Aspects of midwifery care 2: 'enhanced role' and social aspects

This is the second in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify and address continuing educational need. The background to the study and the titles of other papers in the series were outlined in the first paper. This paper focuses on two key aspects of the midwife’s role: ‘enhanced role’ activities and social and emotional care. The implications of the findings for practice and education are discussed.

Aspects of midwifery care 3: organisation of midwifery care

This is the third in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify continuing educational need. The background to the study and the titles of the other papers in the series have been outlined in the first paper. Issues related to the way midwifery care is organized nationally are discussed in this paper. Midwives and supervisors indicated a strong commitment to providing woman-centred care in a caring and sensitive manner, often in the face of enormous structural and organizational change. This paper addresses key issues that arose for midwives and supervisors when planning and providing an optimum quality service.

Aspects of care 4: views of professionals and mothers

This is the fourth in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify continuing educational need. The background to the study and the titles of the other papers in the series have been outlined in the first paper. This paper focuses on midwives’, supervisors’, doctors’ and mothers’ views regarding quality of care issues, with particular emphasis on what makes a ‘good’ midwife.

Aspects of care 5: the continuing educational needs of midwives

This is the fifth in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify continuing educational need. The background to the study and the titles of the other papers in the series have been outlined in the first paper. This paper focuses on the methods used to identify the continuing educational needs of midwives, and provides an overview of the findings related to midwives' perceived confidence/competence to practice and their continuing educational needs.

Aspects of care 6: continuing educational needs of midwives 2

This is the last in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives in England and to identify and address continuing educational needs. The background to the study and the titles of other papers in the series have been outlined in the first paper. The first five papers have provided an overview of the main research findings that have been used to determine the continuing educational needs of midwives. This paper provides a more detailed picture of the issues that were identified in relation to educational need, and an overview of the way in which an educational package was developed on the basis of the research findings for use by midwives nationally.

[1H,15N] N.M.R. Kinetic Studies of Reactions of cis- and trans-[PtCl2(15NH3)(c-C6H1115NH2)] with Guanosine 5'-Monophosphate

cis-[PtCl2(15NH3)(c-C6H11NH2)] is an active metabolite of the oral platinum(IV) anticancer drug cis,trans,cis-[PtCl2(CH3CO2)2(NH2)(c-C6H11NH2)]. Since it is likely that guanine bases on DNA are targets for this drug, we have analysed the kinetics of reaction of this platinum(II) metabolite with guanosine 5′-monophosphate (5′-GMP) at 310 K, pH 7, using [1H, 15N] n.m.r. methods. Reactions of the trans isomer are reported for comparison. The reactions proceed via aquated intermediates, and, for the cis isomer, the rates of aquation and substitution of H2O by 5′-GMP are 2-5 times faster trans to the amine ligand (c-C6H11NH2) compared to trans to NH3 for both the first and second steps. For the trans complex, the first aquation step is c. 3 times faster than for the cis complex, as expected from the higher trans influence of Cl¯, whereas the rate of the second aquation step (trans to N7 of 5′-GMP) is comparable to that trans to NH3. These findings have implications for the courses of reactions with DNA.

Identifying the damage mechanisms in paper using the acoustic emission monitoring technique

This paper investigates the use of the acoustic emission (AE) monitoring technique for use in identifying the damage mechanisms present in paper associated with its production process. The microscopic structure of paper consists of a random mesh of paper fibres connected by hydrogen bonds. This implies the existence of two damage mechanisms, the failure of a fibre-fibre bond and the failure of a fibre. This paper describes a hybrid mathematical model which couples the mechanics of the mass-spring model to the acoustic wave propagation model for use in generating the acoustic signal emitted by complex structures of paper fibres under strain. The derivation of the mass-spring model can be found in [1,2], with details of the acoustic wave equation found in [3,4]. The numerical implementation of the vibro-acoustic model is discussed in detail with particular emphasis on the damping present in the numerical model. The hybrid model uses an implicit solver which intrinsically introduces artificial damping to the solution. The artificial damping is shown to affect the frequency response of the mass-spring model, therefore certain restrictions on the simulation time step must be enforced so that the model produces physically accurate results. The hybrid mathematical model is used to simulate small fibre networks to provide information on the acoustic response of each damage mechanism. The simulated AEs are then analysed using a continuous wavelet transform (CWT), described in [5], which provides a two dimensional time-frequency representation of the signal. The AEs from the two damage mechanisms show different characteristics in the CWT so that it is possible to define a fibre-fibre bond failure by the criteria listed below. The dominant frequency components of the AE must be at approximately 250 kHz or 750 kHz. The strongest frequency component may be at either approximately 250 kHz or 750 kHz. The duration of the frequency component at approximately 250 kHz is longer than that of the frequency component at approximately 750 kHz. Similarly, the criteria for identifying a fibre failure are given below. The dominant frequency component of the AE must be greater than 800 kHz. The duration of the dominant frequency component must be less than 5.00E-06 seconds. The dominant frequency component must be present at the front of the AE. Essentially, the failure of a fibre-fibre bond produces a low frequency wave and the failure of a fibre produces a high frequency pulse. Using this theoretical criteria, it is now possible to train an intelligent classifier such as the Self-Organising Map (SOM) [6] using the experimental data. First certain features must be extracted from the CWTs of the AEs for use in training the SOM. For this work, each CWT is divided into 200 windows of 5E-06s in duration covering a 100 kHz frequency range. The power ratio for each windows is then calculated and used as a feature. Having extracted the features from the AEs, the SOM can now be trained, but care is required so that the both damage mechanisms are adequately represented in the training set. This is an issue with paper as the failure of the fibre-fibre bonds is the prevalent damage mechanism. Once a suitable training set is found, the SOM can be trained and its performance analysed. For the SOM described in this work, there is a good chance that it will correctly classify the experimental AEs.

Survival in 176 patients with inoperable non small cell lung cancer treated initially with chemotherapy in a district general hospital

In advanced non-small cell lung cancer (NSCLC) platinum based chemotherapy with second generation drugs improves median survival (MS) to 8 months and 29% and 10% at 1 and 2 years. Platinum with a third generation drug can improve survival further (BMJ 1995;311: 899) (Spiro et al. Thorax 2004;59:828 Big Lung Trial; N Engl J Med 2003;346:92 ECOG study). NICE now recommends chemotherapy with platinum and a third generation drug for inoperable NSCLC as the first treatment modality. Methods: We audited survival of 176/461 consecutive patients referred for at least 3 courses of platinum and either gemcitabine or vinorelbine from July 2001 to December 2005. Minimal follow up 17 months. Chemotherapy was given on site. Radical radiotherapy for stage IIIA, palliative radiotherapy and second line drugs were given as felt appropriate. Results: 64% were male. 30 (17%) were <55 years ; 66 (37.5%) age 55–65 years; 63 (35.8%) aged 66–75 and 16 (9.1%) >75 years. 5 (2.8%) were stage II; 46 (26%) stage IIIA; 68 (38%) stage IIIB and 55 (30.8%) stage IV. 68 (38%) had 0– 2 courses; 63 (36%) 3 courses and 44 (25%) had 4 or more.