Biomedical subjects
Publications and source records attributed to M K Mitchell.
In the story of CHAP's fight for deemed status, Mitchell, CHAP's president, finds important opportunities for nursing to exert moral leadership and initiate political reforms that will have a lasting impact on the quality of community-based care.
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Low-birth-weight infants requiring total parenteral nutrition receive inadequate intakes of calcium (Ca) and phosphorus (P) due to poor solubility of available mineral salts. To optimize Ca/P delivery, we tested the effects on in vitro solubility of mineral salt:calcium glycerophosphate (CaGP) versus calcium gluconate and K2HPO4 (CG + P); Ca:P ratios of 1:1 (at 12.5 and 25 mmol/L of Ca and P) and 2:1 (25:12.5 mmol/L); amino acid (AA) formulation: Aminosyn (A), Aminosyn-PF (A-PF), TrophAmine (T) or Vaminolac (V); and AA concentration (25 versus 8.3 g/L). Parenteral nutrition solutions contained 10% dextrose and vitamins and minerals typical of a neonatal prescription. Solutions were sampled at preparation, after 24 h in the neonatal unit (25 degrees C), and from before and after a 0.22-micron filter in extension tubing through which solutions were pumped at 5 ml/h within an incubator at 37 degrees C. Samples were analyzed for Ca and pH, and precipitation by spectrophotometry at 600 nm and light microscopy at x 100 magnification. The Ca concentration was unaffected by filtration. While spectrophotometry detected only gross precipitation, with light microscopy crystal formation was evident with 25 mmol/L of Ca and P as CG + P in A and T at 25 g of AA/L and in A, V, T, and A-PF at 8.3 g of AA/L. Precipitation did not occur with CaGP or CG + P at 12.5 mmol/L of Ca and P. Under in vitro conditions mimicking the neonatal unit, CaGP versus CG + P resulted in greater mineral solubility even at low AA concentrations.
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CHAP not only promises quality control for health care delivered in the community but also provides for nursing autonomy in regulating its own practice. Mitchell, the senior vice president of CHAP, explains.
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