recorded and analyzed. Results: Securing the endotracheal tube to both the maxillary and mandibular borders with Durapore™ silk tape held the endotracheal tube in the strongest, requiring the greatest force to dislodge it from the airway. Angle of force also showed statistical significance. Conclusions: The amount of force required to dislodge endotracheal tubes is affected by tape type, taping method, and direction of force. Durapore™ silk tape applied to both maxillary and mandibular borders was superior at holding the endotracheal tube in place when compared to other tape varieties and taping methods.   Keywords: Airway control, airway extubation, airway management, intubation, endotracheal intubation.