Disaster nursing: a retrospective review

A plethora of information exists in the literature regarding emergencies and disasters. Nevertheless, significant gaps in the science related to nurses working during disasters are revealed. Few studies have addressed the perspective of nurses and their intent to respond to future disasters. Because nurses are invaluable to disaster response efforts, more research is essential to validate current findings and elucidate the needs of nurses who respond to disasters and other health emergencies. There is a paucity of research in the literature describing nurses' lived experiences of working during hurricanes. Natural disasters inevitably inflict human suffering, and nurses are expected to respond and provide services during these catastrophic times. Lost within this expectation are the experiences and concerns of the nurses who are called upon and intend to respond to the disaster, and yet are themselves affected by the disaster. Understanding the experiences and needs of nurses who decide to respond to the call of duty and work during disasters remains unclear in the literature. Research in the area of disaster response intentions by nurses becomes the initial step in understanding the phenomenon of working during a disaster and creating innovative approaches that address working during disasters. Disaster policies have been developed and implemented at the international, national, state, local, and hospital level. Nevertheless, disasters continue to adversely impact communities and hospitals at all levels causing injuries, death, and destruction of infrastructure. To reduce the impact of disasters, continued research is needed to inform and strengthen future disaster policies. Knowledge gained from future research has great potential to inform nursing education, research, and practice, as well as health policy related to the care of individuals and responders before, during, and after disasters.     

Limitations in assessing the severity of aortic stenosis by Doppler gradients

Continuous wave Doppler echocardiography was performed before cardiac catheterisation in 69 consecutive patients with suspected aortic stenosis. Agreement between the maximum and the mean Doppler gradients and catheterisation gradients was good. Doppler echocardiography, however, systematically underestimated the maximum and mean gradients, particularly in the high range. Stepwise regression analysis of the small pressure difference between the two methods showed that it could not be explained by age, sex, stroke volume, differences in heart rate, ejection fraction, the presence of coronary artery disease, or severity of aortic regurgitation. There was a negative curvilinear correlation between the maximum and mean Doppler gradients and the aortic valve areas that were measured at catheterisation in patients with pure aortic stenosis. The degree of correlation decreased when patients with concomitant aortic regurgitation were included. The scatter of gradients above and below the correlation line was large and this was caused by low and high transvalvar flow. These results show that the usefulness of Doppler gradients for judging the severity of aortic stenosis, both in relation to immediate diagnosis and follow up, is severely limited if transvalvar flow is not taken into account.     

Respiratory gas exchange during treadmill exercise testing: reproducibility and comparison of different exercise protocols.

Ten subjects performed 4 maximal exercise tests to evaluate reproducibility and effects of treadmill inclination on submaximal and maximal oxygen consumption. They performed a standard Bruce protocol twice, and 1 protocol with progressive speed increase with constant, or without, inclination. At maximal exercise there was no significant difference between the protocols in oxygen consumption, respiratory gas exchange ratio, minute ventilation, plasma lactate, serum potassium or heart rate. Exercise time and treadmill distance were shorter than Bruce protocol with inclination, and considerably prolonged without. Reproducibility for Bruce protocol was good for group comparison of oxygen consumption throughout exercise. The individual variations for oxygen consumption were small at maximal exercise, but were considerable at rest and at the lowest exercise steps, this was slightly improved by analysing longer sampling time. Thus, measurement of oxygen consumption is reliable for group analysis, but interpretation must be careful in individuals unless maximal exercise is obtained. Treadmill inclination may be adjusted according to individual preferences.     

Lipid accumulation in the myocardium during acute regional ischaemia in cats

Accumulation of lipid material in the myocardium was studied in cat hearts with acute regional ischaemia of 3 h duration. The fractional volume of lipid droplets in cytosol was analysed by electron microscopy of myocardial biopsies using a quantitative stereologic technique. Ischaemic and normally perfused myocardium were identified by fluoresceine injection, and tissue blood flow measurements were performed with labelled microspheres. In normal myocardium only small amounts of lipid droplets were found. A marked accumulation of lipid droplets occurred in borderline tissue between the two types of myocardium, whereas lipid accumulation in ischaemic myocardium was less pronounced. The arterial concentration of nonesterified fatty acids was clearly increased during the 3 h coronary artery occlusion period. Increased triglyceride synthesis from arterial fatty acids, or redistribution of intracellular lipids, are suggested as possible explanations for lipid accumulation during acute myocardial ischaemia.     

Perforated peptic ulcer over 56 years. Time trends in patients and disease characteristics.

Perforated gastroduodenal ulcer was studied in 1483 patients in the Bergen area during the years 1935-90 to discover time trends in age and sex, disease characteristics, treatment, and outcome. The male:female ratio fell from 10:1 to 1.5:1, median age increased from 41 to 62 years. Most perforations were found in the duodenum in 1935-64, and in the pyloric and praepyloric area in 1965-90. There was a 10% occurrence of gastric ulcers throughout the study period. Ulcer site was related to age (more gastric and less duodenal perforations with increasing age) and sex (more pyloric and less duodenal ulcers among women). There were twice as many perforations in the evening compared with the early morning. The diurnal variation was more pronounced for duodenal and pyloric than for gastric and praepyloric perforations. Circadian and seasonal variation of ulcer perforation did not change during the 56 years studied. Treatment delay increased from median five hours to median nine hours. Infective complications and mortality fell with the introduction of antibiotics around 1950. General complications has increased in recent years because of the increase of elderly patients. Among patients who died, the proportion with associated disease rose from 27 to 85% during the study period.     

DNA methylation of the CYP1A1 enhancer is associated with smoking-induced genetic alterations in human lung

CYP1A1 (cytochrome P4501A1) catalyze the conversion of polycyclic aromatic hydrocarbons into reactive metabolites, which may induce DNA damage. We hypothesized that DNA methylation of the CYP1A1 enhancer could be involved in inter-individual differences in mRNA levels of CYP1A1 or affect the smoking-induced DNA damage in human lung. Using DNA bisulfite conversion and pyrosequencing, we show that DNA methylation of the CYP1A1 enhancer is affected by smoking. In adjacent histologically normal lung from lung cancer patients (n = 120), low levels of DNA methylation of the CYP1A1 enhancer were related to high levels of smoking-induced hydrophobic DNA adduct (p < 0.03), and to the presence of TP53 or K-ras mutations in the corresponding lung tumors (p < 0.03). We found an inverse correlation between DNA methylation of the CYP1A1 enhancer and mRNA levels in vivo (Spearman r = -0.54; p < 0.0001). Thus, in lung tumor tissues, the CYP1A1 enhancer hypermethylation was associated with lower mRNA levels compared to adjacent histologically normal tissue (p < 0.0001). In vitro, using a panel of cultured human lung cells, we found hypermethylation of the CYP1A1 enhancer in cancer cell lines and an inverse correlation between DNA methylation and mRNA levels (Spearman r = -0.53; p = 0.003). Altogether, our results indicated that low levels of DNA methylation of the CYP1A1 enhancer in histologically normal human lung were associated with high CYP1A1 mRNA levels and with smoking-induced genetic alterations; thus, it may play a role in the initiation of lung carcinogenesis.     

Polymorphisms of DNA repair genes and risk of non-small cell lung cancer

Lung cancer is a leading cause of cancer mortality with an inter-individual difference in susceptibility to the disease. The inheritance of low-efficiency genotypes involved in DNA repair and replication may contribute to the difference in susceptibility. We investigated 44 single nucleotide polymorphisms (SNPs) in 20 DNA repair genes including nucleotide excision repair (NER) genes XPA, ERCC1, ERCC2/XPD, ERCC4/XPF and ERCC5/XPG; base excision repair (BER) genes APE1/APEX, OGG1, MPG, XRCC1, PCNA, POLB, POLiota, LIG3 and EXO1; double-strand break repair (DSB-R) genes XRCC2, XRCC3, XRCC9, NBS1 and ATR; and direct damage reversal (DR) gene MGMT/AGT. The study included 343 non-small cell lung cancer (NSCLC) cases and 413 controls from Norwegian general population. Our results indicate that SNPs in the NER genes ERCC1 (Asn118Asn, 15310G>C, 8902G>T), XPA (-4G>A), ERCC2/XPD (Lys751Gln) and ERCC5/XPD (His46His); the BER genes APE1/APEX (Ile64Val), OGG1 (Ser326Cys), PCNA (1876A>G) and XRCC1 (Arg194Trp, Arg280His, Arg399Gln); and the DSB-R genes ATR (Thr211Met), NBS1 (Glu185Gln), XRCC2 (Arg188His) and XRCC9 (Thr297Ile) modulate NSCLC risk. The level of polycyclic aromatic hydrocarbon-DNA (PAH-DNA) adducts in normal lung tissue from 211 patients was analysed. The variant alleles of XRCC1(Arg280His), XRCC1 (Arg399Gln), ERCC1(G8092T), ERCC5(His46His) and MGMT/AGT(Lys178Arg) were more frequent in patients with PAH-DNA adduct levels lower than the mean whereas the XRCC1(Arg194Trp) variant was more frequent in cases with higher adduct levels than the mean.     

The female gender has a positive effect on survival independent of background life expectancy following surgical resection of primary non-small cell lung cancer: a study of absolute and relative survival over 15 years

Surgical resection is the treatment of choice for non-advanced lung cancer, but is encumbered with an overall relative poor long time prognosis. The purpose of this study was to examine if long time survival for patients operated for non-small cell lung cancer have changed over a 15 years period. We retrospectively studied hospital records of the 351 patients operated, with the intention to cure, for a primary non-small cell carcinoma (NSCLC) in our department between 1 January 1988 and 31 December 2002. Preoperative clinical variables were noted together with variables allowing staging based on pathological examination. Absolute survival and survival relative to expected was studied for the whole group using uni- and multivariate Cox analyses. Early 30 days mortality was 2.0%. The 5-year absolute and relative survivals for all patients were 46.3% and 52.6%, respectively. After 10 years corresponding values were 32.9% and 44.6%. At the end of the study, the 15-year absolute survival was 27.8% with a relative survival of 46.2%. Univariate analysis revealed that age, gender, nodular stage, tumour size, p-stage, type of resection, time of operation and additional cardiovascular disease at the time of operation significantly influenced survival. Multivariate analysis for all patients revealed that low age, female gender, low nodular stage, and operation late in the study period were significant prognostic factors predicting improved survival. When including a population based age- and gender-adjusted median expected life time for every patient as a predictor for survival, only female gender and low nodular stage were additional significant and independent positive prognostic factors.