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Aim The objective of this study was to explore nurses' perceptions regarding their knowledge, skills, and preparedness for disasters and how they acquired their knowledge about disaster preparation using a quantitative approach. Methods A descriptive cross-sectional survey using the Disaster Preparedness Evaluation Tool was distributed to nurses in six hospitals (three private, three public) throughout Miyazaki Prefecture located in southern Japan. Results Nine hundred and seventy-three surveys (87.4%) were returned. Seventy-two were eliminated leaving 902 (81.0%) for data analysis. Mean scores for preparedness, response abilities, and evaluation all scored below normal on a 6 point Likert scale (2.63, 2.02, and 2.05, respectively). Overall, nurses felt they were not able to respond in a variety of disaster situations, were aware of their workplace emergency disaster plan, but did not think they could execute them, and were not aware of the level of preparedness of the healthcare systems in their communities. Conclusion The amount of information nurses need to know on the knowledge, skills, and preparation of disasters are in great need. Such skills are understood, but lacking for various reasons. In-house programs for nurses to learn more about disaster nursing are needed. Furthermore, a curriculum for disaster preparedness for undergraduate and graduate nursing programs would also help these future nurses gain more information earlier on to better prepare them for possible disaster situations in their future careers.

The objective of this study was to explore nurses' perceptions regarding their knowledge, skills, and preparedness for disasters and how they acquired their knowledge about disaster preparation using a quantitative approach.A descriptive cross-sectional survey using the Disaster Preparedness Evaluation Tool was distributed to nurses in six hospitals (three private, three public) throughout Miyazaki Prefecture located in southern Japan.Nine hundred and seventy-three surveys (87.4%) were returned. Seventy-two were eliminated leaving 902 (81.0%) for data analysis. Mean scores for preparedness, response abilities, and evaluation all scored below normal on a 6 point Likert scale (2.63, 2.02, and 2.05, respectively). Overall, nurses felt they were not able to respond in a variety of disaster situations, were aware of their workplace emergency disaster plan, but did not think they could execute them, and were not aware of the level of preparedness of the healthcare systems in their communities.The amount of information nurses need to know on the knowledge, skills, and preparation of disasters are in great need. Such skills are understood, but lacking for various reasons. In-house programs for nurses to learn more about disaster nursing are needed. Furthermore, a curriculum for disaster preparedness for undergraduate and graduate nursing programs would also help these future nurses gain more information earlier on to better prepare them for possible disaster situations in their future careers.

Cardiac Memory Modifies Repolarization Dispersion.Introduction: Transient T wave changes after cessation of preexcitation have been attributed to cardiac memory. However, there have been no reports on the effects of long-term cardiac memory on repolarization dispersion before and after catheter ablation in patients with Wolff-Parkinson-White (WPW) syndrome. Methods and Results: We investigated 47 patients with an accessory pathway (AP; 24 manifest left-sided, 14 manifest right-sided, and 9 concealed left-sided). Repolarization dispersion was analyzed by two methods, recovery time (RT) dispersion and newly proposed T wave width (WT), from 87-lead body surface maps before, 1 day after, and 7 days after catheter ablation. RT dispersion and WT were significantly correlated before, 1 day after, and 7 days after catheter ablation (r = 0.78). In patients with preexcitation, RT dispersion and WT increased significantly (P < 0.05) 1 day after catheter ablation (178 ± 32 msec and 172 ± 30 msec) compared with those before (154 ± 24 msec and 156 ± 18 msec) and 7 days after catheter ablation (147 ± 19 msec and 156 ± 16 msec), respectively. However, there were no significant changes in RT dispersion and WT before and after catheter ablation in concealed WPW syndrome. Conclusion: The findings suggest that the abrupt changes in activation sequence increase repolarization dispersion in the presence of previous cardiac memory, and that the dispersion decreases days or weeks after alteration of activation sequence by catheter ablation, with development of new cardiac memory in patients with manifest WPW syndrome.

Preexcitation in Wolff-Parkinson-White syndrome (WPW) has been reported to induce long-lasting changes in ventricular recovery properties. However, there has not been a report concerning changes in the activation-recovery interval (ARI) in 12-lead ECGs before and after catheter ablation (CA) in patients with WPW syndrome. The present study compared changes in ARIs from 12-lead ECGs with those from body surface unipolar leads before and after CA to examine whether ARIs from limb leads of 12-lead ECGs provide useful information on changes in recovery properties in addition to the ARIs from precordial leads. The study population consisted of 27 manifest WPW patients with a left- (n=18, group A) or right-sided accessory pathway (n=9, group B). ARIs in leads I, II, and III were strongly correlated with those in unipolar leads over the left lateral, left lower, and right lower chest, respectively. ARIs in leads aVR, aVL, and aVF showed a significant correlation with those in unipolar leads over the right upper, left upper, and lower anterior chest, respectively. These correlations were maintained before and after CA. Furthermore, in group A, ARIs in lead V1 tended to increase on day 7 post CA compared with before CA and on day 1. In group B, ARIs in lead III significantly decreased on day 7 compared with before CA and on day 1. These findings suggest that ARIs from the limb leads of 12-lead ECGs may represent those from unipolar leads of a particular area over the body surface, and that ARIs from 12-lead ECGs may provide useful quantitative information on changes in recovery properties before and after CA in patients with manifest WPW syndrome.

本研究は, 初対面の患者に対し, 看護実践を発展的に継続するための看護現象の情報化に関する知見の検証を目的とする。研究対象は某精神病院に入院中の女性患者に初めて関わりをもった看護場面における看護職者の認識である。研究方法は, まず筆者自身が関わった性質の異なる5事例との初対面の看護場面を, 看護職者の認識に焦点を当て, 感情とそれ以外の認識に分けて分析できるフォーマットを用いて再構成した。その後, 各看護場面の看護職者の認識を, 状況の流れに沿って個別性を捨象しつつ性質をとり出す科学的抽象法を用いて分析したところ, 以下の4つの項目の認識の特徴を抽き出すことができ, 1,3,4の項目は看護実践を発展的に継続するための看護現象の情報化に関する知見として検証できた。1.看護職者が患者に対し, 自己の心情を語り, 自己開示を行うと, 患者は看護職者に関心をもち始め, 互いの感情交流が深まる。2.看護職者のタイミングのよい反復された働きかけで, 患者は自分だけの世界から自分以外の世界への事象に関心を持ち始める。3.看護職者が, 患者の顔の表情や態度などの変化から精神状態を予測した働きかけをすることで, その後の看護実践が発展する。4.看護職者が患者の立場を理解できると, 次の看護実践へのとりかかりが容易になる。, This study aims at verifying the knowledge on information processing of nursing phenomena in order to continue favorable nursing practices. The subject of investigation here is the understanding of a nursing staff at the first meeting with female patients in the mental hospital. The procedure is as follows ; a format is designed with which nursing staff can reproduce each nursing scene of their first meetings with their patients. First the author, a nursing staff, records 5 cases of different types he partcipated in terms of his emotional and non-emotional understanding respectively. Then these cases are analyzed using the scientific abstract method, which eliminates individualities and extracts common natures. As a result, 4 types of understanding are extracted in common. We see that type 1 and type 3 and type 4 of understanding are verified. 1. When a nurse shows personal feelings and expresses his or herself to the patient, the patient will begin to have interest in the nurse, deepening the exchange of feelings between the two. 2. With good repeated timing by nurses, patients can begin to have feelings towards phenomenon not only in their own world but also into worlds other than their own. 3. By exerting much effort into predicting the mental state of a patient from the changes in the expressions on a patient's face or attitudes, nurses develope their nursing practices. 4. When a nurse is able to understand the patient's positions, it becomes easier to start the next nursing practice.

Radiofrequency catheter ablation guided by pace-mapping techniques has proven effective in eliminating idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT). A method for rapidly identifying the origin of VT from 12-lead electrocardiogram (ECG) findings would be helpful for the catheter ablation procedure. The purpose of this study is to precisely localize the origin of idiopathic VT from the RVOT by a 12-lead ECG from a study of multipoint pace mapping. In one patient with premature ventricular complex (PVC) and 3 with VT, a "basket" catheter was deployed in the RVOT for bipolar pacing from 56 sites in the endocardium of RVOT. Under fluoroscopy the pacing sites were classified into the septum and free wall. We investigated the QRS morphology in leads, I, II, and III; the depth of the QS wave in leads aVR and aVL; and the height of the initial r wave in leads V1 and V2. Pacing was captured in 30-47 of 56 sites (54%-84%). As the pacing sites changed from the anterior to posterior of the septum, the QS notch (-) type in lead I shifted through rs to R, while a shift from R type to rR' or Rr' was noted in leads II and III. As the pacing sites changed from the anterior to posterior of the free wall, lead I showed a shift from the QS notch (+) type to R, while a shift from rR' to Rr' (or rR' unchanged) was found in leads II and III. The depth of the QS wave in leads aVR and aVL showed a tendency for aVR to be deeper than aVL toward the posterolateral attachment of both the septum and free wall, whereas aVL tended to be deeper than aVR toward the anterior attachment. The initial r waves in V1 and V2 became greater as the pacing site was positioned at a higher or more posterior location. These findings may provide more precise and clinically useful diagnostic information on the site of the origin of idiopathic VT originating from the RVOT by a 12-lead ECG.

The activation-recovery interval (ARI), measured directly from the myocardium, has shown a good correlation with the action potential duration (APD) in experiments. APD has been reported to be inversely related to the activation time (AT). However, no studies have examined the correlation between the body-surface ARI and AT in normal subjects. Fifty normal subjects (25 men and 25 women) were studied to elucidate the relationship between the body-surface ARI and AT. The body-surface AT was defined as the duration between the QRS onset and the minimum dV/dt of the QRS wave, and ARI as the interval between the minimum dV/dt of the QRS wave and the maximum dV/dt of the T wave in each lead of an 87 unipolar lead system. We also measured the recovery time (RT) defined as the duration between the QRS onset and the maximum dV/dt of the T wave. ARI was inversely correlated with AT (r = -0.73). RT was also inversely correlated with AT (r = -0.61), however, RT had a less heterogeneous distribution than ARI (148 ms vs 159 ms). There were no differences between male and female subjects in the relation between ARI and RT or in the body-surface distribution of ARI and RT. These findings suggest that the body-surface ARI may reflect recovery properties over the cardiac surface and that APD may distribute inhomogeneously over the human cardiac surface with a longer RT over an area with a shorter AT. ARI calculated from body-surface ECG may be a useful noninvasive and repeatedly measurable estimate of APD.

Background: White-coat hypertension has been diagnosed arbitrarily based on different criteria. In 1997, the Joint National Committee-VI (JNC-VI) reported a new classification of hypertension and strongly emphasized the importance of ambulatory blood pressure (ABP) monitoring. The report pronounced normal ABP values for the first time. Hypothesis: The study's aim was to clarify the relationship between casual blood pressure (BP) and ABP of patients with essential hypertension in each stage of JNC-VI classification, and the prevalence of white-coat hypertension diagnosed by using JNC-VI normal ABP criteria. Methods: Ambulatory blood pressure was monitored noninvasively in 232 patients with essential hypertension whose casual BP was ≥ 140/90 mmHg. The patients were classified according to JNC-VI classification, and their casual BP was compared with ABP. The criterion of white-coat hypertension was defined as casual BP ≥ 140/90 mmHg with normal ABP according to JNC-VI criteria (< 135/85 during daytime and < 120/75 during nighttime). Results: Mean ABP increased as the stage advanced, and the differences between casual BP and ABP also increased. There were considerable overlaps in the distribution of ABP among stages. The prevalence of white-coat hypertension was 13% overall: 30% of the patients with isolated systolic hypertension, 19% of those in stage 1,10% in stage 2, and 4% in stage 3. Conclusions: Classification of hypertension based on casual BP may not always correspond in severity to that based on ABP. Ambulatory blood pressure monitoring recommended by JNC-VI is very useful for the evaluation of hypertension to differentiate white-coat hypertension from true hypertension.

Marked T wave abnormalities in 12-lead electrocardiograms often appear after radiofrequency ablation in patients with Wolff-Parkinson-White (WPW) syndrome. Durations of the QRS complex before ablation have been reported to be significantly greater in patients with repolarization abnormalities after ablation than in those with normal repolarization. However, there has been no report concerning the relationship between QRS duration and repolarization abnormalities before ablation. It has been reported that QRST isointegral maps are dependent on local cellular repolarization properties but largely independent of activation sequence, and that they provide quantitative information about repolarization abnormalities. Isointegral maps were constructed from data recorded in 34 patients with WPW syndrome and QRS durations of 0.1 second or longer (21 patients with left-sided accessory pathways and 13 with right-sided pathways) in order to investigate the relationship between QRS duration and abnormalities in repolarization properties during preexcitation. Body surface ECGs were recorded with an 87-lead system at a sampling interval of 1 ms. The QRST values (mean +/- 2SD) from 607 normal individuals were taken to represent the normal range. The area with abnormally low QRST values was designated as the -2SD area and the sum of the QRST values (sigma QRST) in this area was calculated. The QRS duration was found to be significantly related to sigma QRST. These results demonstrate that the patients with WPW syndrome had abnormalities in local repolarization properties that were significantly related to QRS duration during preexcitation. The degree of preexcitation may be important in producing these abnormalities in patients with manifest WPW syndrome. This may result in T wave abnormalities after ablation of the accessory pathway attributable to cardiac memory.

Activation-Recovery Interval in WPW Syndrome. Introduction: Preexisting changes in repolarization properties play an important role in T wave abnormalities (cardiac memory) after ablation in patients with Wolff-Parkinson-White (WPW) syndrome. However, no report has provided direct evidence for prolongation of action potential duration (APD) over a preexcited region before and after ablation. Methods and Results: We studied 10 patients with ventricular preexcitation due to a left-sided accessory pathway (AP) (group M) and 12 patients with concealed left-sided AP (group C) to clarify prolongation of APD using activation-recovery intervals (ARIs) from epicardial and endocardial unipolar electrograms in patients with WPW syndrome. ARI was calculated from unipolar electrograms at the His bundle and the coronary sinus adjacent to the AP during atrial pacing (100 beats/min) before and 30 minutes after ablation. Before ablation, ARIs at the AP site were significantly longer in group M than in group C (255 ± 21 msec vs 211 ± 24 msec; P < 0.01), whereas ARIs at the His bundle did not differ between the two groups (255 ± 20 msec vs 245 ± 27 msec; P = NS). After ablation, group M showed no significant changes in ARIs at the AP and His bundle (256 ± 19 msec and 253 ± 15 msec) compared with before ablation. Conclusion: We found by direct analysis of ARIs from the epicardium that APD prolongation over the preexcited region was present before catheter ablation and persisted after catheter ablation. The gradual changes in repolarization properties, including APD prolongation after discontinuation of AP, may be one mechanism of cardiac memory after catheter ablation in patients with WPW syndrome.

Background —Intracellular calcium overload is believed to play an important role in development of reperfusion arrhythmias. Dipyridamole, an inhibitor of cellular uptake of adenosine, may prevent or terminate reperfusion arrhythmias by reducing intracellular calcium overload. Methods and Results —First, we tested for a preventive effect of dipyridamole. Sixty-one patients who underwent primary PTCA for treatment of acute anterior wall myocardial infarction were enrolled in this prospective study. Patients were divided into dipyridamole (DP) and nondipyridamole (non-DP) groups. The 2 groups had similar baseline characteristics. In the DP group, dipyridamole 0.5 mg/kg was infused intravenously for 3 minutes immediately before reperfusion during primary PTCA. Arrhythmias after reperfusion were analyzed from continuous ECG recordings. None of the patients in the DP group (n=23) had accelerated idioventricular rhythms (AIVR) or ventricular tachycardia (VT). In contrast, 7 (18.4%) had AIVR and 3 (7.9%) had VT in the non-DP group (n=38; P Conclusions —These results indicate that administration of dipyridamole can prevent and terminate reperfusion arrhythmias such as AIVR and VT. cAMP-mediated triggered activity may, at least in part, be responsible for reperfusion-induced AIVR and VT.

Background T-wave abnormalities after catheter ablation in patients with manifest Wolff-Parkinson-White (WPW) syndrome have been attributed to a continuation of repolarization abnormalities induced by preexcitation (cardiac memory). Methods and Results To clarify changes in repolarization properties, we analyzed the activation-recovery interval (ARI) obtained from body-surface maps and the relationship between the activation time (AT) and ARI in 30 patients with WPW syndrome (group A, 18 patients with manifest left-sided accessory pathway; group B, 7 patients with manifest right-sided accessory pathway; and group C, 5 patients with concealed left-sided accessory pathway) before, 1 day after, and 1 week after ablation. The ARI significantly decreased 1 week after ablation compared with before and 1 day after ablation over the preexcited area in groups A and B. Correlation coefficients between the AT and ARI showed a significantly ( P r =−.58) and 1 week after ( r =−.64) ablation than 1 day after ablation ( r =−.46) in groups A and B. In group C, the ARI and correlation coefficients between the AT and ARI showed no significant changes. Conclusions These findings suggest a prolongation of the action-potential duration over the preexcited area before and just after ablation as ventricular “electrical remodeling,” a decrease in the inverse relationship between the AT and action-potential duration 1 day after ablation, and a gradual recovery of the action-potential duration over the preexcited area and inverse relationship 1 week after ablation.

Pulmonary embolism has been thought as a relatively rare disease in Japan. In the recent reports, however, the rate of increase of this disease is almost similar to that in the United States. We reported already about the experimental studies on pulmonary embolism by our original method and studied the roentgenographic changes in relation to the pathohistological findings. In this paper we will report on the experimental studies on embolectomy in the pulmonary artery, especially on the limitation of the effectiveness of this procedure. A total of 45 dogs were used for this study. The embolectomy and thrombectomy by thoracotomy were performed after 1, 2, 3 and 4 days and 1 week following the insertion of the Laminaria-embolus. During thoracotomy the pressure of the pulmonary artery was measured before and after embolectomy. X-rays of the chest were taken after 1 and 3 days and 1 week following embolectomy and we made pathohistological examinations of the resected lungs. We were not able to find any literature on the limitation of the effectiveness of embolectomy in the pulmonary artery. We suppose from these findings that embolectomy should be done 1 or 2 days after the pulmonary embolism occurs and in the early stage when the changes caused by pulmonary embolism are still reversible.