Biomedical subjects
Publications and source records attributed to M Redshaw.
Using Doppler-tuned fast-beam laser spectroscopy the 1s2s 1S0-1s2p 3P1 intercombination interval in 28Si12+ has been measured to be 7230.5(2) cm(-1). The experiment made use of a single-frequency Nd:YAG (1.319 microm) laser and a high-finesse optical buildup cavity. The result provides a precision test of modern relativistic and QED atomic theory.
A comparison was made of the different educational programmes developed to train Neonatal Nurse Practitioners (ENB A19) in the UK. The structure and character of the programmes were examined in relation to course aims and philosophies, learning outcomes, content, teaching strategies and methods of assessment. Documentation provided by course leaders included hand-books, timetables, teaching staff details and documents concerning supervision and assessment. When viewed closely there are differences between the programmes that are evident in design and curriculum content and which present a quality assurance issue to the institutions validating and running these programmes. The issue of parity and standards is also a critical one for those supporting the development regionally and nationally. Viewed within the broader perspective of post-registration nurse education, these relatively new programmes could be regarded as experiments in which professionals, as teachers and learners, are trying to address the changing boundaries of expertise and professional identities. It is suggested that the nurse practitioner programmes developed for neonatal care could provide a model for similar programmes in other specialties and argued that the experience gained in planning and running these courses could contribute positively to the development of other comparable educational programmes for established and experienced nurses.
The boundaries of nursing in neonatal care, and the interface between the work of nursing and medical staff in delivering care, are changing. The enhanced or expanding role of the neonatal nurse is not a universally accepted one. If this professional development is to be widely accepted and implemented, some key issues will need to be addressed so that the changing role of the nurse and associated skill base are well founded. As part of a large-scale national study of neonatal nursing in England, data were collected from nurses working in 24 different units. Regional centres, subregional centres and district units from six widely separated health regions participated, and individual data were collected from 718 nurses (599 D-I grades and 119 A-C grades). While indicating that there is inter-unit variation in nursing practice, the results also show that many nurses are already in the process of changing their role in this acute specialty. Nurses doing so are more likely to have a qualification in this specialty, though not all of them have. A small number of nursery nurses and nursing auxiliaries were undertaking tasks that could be considered part of an expanded role. The implications of the findings are discussed.
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Neonatal behaviour in a group of infants whose mothers received pethidine during labour was assessed at delivery and during the first six weeks of life by means of the Brazelton Neonatal Behavioural Assessment Scale. The influence of the total maternal dose of pethidine and umbilical cord blood concentration of the drug on such behaviour has been examined with the confounding effects of all other variables controlled. Higher cord blood levels of pethidine were associated with babies who were more prone to respiratory difficulties, drowsy and unresponsive immediately after delivery. Throughout the six weeks in which the assessments were made, depressed attention and social responsiveness were found in infants with high drug levels. At three and six weeks, the infant whose exposure ao pethidine had been high tended to change state more frequently, to cry during the test and to be less capable of quieting himself. These findings suggest that the newborn infant responds to pethidine in the same way as the adult, but the changes observed were relatively subtle, and comparison of these infants with a control groups whose mothers had received no drugs revealed no between-group differences in behaviour.
Four areas of neonatal behaviour have been assessed at delivery and during the following six weeks in a group of infants whose mothers were given epidural bupivacaine during labour. The influence on such a behaviour of the total maternal dose of bupivacaine and umbilical cord blood concentration of the drug has been examined with the confounding effects of other maternal and obstetric variables controlled. Significant and consistent effects of bupivacaine throughout the assessment period can be demonstrated. Immediately after delivery, infants with greater exposure to bupivacaine in utero were more likely to be cyanotic and unresponsive to their surroundings. Visual skills and alertness decreased significantly with increases in the cord blood concentration of bupivacaine, particularly on the first day of life by also throughout the next six weeks. Adverse effects of bupivacaine levels on the infant's motor organisation, his ability to control his own state of consciousness and his physiological response to stress were also observed. Muscle tone alone appeared to improve with increases in the values of the drug variables. These results show that the neonate differs from the adult in respect of both the nature of effects of the drug and sensitivity to it.
The continuous fetal heart rate rate pattern, condition of the baby at birth and its subsequent behaviour were compared in three groups of infants whose mothers received during labour either no drugs, intramuscular pethidine or epidural bupivacaine. The blood levels of pethidine and bupivacaine were measured at delivery in a maternal vein, and umbilical artery and vein, and in the newborn during the first 48 hours of life. The only significant changes in the fetal heart rate pattern occurred in association with maternal hypotension or uterine hyperstimulation. The Apgar scores at one minutes were 7 or less in more infants in the intramuscular pethidine and epidural bupivacaine groups as compared with the controls. There were no differences in the Apgar scores at five minutes. Neonatal behaviour during the first six weeks of life was not significantly affected by pethidine or epidural bupivacaine when compared with the control group. Pethidine and bupivacaine were shown to cross the placenta freely. The half-life of these drugs in the newborn was longer than in the adult.
The changes in serum trypsin concentration have been measured in 47 subjects for up to 2 hours after a Lundh meal. In 18 healthy controls, mean fasting trypsin concentration was 285 +/- 125 ng/ml (mean +/- 2 SD). The maximum increase after the Lundh meal (the trypsin response ratio) was 6.7 +/- 7.5%. Six patients with chronic renal failure had elevated fasting serum trypsin concentrations (range 460-1100 ng/ml) but trypsin response ratios fell within the control range. Of five patients with relapsing pancreatitis, two had raised and three normal or low fasting trypsins. After stimulation two had elevated trypsin response ratios; one of the two had evidence of main duct obstruction. Eleven out of 12 patients with chronic pancreatitis (with or without insufficiency) had low fasting trypsin concentrations (range 0-120 ng/ml) Seven of the 12 also had raised trypsin response ratios. In six patients with cancer of the pancreas, fasting trypsin was low in three, normal in two, and raised in one. Both patients with a normal fasting level had a raised trypsin response ratio. The combination of a single estimation of fasting serum trypsin concentration followed by serial measurements after a Lundh meal provides a useful screening test for chronic pancreatic disease.
A specific and sensitive radioimmunoassay (R.I.A.) has been developed which makes possible the determination of serum or plasma trypsin concentrations despite the presence of trypsin inhibitors, which have invaldiated previously available enzymatic techniques. The assay was most precise at about 300 microng trypsin standard Ag5 per litre of serum, a value comparable with the mean in 76 healthy volunteers (273 microng/1) and in 20 hospital patients with non-pancreatic disease (266 microng/1). Markedly raised concentrations (970-6500 microng/1) were found in all 14 patients with acute pancreatitis and in 8 patients with chronic renal failure (580-1360 microng/1). Abnormal concentrations were found in 11 of 16 patients (69%) with pancreatic cancer (8 high, 3 low) and in 15 of 23 patients (65%) with chronic pancreatitis (3 high, 12 low). Patients with jaundice had normal or marginally lower than normal concentrations unless pancreatic disease or common-duct gallstones were present.
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Legislative changes relating to professional nursing practice and a reduction in junior doctors' working hours have led to an increase in the number of nurse practitioners in the UK. While the educational preparation for these new roles is varied, the challenges faced by nurse practitioners are similar in nature and have implications for the nursing profession as a whole. The measures that can facilitate the development of individual nurse practitioners include: effective communication and negotiation regarding the introduction of their role; clearly defined and documented role descriptions; clarification regarding areas of risk and liability; and organizational and professional support. The stance of the nursing profession in relation to the development of the nurse practitioner role is also explored and questions are raised about cross-boundary working, future role development, and the impact of nurse practitioners on the delivery of patient care.
As part of a study evaluating neonatal nurse practitioner programmes in England, data were collected on the experience of students from four separate English National Board (ENB, A19) programmes. A total of 123 nurses participated. Data were collected from 68 nurses using questionnaires at three points (the start, middle and end of the programme. The data show key concerns relating to the content and organization of course, the need for effective clinical supervision and teaching during the programmes, role transition issues and the value of informal and formal professional support. Senior and experienced nurses may find that their exposure to programmes of this kind is of interest and relevance to nurses facing similar challenges in other fields. It is also of vital importance in planning future skill mix and organizing critical care in specialties such as neonatal care.
The delivery of front-line care in an acute sector of the health care system, the neonatal service, was the focus for a large-scale investigation. The aim was to carry out a major study that could inform policy and identify possible improvements in practice and organisation in the context of concerns about stress in neonatal nursing, staffing levels, skill mix and training. Fifty-six neonatal units and more than 700 nurses participated. Large inter-units differences were found and in many neonatal units the staffing levels and qualification in specialty rates were found to be lower than those recommended. The implementation of the findings are discussed and recommendations made.