Plasma N-terminal Pro-atrial Natriuretic Peptide Predicts Death after Premature Myocardial Infarction,but not as well as Radionuclide Ejection Fraction. A Ten-year Follow-up Study

Objective –To assess N-terminal pro-atrial peptide (N-ANP) as a predictor of total and cardiac death in patients with previous premature myocardial infarction (MI). Design –In this prospective cohort study, we measured plasma N-ANP by ELIZA assays and ejection fraction (EF) by radionuclide ventriculography in a cohort of 247 patients (193 men and 54 women) who had had MI at a relatively young age (males: first MI at age &#104 55; females &#104 60). Results –After 10 years 44 patients had died, 36 from cardiac causes. After using a stepwise procedure to adjust for other prognostic factors (i.e. plasma total homocysteine (tHcy), C-reactive protein and age), the relative risk (RR) was 2.00 (95% confidence interval (CI) 1.05-3.80) ( p = 0.03) for death of all causes and 2.32 (95% CI 1.19-4.55) ( p = 0.01) for cardiac death when the top quartile was compared to the three lower quartiles of N-ANP. When radionuclide EF entered the Cox model, N-ANP became insignificant as a predictor of mortality. Conclusion –N-ANP was a significant predictor of total death and cardiac death in young survivors of MI, but radionuclide EF was a more independent prognostic variable.     

Cross‐sector emergency planning for water supply utilities and healthcare facilities

The purpose of this article is to outline the criticality of water supply in sustained operations of healthcare facilities, particularly during community emergencies, and to advocate for enhanced cross‐sector support from the water utilities in meeting this need. Information and ideas presented here were developed in the course of a regional project sponsored by the Metropolitan Washington Council of Governments (MWCOG) for development of emergency water supply operations plans for critical water uses in the Washington, DC, area.     

Exhaled Nitric Oxide: A Novel Biomarker of Adverse Respiratory Health Effects in Epidemiological Studies

The sampling of exhaled breath is a noninvasive procedure that can be performed easily in adults, children, and patients with respiratory disease. Several studies have demonstrated increased exhaled nitric oxide in patients with pulmonary disease, including asthma. In addition, exhaled nitric oxide may be an elegant tool for monitoring of environmental health effects of air pollution and the prevalence of atopy in epidemiological surveys. Recent literature about exhaled nitric oxide is presented in this article. Technical, physiological, and behavioral confounding factors of exhaled nitric oxide measurement are outlined.     

Loyalty in the Workplace: Some Considerations for Mental Health Nurses

Nurses are expected to be loyal to their patients, employer and the nursing profession, while also remaining ‘loyal’ to their own values and aims as both a person and clinician. Loyalty therefore is of central importance to how we relate to people in personal and professional relationships and may affect our attitude to the organization we work for. This column explores the concept of loyalty, and its role in professional relationships, behaviour and practice. Ways that loyalty can be influential in achieving personal, patient and organizational outcomes are explored and the potential to enhance loyalty is considered.