ABSTRACT
BACKGROUND: Immunization policy-making bodies advised against immunizing too early before the influenza season because vaccine-specific antibody may wane before the end of the influenza season. Lung transplant patients are included in the group of high-risk patients for whom this recommendation had been made. We hypothesized that immunosuppressed lung transplant patients would maintain protective concentrations of influenza antigen-specific antibodies between seasons. METHODS: As part of a planned 5-year study of influenza vaccine responses in lung transplant patients, we measured influenza antibody concentrations by hemagglutination inhibition assay before influenza immunization annually. The fraction of lung transplant patients who maintained seroprotective levels (≥ 40 hemagglutination units) approximately 11 months from last season immunization was calculated. Antibody concentrations and response rates in lung transplant patients were compared with healthy individuals and those waiting for lung transplantation. RESULTS: The majority of lung transplant patients maintained seroprotective influenza antigen-specific antibody concentrations for approximately 11 months after immunization. Seroprotection rates varied greatly with influenza antigens (healthy 68-100%, pretransplant 44-100%, transplant 64-100%), and were similar when groups were compared. More than 70% of lung transplant patients maintained seroprotective antibody concentrations to 10 of 11 vaccine antigens. CONCLUSION: Seroprotective influenza antibody concentrations are maintained at very high rates among immunosuppressed lung transplant patients and depend more on the vaccine virus than the immunostatus of the vaccine recipient. Early seasonal influenza immunization of lung transplant patients is appropriate.
Subject(s)
Antibodies, Viral/physiology , Influenza Vaccines/immunology , Influenza, Human/prevention & control , Lung Transplantation/immunology , Adult , Female , Humans , Influenza, Human/immunology , Male , Middle Aged , Seasons , Time FactorsABSTRACT
An exploratory study of 168 nurses has yielded a new dimension of practice patterns, work excitement, a prerequisite to effective practice and quality care. Four reasonable and attainable factors were found to be significant predictors of work excitement: work arrangements; a learning environment that fosters individual growth and development; variety of experiences; and positive working conditions.
Subject(s)
Burnout, Professional/prevention & control , Job Satisfaction , Nursing Staff/psychology , Adult , Burnout, Professional/etiology , Creativity , Female , Humans , Internal-External Control , Learning , Male , Middle Aged , Nursing Staff/education , Organizational Culture , Professional Practice , Surveys and QuestionnairesABSTRACT
Rotary aircraft play a growing role in the transport of critically ill patients who may require emergency treatment, including defibrillation, during transport. The close quarters and proximity of vital electronic equipment have generated concern among personnel carrying out defibrillation in the air. We address the chief safety issues in helicopter defibrillation by providing measurements of the transient leakage current resulting from contact with a paddle and tested in-flight electronic interference and survey the defibrillation experience of helicopter programs. Our data show that airborne defibrillation is safe. A maximum of 1.5 mA of transient leakage current was measured from a standard battery-powered defibrillator, well within the accepted safety standard of 50 mA. In flight, there was no interference with the avionics or medical equipment, and adequate clearance was available for personnel. Of the helicopter programs surveyed, 69 (87%) had defibrillated in flight without incident. We conclude that defibrillation can be performed in the helicopter without hesitation whether on the ground or in the air, provided standard defibrillation precautions are observed.
