The use of maternal weight measurements during antenatal care. A national survey of midwifery practice throughout the United Kingdom

The aim of the present study was to examine the use of maternal weight measurements during antenatal care throughout the United Kingdom. A postal questionnaire and follow-up letter were sent to 1500 midwives throughout the United Kingdom, selected at random from the UKCC register. The postal survey achieved a response rate of 44.8% (672/1500 questionnaires), and obtained responses from at least 10 midwives in all but the lowest grade. Respondents were representative of midwives practising throughout the country, in terms of their gender, working hours and grade, although there were fewer midwives in community settings than those in a contemporary representative English sample. The questionnaire obtained information on the background, training and experience of each midwife, together with their attitudes towards antenatal weighing. For those midwives currently involved in antenatal care, additional information was collected on the schedule of antenatal weight measurements, the criteria used to identify ‘abnormal’ weight gain, and the action taken in response to ‘abnormal’ weight gain. 61.8% of the midwives thought that the pattern of maternal weight gain was ‘not important’ in antenatal care, and only 51.5% of those who currently provided antenatal care weighted women at every antenatal visit. However, most midwives (86.1%) cited at least one clinical condition to explain why women are routinely weighed during pregnancy, and over a third of midwives thought that maternal weight gain could detect seven clinical conditions, including obesity, oedema, pre-eclampsia and polyhydramnios. Midwives with more advanced qualifications (degrees and teaching qualifications) and those working in educational or community settings were least likely to believe that weight gain was good at detecting clinical outcomes. Differences in the perceived utility of antenatal weighing influenced whether midwives would act in response to ‘abnormal’ maternal weight gain, and whether they advised women to gain or lose weight during pregnancy. However, the criteria that midwives used for identifying ‘abnormal’ weight gain were variable, and often inappropriate, so that different midwives are unlikely to intervene consistently or to give consistent advice on the basis of maternal weight gain. These differences in practice may lead to extensive and inappropriate variation in antenatal care. Clear guidelines are urgently required to ensure that, if maternal weight measurements are collected during antenatal care, they are collected and used consistently.     

Quantitation of CD62, soluble CD62, and lysosome-associated membrane proteins 1 and 2 for evaluation of the quality of stored platelet concentrates

BACKGROUND: Platelets become activated during storage, which results in secretion of granules, vesiculation of microparticles, secretion of protein, and a number of other biochemical and morphologic processes that decrease the utility of platelet concentrates stored for transfusion. STUDY DESIGN AND METHODS: To evaluate the quality of stored platelet concentrates, the cell surface expression of specific activation-dependent antigens (CD62 and lysosome-associated membrane proteins 1 and 2 [LAMP-1, LAMP-2]) on platelets stored in a hospital blood bank over a 7-day period was examined. Relative microparticle counts and the expression of CD62 by microparticles, as well as platelet concentrate supernatant levels of soluble CD62, were determined. RESULTS: The percentage of platelets expressing CD62 increased significantly from Day 1 to Day 5 (p < 0.05) of storage; the mean fluorescence values for CD62 did not. In contrast, the mean fluorescence values of LAMP-1 and LAMP-2 rose significantly (p < 0.01 and p < 0.05, respectively) between Days 1 and 5. Significant declines in CD62, LAMP-1, and LAMP-2 percent expression and mean fluorescence were seen on Day 6 of storage (p < 0.001). Microparticle numbers increased significantly during storage and correlated with levels of CD62 protein (free and membrane-bound) (r = 0.95 vs. Day 2, p < 0.05; r = 0.88 vs. Day 5, p < 0.05). CONCLUSION: Flow cytometric evaluations of the expression of cell surface CD62, LAMP-1, and LAMP-2 are complementary tests that, especially when used in conjunction with the quantitation of CD62 protein, provided a simple and effective means of evaluating the quality of platelet concentrates stored for transfusion.     

The internal consistency and intra-rater reliability of an assessment practice grid for community nurses

The development of instruments to measure clinical competence in nursing shows little evidence of a systematic approach and studies of reliability and validity are absent. The present study was carried out using data on practice assessment collected in the course of a post-registration nursing programme. The data were analysed for internal consistency and intra-rater reliability. The instrument used to assess practice in the present study is highly internally consistent and there is evidence to support intra-rater reliability. However, further development and testing of the instrument is required.     

An inquiry into the attitudes of qualified nursing staff towards the use of individualized nursing care plans as a teaching tool

This paper summarizes a research study inquiring into the attitudes of qualified nursing staff towards the use of individualized nursing care plans as a teaching tool. The survey was conducted in medical and surgical wards used for nurse training, in two hospitals. In common with many hospitals, the introduction ofthe nursing process into the surgical wards is of more recent origin than the medical areas, so would this be reflected in the attitudes of staff? Results indicated an overall positive attitude of all staff, although significant differences were identified between the grades of staff participating in the study and between the two hospitals. There was no significant difference shown in the comparison of all surgical staff with all medical staff, but the ward sister demonstrated a more positive attitude than staff nurses or enrolled nurses. The length of time care plans had been in use and whether the Open University Programme P553 had been completed, were taken into consideration. Analysis ofthe individual statements which clustered around the same theme is discussed. Possible factors affecting the attitudes identified are suggested and recommendations which include ongoing educational support, in particular for the enrolled nurse, and exploration ofthe ‘role model’ function ofthe ward sister made. Finally, the method of study is critically examined.     

Florence Nightingale, feminism and nursing

Three key aspects of Florence Nightingale's remarkable life are examined. First, the influences during her formative years: the education and guidance provided by her father, the resistance by her family when she decided to become a nurse; and the rejection by Nightingale of the societal expectations of a woman in the Victorian era. Secondly, her professional life is examined, in particular how she appears to have been viewed by certain members of society, and how in turn she viewed them. It is anticipated that her position as an early feminist will be postulated and illuminated. Thirdly, an analysis of her personal and professional life indicates a way forward for the nursing profession.     

Annexin V for flow cytometric detection of phosphatidylserine expression on B cells undergoing apoptosis

Apoptosis, or programmed cell death, is a general mechanism for removal of unwanted cells from the immune system. It is characterized by chromatin condensation, a reduction in cell volume, and endonuclease cleavage of DNA into oligonucleosomal length fragments. Apoptosis is also accompanied by a loss of membrane phospholipid asymmetry, resulting in the exposure of phosphatidylserine at the surface of the cell. Expression of phosphatidylserine at the cell surface plays an important role in the recognition and removal of apoptotic cells by macrophages. Here we describe a new method for the detection of apoptotic cells by flow cytometry, using the binding of fluorescein isothiocyanate-labeled annexin V to phosphatidylserine. When Burkitt lymphoma cell lines and freshly isolated germinal center B cells are cultured under apoptosis inducing conditions, all cells showing chromatin condensation strongly stain with annexin V, whereas normal cells are annexin V negative. Moreover, DNA fragmentation is only found in the annexin V-positive cells. The nonvital dye ethidium bromide was found to stain a subpopulation of the annexin V-positive apoptotic cells, increasing with time. Our results indicate that the phase in apoptosis that is characterized by chromatin condensation coincides with phosphatidylserine exposure. Importantly, it precedes membrane damage that might lead to release from the cells of enzymes that are harmful to the surrounding tissues. Annexin V may prove important in further unravelling the regulation of apoptosis.