Re-mediastinoscopy in the assessment of resectability of lung cancer.

OBJECTIVE: Thirty-one patients underwent re-mediastinoscopy in the diagnostic assessment of lung cancer. The reason for a repeat mediastinoscopy was either a negative result at the first operation in spite of CT indication of enlarged nodes or an incomplete first mediastinoscopy. METHODS: All patients underwent a conventional mediastinoscopy. RESULTS: In 22 patients with enlarged mediastinal lymph nodes at computed tomography, 10 had a positive lymph node histology at re-mediastinoscopy, while 12 were negative. In 9 patients with no enlarged mediastinal nodes at CT scan, but incomplete biopsies at the first mediastinoscopy, 1 patient had lymph node metastases. The median duration from the first to the second mediastinoscopy was 43 days. No major complications occurred. The staging of the patients was greatly affected by the re-mediastinoscopy. Of 31 patients judged as operable according to the initial mediastinoscopy only 60% were found to be operable following the second mediastinoscopy. CONCLUSION: This study has demonstrated the value of re-mediastinoscopy in assessment of resectability of lung cancer.

Jurisdiction in community nursing services.

This article focuses on community-health nursing services and their jurisdiction in Norway. The aim of the study was to analyze and gain a better understanding of community-nursing services' jurisdiction and jurisdictional pressure. The areas of investigation were degree of jurisdictional control, pattern of pressure in the jurisdiction, and nurses' strategies to deal with this pressure. The respondents were nurses in public health nursing service, home nursing service, and nursing homes. The results showed that nurses in the three different community-nursing services had different degrees of formal and informal control in their jurisdictions. Patterns of pressure were visible both inside and outside of the jurisdiction. Jurisdictional pressure led to strategies that strengthened control of the work, fortified professional status, or both.

A DNA vaccination regime including protein boost and electroporation protects cattle against foot-and-mouth disease.

Protection against foot-and-mouth disease (FMD) using DNA technology has been documented for sheep and pigs but not for the highly susceptible species of cattle. Twenty-five Holstein Friesian cross-bred cattle were vaccinated twice, 21 days apart, with a DNA vaccine containing the capsid coding region (P1) along with the non-structural proteins 2A, 3C and 3D (pcDNA3.1/P1-2A3C3D) of O(1) Kaufbeuren alone or coated onto PLG (d,l-lactide-co-glycolide) microparticles. In some pcDNA3.1/P1-2A3C3D was also combined with an adjuvant plasmid expressing bovine granulocyte macrophage colony stimulating factor (GM-CSF). DNA vaccinations were administered intramuscularly with, or without, the use of electroporation and at 42 days post primary vaccination cattle received a protein boost of 146S FMD virus (FMDV) antigen and non-structural protein 3D. For comparison, four cattle were vaccinated with a conventional FMD vaccine and two more included as unvaccinated controls. Apart from those immunised with PLG microparticles all cattle were challenged with 10(5) TCID(50) cattle adapted O(1) Lausanne FMDV virus at day 93 post primary vaccination. All DNA vaccinated cattle regardless of regime developed good humoral and cell mediated responses prior to challenge. The best overall virus neutralising antibody, IFN-γ and clinical protection (75%) were seen in the cattle whereby the DNA was delivered by electroporation. In contrast, only 25% of cattle vaccinated with the DNA vaccine without electroporation were clinically protected. The addition of GM-CSF in combination with electroporation further improved the efficacy of the vaccine, as demonstrated from the reduction of clinical disease and virus excretions in nasal swabs. We thus demonstrate for the first time that cattle can be clinically protected against FMDV challenge following a DNA prime-protein boost strategy, and particularly when DNA vaccine is combined with GM-CSF and delivered by electroporation.

Potentiation of an anthrax DNA vaccine with electroporation.

DNA vaccines are a promising method of immunization against biothreats and emerging infections because they are relatively easy to design, manufacture, store and distribute. However, immunization with DNA vaccines using conventional delivery methods often fails to induce consistent, robust immune responses, especially in species larger than the mouse. Intramuscular (i.m.) delivery of a plasmid encoding anthrax toxin protective antigen (PA) using electroporation (EP), a potent DNA delivery method, rapidly induced anti-PA IgG and toxin neutralizing antibodies within 2 weeks following a single immunization in multiple experimental species. The delivery procedure is particularly dose efficient and thus favorable for achieving target levels of response following vaccine administration in humans. These results suggest that EP may be a valuable platform technology for the delivery of DNA vaccines against anthrax and other biothreat agents.

Electroporation-based DNA transfer enhances gene expression and immune responses to DNA vaccines in cattle.

Despite the potential of DNA vaccines to induce strong, balanced immune responses in small experimental species, the immune responses to DNA immunization in larger species have generally been moderate and inconsistent. In this study, the TriGridtrade mark Delivery System (TDS), an electroporation-based DNA delivery platform, was evaluated for administration of DNA vaccines to calves. When compared to conventional intramuscular delivery, TDS-based delivery markedly and consistently enhanced gene expression from a plasmid encoding a reporter gene, secreted alkaline phosphatase, and improved cell-mediated and humoral immune responses to a plasmid encoding a model antigen, hepatitis B surface antigen. Importantly, the TDS-based procedure was well tolerated by the calves, which did not need to be anesthetized or sedated. These results suggest that the TDS is a useful delivery method for DNA vaccines in cattle.

Enhancement of immune responses to an HBV DNA vaccine by electroporation.

These studies document the ability of electroporation (EP)-based DNA vaccination to induce multi-specific CTL responses to hepatitis B virus (HBV) DNA vaccination in normal mice and marked immune responses to multivalent HBV DNA immunization in larger animal species. These results suggest that electroporation-mediated HBV DNA vaccination is worth pursuing as a treatment for chronic HBV infection.

The experience of collaboration: a comparison of health visiting in Scotland and Norway.

This investigation compared health visiting in Scotland and Norway by focusing on collaboration in health visiting. The data are based upon in-depth interviews with a non-probability sample, with voluntary participation of nine health visitors from Scotland and 12 health visitors from Norway. The results showed that there were more similarities than differences between the Scottish and Norwegian health visitors' experience of collaboration in their work. Both groups had a complex role-set and experienced dependency on role partners. Collaborative strain was experienced through lack of recognition and system deficiencies. Tensions in collaboration evolved from the definition and question of responsibility in grey areas, jurisdictional threats and conflicts. Within these areas the degree and importance of collaboration differed. The Scottish health visitors were more dependent on client referrals to them and their referrals to other agencies, whereas the Norwegians health visitors experienced an asymmetrical relationship, as they were more dependent on the capacity of the agency to accept the referrals. Lack of recognition seemed to be a stronger experience in Norway than in Scotland. All of this had a marked influence on the performance of the health visitors. Further research should address the question of collaboration in health visiting work and to what degree it influences the quality of health visiting and consequences for clients, the community and health visiting service.

Changes in health visitors' work.

AIMS: The purpose of this investigation is to describe Scottish health visitors (HVs) experience of changes in their work and compare these with their Norwegian counterparts. BACKGROUND: The renewed emphasis on community health care, health promotion and illness prevention is a strong reason to focus on health visiting work. Knowledge about changes in practice are of special interest for nursing science as such knowledge could contribute to the development and advancement of the health visiting service. DESIGN: The study used a comparative descriptive design. The data are based upon in-depth interviews with nine HVs from Scotland and 12 HVs from Norway. RESULTS: The results showed similarities as well as differences. HVs in Scotland and Norway experienced changes in work load with decreases in some areas and increases in others, changes in work practice, approaches and techniques with more emphasis on clients' empowerment, and also fewer management positions held by nurses. The differences mainly related to the ways that the health visiting service had specialized and expanded. The aim of Scottish health visiting from 'cradle to grave' service was not adopted by the Norwegian HVs to the same extent. Scottish HVs specialized individually in some areas and used each other's competence to a much greater degree than the Norwegian HVs. CONCLUSIONS: It appeared that the Scottish HVs had found a path where health visiting work aimed at illness prevention and health promotion for everyone was on the way to becoming a comprehensive service and a stronger and more integrated part of the health visiting service. This is a pathway that Norwegian HVs still have to pursue. The qualitative approach and the slightly different samples limited the possibility for generalizations. Further research should address the question of changes and patterns in health visiting work, of how the development came about, and what are the bases for the differences in specialization and expansion of the service. Secondly it should be asked to what degree the development influences the quality of health visiting and consequences for clients, community and health visiting service.

Influence and leadership in community-based nursing in Norway.

This study investigated the perception of influence and decision making among mid-level community-based nurses. Respondents were nurses and nurse leaders in public health nursing, home nursing, and nursing in nursing homes in the municipality. Nurses in three nursing services located within each municipality's Community Health Service in 72 municipalities were surveyed or interviewed. The results show that the leaders of the nursing service and nurses in the three services are regarded as having influence, and in fact, possess more influence on the decision process than the administrative leaders and political management. There are great differences in the perception of decision making among the leaders of the nursing service and nurses in the three services. The leader of the health visiting service has less influence on decision making than the leader of the nursing home, while the health visitor has more influence on decision making and autonomy in professional work than the nurse in the nursing home. These differences might be explained by contextual factors such as tradition, gender, and work process.

Health visiting in Scotland and Norway: commonalties and differences.

This investigation compared health visiting in Scotland and Norway by focusing on health visitors' influence on management matters, work tasks and work conditions. The data are based upon in-depth interviews with nine health visitors from Scotland and 12 health visitors from Norway. The results showed more similarities than differences between the Scottish and Norwegian health visitors. Both groups experienced autonomy at work. The hardships of work were the lack of visibility for their work and an inability to demonstrate in measurable ways the effect of their work. Issues related to lack of time and priority of the newborn and young children were also similar as well as the experience of insecurity and strain at work. The differences were mostly within the area of organizational structure and its influence on management matters. While the Norwegian HV participated in plans for the service, employment and budget proposals, the Scottish HV was involved in these matters to a lesser degree. All in all, the similarity of the themes and the comparable units suggest the core of health visiting extends beyond the limits of cultural and national boundaries.

Facial palsy in acute otitis media.

During the 17-year period from 1977 to 1994 a total of 23 patients in Copenhagen County were admitted to hospital with facial palsy, developed during acute otitis media. This corresponds to an annual incidence of 2.3 per million inhabitants. In the pre-antibiotic era it was estimated that 0.5% of patients with acute otitis media developed facial palsy. Our figures indicate a decrease of this complication by a factor of 100, to 0.005%. Although fourteen of the patients were children, the risk of an acute otitis media being complicated by facial palsy seems to be highest in adults (who have a low incidence of acute otitis media). All the children were < or = 3 years of age and 2/3 of the adults > or = 50 years of age. Complete remission was seen in all patients, except one. The time interval to complete remission was correlated significantly with the degree of the facial palsy on admission, as it was longest in the most severe facial palsies.

Empowered nurses? Nurses in Norway and the USA compared.

This comparative study investigated to what degree nurses from two major university hospitals, one in the USA and one in Norway, experienced empowerment. Nurses' experiences of power were studied, as operationalized by Laschinger in her model and instruments. Laschinger's model is based on Kanter's theory of structural determinants of behaviour in organizations. The Norwegian sample consisted of 590 nurses with a response rate of 70.5%; the North American sample consisted of 135 nurses with a response rate of 55%. The results showed both similarities and differences. Formal power for both samples explained 51% of the variance of the overall empowerment, while informal and formal power explained 62%. The Norwegian nurses experienced slightly more informal power while the USA nurses experienced more formal power. There were significant differences, in each hospital, in items within the theoretical constructs, when cross-tabulated by demographic variables. Leadership position was the demographic variable that most clearly differentiated in both hospital samples, with more power for the leaders. The small differences between nurses from two hospitals in two different countries in developed parts of the world raises some questions. The importance, or lack of importance, of cultural and organizational differences might be one area for further exploration. Overall, the methodology is valuable for further testing of nurse empowerment in different settings, as well as in change and implementation studies.

Humerus varus: a complication of neonatal, infantile, and childhood injury and infection.

Sixteen cases of humerus varus consequent to proximal humeral fracture and osteomyelitis are described. A similar, but variably severe pattern of progressive deformity occurred in all cases. The medial region of the proximal humeral physis usually either developed slowly or failed to develop, whereas the lateral region developed more normally. This caused progressive angular rotation of the proximal humeral epiphysis and physis, so that the lateral region of the growth plate, in its most severe expression, was almost aligned with the longitudinal axis of the shaft. In the majority of the cases, there was a medial-metaphyseal lucency and adjacent medial-osseous bridge. In some cases, a flattened epiphysis and central bridge were present, with less varus deformation with progressive growth. Shortening of the humerus occurred in all cases. Functional impairment, usually a mild to moderate limitation of glenohumeral abduction, was infrequent, even when the dominant arm was involved. Axial lengthening may yet be undertaken. Surgical realignment with a corrective (valgus) osteotomy of the proximal humerus does not, however, appear functionally necessary for all patients.