Caring for children who die unexpectedly: patterns that emerge out of chaos.

Despite medical advances in technology, improved socioeconomics, and medical knowledge, an estimated 55,000 children die every year in the United States. A phenomenological study was conducted at a tertiary-quaternary children's hospital to determine the emerging patterns amidst the chaos with nurses caring for children dying unexpectedly. Implications for nursing practice include a progression of caring, a set of patterns that emerge out of the seeming chaos of a coding patient. These patterns shed light on the interactive relationships within the hospital and can foster collaboration among bedside nurses, advanced practice nurses, inter-professional team members, directors, and hospital administrators.

Myeloperoxidase -463 (G-->A) polymorphism associated with lower risk of lung cancer.

OBJECTIVE: To study the association of the myeloperoxidase (MPO) -463 (G-->A) polymorphism with lung cancer risk. PATIENTS AND METHODS: We performed a paired case-control analysis of 307 patients with primary lung cancer and an equal number of age-, sex-, and ethnicity-matched controls to evaluate the effect of the MPO -463 (G-->4A) polymorphism on disease susceptibility. We also performed conditional logistic regression analyses to evaluate the effect of the polymorphism adjusted for smoking status and chronic obstructive pulmonary disease, 2 established risk factors. We used 2 models for these analyses: one to compare homozygous (AA) genotypes with wild type (GG) and heterozygous (GA) genotypes and one to compare carriers (heterozygotes and AA homozygotes) with GG genotypes. Finally, we combined the results from the published studies of this putative association and performed a stratified analysis. RESULTS: The AA genotype was inversely associated with susceptibility to lung cancer (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.15-1.00). There was no association in heterozygotes. However, in the stratified analysis, we found an association between patients with the AA (OR, 0.44; 95% CI, 0.27-0.68) and GA (OR, 0.77; 95% CI, 0.64-0.93) genotypes vs the GG genotype. CONCLUSION: Our results are consistent with previous reports and show that homozygotes of the less common A allele of MPO -463 polymorphism have a 2.6-fold lower risk of lung cancer.

Genetic determinants of lung cancer short-term survival: the role of glutathione-related genes.

PURPOSE: Survival of lung cancer patients has been dismal. Glutathione enzymes are directly involved in the metabolism of platinum compounds, a group of important chemotherapeutic drugs in cancer treatment. We tested the hypothesis that genes encoding glutathione enzymes may predict lung cancer short-term survival. METHODS: We studied DNA polymorphisms of 250 primary lung cancer patients at four glutathione-related loci: GSTP1, GSTM1, GSTT1 and gamma-GCS that encode glutathione-S-transferase-pi, glutathione-S-transferase-mu, glutathione-S-transferase-theta, and gamma-glutamylcysteine synthetase, respectively. Pearson's chi(2)-square tests, Kaplan-Meier survival curves, log rank tests, and Cox regression models were applied in the analysis. RESULTS: There were 150 (60%) men and 100 (40%) women in this study. Seventeen percent of the patients had never smoked cigarettes, and 61% had stopped smoking at least 6 months prior to their lung cancer diagnosis. Among never smokers, those with null (N) or low (L) genotype experienced a better 1-year-survival rate than those with a positive (P) or high (H) genotype. Patients with P or H at two loci (PP or PH) were compared with patients with N or L at one or both loci (other). Among never smokers, 1-year-survival rates were 60-78% for patients with PP or PH genotypes compared with 89-100% for other types. The survival advantage was greater among advanced-stage patients who were NL or NN than low-stage patients. Similar results were not observed among smokers. CONCLUSIONS: Glutathione-related genes may determine lung cancer survival. Our results, if confirmed, would suggest new directions to enhance cancer treatment, and provide easily measurable markers for clinicians to plan patient-specific therapy.