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Biomedical subjects

J Humphreys

Publications and source records attributed to J Humphreys.

At least 19 recordsLinked to original sources
PubMed1999

Predischarge monitoring of preterm infants.

The objectives of this study were: 1) to perform documented event-monitoring (DEM) for apnea (A, > or = 20 s) and bradycardia (B, < 80 beats per min for > or = 5 s) in premature infants prior to discharge, and 2) to examine the accuracy of nursing documentation (ND) of A and B. Forty-four stable preterm infants, with mean weights and gestational ages at birth (+/- SD) of 1,543 (+/- 365) g, and 30 (+/- 2) weeks, respectively, were studied using DEM for 9 (+/- 2) days prior to discharge. Differences in DEM and ND were analyzed by the z-test for proportions. There were 561 true events recorded by DEM: 56 were As and 505 were Bs. ND revealed 296 events, 190 As and 106 Bs. Of the 56 true As on DEM, only 21 (38%) were correctly reported by ND (P < 0.001, 95% confidence interval (CI) 0.44-0.81). Of the 505 true Bs on DEM, 153 (30%) were correctly reported by ND (P < 0.001, CI 0.63-0.76). When ND was compared with DEM, 174 (59%) of NDs were true events. Of the 106 As on ND, only 21 (20%) were true As on DEM (P < 0.001, CI 0.58-1). Of the 190 Bs on ND, 153 (80%) were true Bs on DEM (P < 0.001, CI 0.13-0.26). ND did not detect 6 of the 33 infants who had significant events on DEM, while 4 of the 11 who had events reported on ND did not have any on DEM. Thus, 10 infants were misclassified by ND (P < 0.01, CI 0.1-0.36). These results indicate that, compared to DEM, ND not only identified significantly fewer true As and Bs, but also misclassified a significant number of infants. We conclude that DEM performed prior to discharge for preterm infants at risk for apnea and bradycardia provides more objective and accurate information than ND.

Apnea↗
PubMed1999

Enrolled nurses and the professionalisation of nursing: a comparison of nurse education and skill-mix in Australia and the UK.

In the UK prior to 1989 two levels of nurse were trained: first level, or 'Registered Nurses' (RNs), and second Level, or 'Enrolled Nurses' (ENs). In 1989 changes to nurse education driven by 'Project 2000' marked the end of EN training: nurse education moved into the higher education sector and a single type of RN education replaced the original split-level training. Yet in Australia, where RN training has followed a similar path into higher education, the split level training of ENs and RNs has been maintained. The reasons for this difference in approach to ENs are investigated and discussed. The paper goes on to explore the implications and possible outcomes of the two different approaches in terms of the professionalisation of nursing and skill-mix in the health care workforce. Now that some UK nursing bodies are pressing for a degree-led profession, it is suggested that the Australian model may have an advantage, as concerns are being raised that English nurses may 'price themselves out of the market', with the nursing role being encroached upon by non-nurse Health Care Assistants.

Australia↗
PubMed1999

Rural health status: what do statistics show that we don't already know?

Arguably the policies and programs designed to bring about improvements in the health status of rural and remote residents have been limited by the absence of systematic statistical data about health status and its relationship with place of residence. The Australian Institute of Health and Welfare addresses this problem in the recent report Health in rural and remote Australia. The report compares the health status, health risk factors and preventative measures, and health resources for rural, remote and urban areas. The data highlights that people in rural and remote areas of Australia have poorer health status than their metropolitan counterparts on several counts. While further work is required, the report provides a useful and important basis for identifying and monitoring the pattern of health status and resource availability in rural and remote Australia.

Australia↗
PubMed1998

Devolution or centralization? Differences in the development of nurse education commissioning policy among the UK nations.

An overview of the different systems for the commissioning of nurse education in the various UK countries is contextualized in the policy concerns of development and marketization driven by Government Working Papers 9 and 10. The different systems for commissioning nurse education in the various UK countries are described, with a particular focus on the English consortia system and its level of efficiency. It is argued that while the mechanism of consortia is being used to marketize nurse education commissioning in England, in the other three nations the commissioning process has actually become more centralized. This centralization is contrary to the policy of development, yet it is suggested here that the consortia mechanism adopted in England has not been followed in the other UK nations, as it has not yet proved an independently efficient method of commissioning.

Contract Services↗
PubMed1998

The commissioning of nurse education by consortia in England: a quasi-market analysis.

The planning and commissioning of nurse education by consortia of NHS trusts and others in England is examined. These arrangements are analysed in terms of quasi-market theory, investigating their ability to co-ordinate effectively the demand for nurse education and workforce demand for nurses. Hence the paper examines evidence concerning the success or failure of consortia to co-ordinate these aspects, discussing the arguments over nurse and student nurse shortages, and the procedure for assessing the demand for nurse training places. The paper argues that current nurse shortages illustrate past planning errors in commissioning nurse training. Consequently, the central body (National Health Service Executive) is still aiding consortia in their decision-making concerning numbers of nurse training places, modelling workforce plans and suggesting increases in training places (and producing the money to pay for this). As such, it is argued, the quasi-market is not as yet a completely devolved one. It is suggested in the concluding discussion that if qualitative benefits of consortia fail to materialize (as suggested elsewhere), and the quantitative functions are inadequate, the utility of consortia as planners and commissioners of nurse education may be questioned.

Education, Nursing↗
PubMed1998

Evaluation of a bicycle helmet giveaway program--Texas, 1995.

OBJECTIVE: To determine the effect of a bicycle helmet giveaway program on helmet use among children. METHODS: In 1995, a bicycle helmet giveaway program was conducted in two rural towns in Texas. Helmets were given to all 403 school children in kindergarten through grade 8. Helmet education, a bicycle rodeo, and incentives to increase helmet use were part of the program. Observations of helmet use were made before the helmet program began and after the program at several intervals throughout the school year and during the summer. A self-reported survey questionnaire was administered to children in grades 4 through 8 before the helmet program began and at several intervals during the school year to determine their attitudes about helmet use, safety perceptions, and peer pressure. A questionnaire also was administered to the parents of these children to determine attitudes and bicycle helmet use among parents. RESULTS: Helmet use increased from 3% before the giveaway to 38% at the end of the school year, 7 months later. However, during the subsequent summer, helmet use decreased to 5%. Helmet use among 7th- and 8th-grade students was 0% at all observations periods after the giveaway. Even though 96% of all students thought that helmet use increased riding safety and 68% thought helmets should be worn at all times when riding, only 25% thought that their friends would approve of helmet use. Most parents also believed that helmets increased riding safety and should be worn, but only 23% reported always wearing one when riding a bicycle. CONCLUSIONS: Bicycle helmet giveaway programs can increase helmet use temporarily, but they may not be sufficient to sustain it. This program was not effective among 7th- and 8th-grade students.

Adolescent↗
PubMed1997

Toward antibody-directed enzyme prodrug therapy with the T268G mutant of human carboxypeptidase A1 and novel in vivo stable prodrugs of methotrexate.

Antibody-directed enzyme prodrug therapy (ADEPT) has the potential of greatly enhancing antitumor selectivity of cancer therapy by synthesizing chemotherapeutic agents selectively at tumor sites. This therapy is based upon targeting a prodrug-activating enzyme to a tumor by attaching the enzyme to a tumor-selective antibody and dosing the enzyme-antibody conjugate systemically. After the enzyme-antibody conjugate is localized to the tumor, the prodrug is then also dosed systemically, and the previously targeted enzyme converts it to the active drug selectively at the tumor. Unfortunately, most enzymes capable of this specific, tumor site generation of drugs are foreign to the human body and as such are expected to raise an immune response when injected, which will limit their repeated administration. We reasoned that with the power of crystallography, molecular modeling and site-directed mutagenesis, this problem could be addressed through the development of a human enzyme that is capable of catalyzing a reaction that is otherwise not carried out in the human body. This would then allow use of prodrugs that are otherwise stable in vivo but that are substrates for a tumor-targeted mutant human enzyme. We report here the first test of this concept using the human enzyme carboxypeptidase A1 (hCPA1) and prodrugs of methotrexate (MTX). Based upon a computer model of the human enzyme built from the well known crystal structure of bovine carboxypeptidase A, we have designed and synthesized novel bulky phenylalanine- and tyrosine-based prodrugs of MTX that are metabolically stable in vivo and are not substrates for wild type human carboxypeptidases A. Two of these analogs are MTX-alpha-3-cyclobutylphenylalanine and MTX-alpha-3-cyclopentyltyrosine. Also based upon the computer model, we have designed and produced a mutant of human carboxypeptidase A1, changed at position 268 from the wild type threonine to a glycine (hCPA1-T268G). This novel enzyme is capable of using the in vivo stable prodrugs, which are not substrates for the wild type hCPA1, as efficiently as the wild type hCPA1 uses its best substrates (i.e. MTX-alpha-phenylalanine). Thus, the kcat/Km value for the wild type hCPA1 with MTX-alpha-phenylalanine is 0.44 microM-1 s-1, and kcat/Km values for hCPA1-T268G with MTX-alpha-3-cyclobutylphenylalanine and MTX-alpha-3-cyclopentyltyrosine are 1.8 and 0.16 microM-1 s-1, respectively. The cytotoxic efficiency of hCPA1-268G was tested in an in vitro ADEPT model. For this experiment, hCPA1-T268G was chemically conjugated to ING-1, an antibody that binds to the tumor antigen Ep-Cam, or to Campath-1H, an antibody that binds to the T and B cell antigen CDw52. These conjugates were then incubated with HT-29 human colon adenocarcinoma cells (which express Ep-Cam but not the Campath 1H antigen) followed by incubation of the cells with the in vivo stable prodrugs. The results showed that the targeted ING-1:hCPA1-T268G conjugate produced excellent activation of the MTX prodrugs to kill HT-29 cells as efficiently as MTX itself. By contrast, the enzyme-Campath 1H conjugate was without effect. These data strongly support the feasibility of ADEPT using a mutated human enzyme with a single amino acid change.

Animals↗
PubMed1997

National rural health policy and the role of the National Rural Health Conferences.

The biennial National Rural Health Conference has become as essential feature on the calendar of events for rural and remote health professionals, researchers, public servants and consumers. Since the first conference held in 1991, attendance has grown significantly, factors hindering the achievement of optimal health for all rural and remote Australia have been clearly identified, and recommendations for action have been endorsed by the broad rural health constituency. These recommendations have provided valuable input to the National Rural Health Strategy and many programs and policies of Commonwealth and State departments of health. Significantly, too, the first four conferences have facilitated greater collaboration among rural and remote health professionals and provided a major catalyst in fostering cooperation between consumers, health workers, service providers and governments.

Australia↗
PubMed1996

Old idea, new jargon.

Explore the source record for details and available documents.

Health Services Research↗
PubMed1996

The impact of the EN conversion programme on the NHS nursing workforce.

States that the number of enrolled nurse conversions completed during the last ten years has had a significant impact on the number of registered nurses (RNs) available for employment in the National Health Service (NHS), and the contribution made by the enrolled nurse conversion course programme to the NHS workforce may have delayed the impact of the "demographic time bomb" on nursing recruitment. Emphasizes that the winding down of the conversion programme, and a fall in the number of RNs employed in the NHS, combined with a decline in entries to preregistration (initial) training, could signal the beginning of the long-awaited crisis facing the nursing profession.

Education, Nursing, Continuing↗
PubMed1996

Education commissioning by consortia: some theoretical and practical issues relating to qualitative aspects of British nurse education.

In 1995 the British National Health Service (NHS) Executive published details of a new framework for planning and commissioning education and training in the NHS. Among the central elements of these new arrangements are consortia of representatives from health care provider organizations and purchasing authorities among others, who will in due course take on responsibility for the commissioning of non-medical education and training (NMET). This NMET market is clearly distinct from the larger 'internal market' for health care provision by virtue of its separate funding, and different supply and demand side components. This paper includes an analysis of the new arrangements in terms of quasi-market theory and articulates a key role for consortia in harmonising the distinct markets for health services and NMET. A primary purpose of the paper is to examine the extent to which the new arrangements generally, and consortia in particular, can ensure that NMET contributes to NHS reform. Evidence from consortium development work in the South Thames Regional Health Authority, England, is discussed and it is argued that consortia will only perform effectively if they receive devolved real powers to an extent that persuades members to genuinely commit themselves to the proper development of consortia and the responsibilities of NMET commissioning. Finally a tendency to become preoccupied with education and training operations and processes rather than outputs is described and identified as a threat both to consortium effectiveness and educational innovation.

Contract Services↗
PubMed1996

British National Health Service trust chief executives on nurse education: corporate instrumentalism and doubts on quasi-market structure.

The funding of nurse education through Working Paper 10 arrangements is susceptible to analysis as a 'quasi-market' in which regional purchasers (in England) commission education and training services on behalf of National Health Service (NHS) trusts. In this context, some regions have developed ways of managing the demand side of the market in such a way as to enable NHS trust involvement in purchasing decisions, sometimes through consortium configurations. This paper reports the findings of an empirical study of the views of NHS trust chief executives on nurse education. The investigation was conducted to provide the information base for a consortium development reported earlier in the Journal of Advanced Nursing. The consensus views of chief executives revealed an ideological stance, referred to as corporate instrumentalism. This was shown to be derived from the position of trusts as newly corporate organizations undergoing considerable change in a volatile and competitive environment. Education was seen as potentially capable of contributing significantly to both health service quality and organizational change. Chief executives described an ideal of collaboration in which college providers are highly responsive to their needs, but doubted that the current quasi-market arrangements can in fact deliver this. A comparison of chief executive and senior executive nurse views revealed some significant differences of emphasis, and a mechanism is provisionally suggested by which educational innovation could be suppressed. Finally the education quasi-market was analysed in terms of both its implications for the professional status of nurses and its potential to facilitate NHS reform.

Attitude of Health Personnel↗
PubMed1995

Postnatal maturation of tissue kallikrein-producing cells (connecting tubule cells) in the rat kidney: a morphometric and immunohistochemical study.

The mature, fully differentiated connecting tubule (CNT) cell plays an important role in the regulation of serum potassium levels and synthesizes the enzyme tissue kallikrein, a main component of a renal vasoactive system, the kallikrein-kinin system. To characterize the growth of CNT cells (tissue kallikrein-producing cells), we studied the rat kidney at three different time points of postnatal development: at day 5, day 15, and day 30. The CNT cells were identified on tissue sections by a standardized immunohistochemical procedure. The tissue kallikrein content was determined by radioimmunoassay and the activity of the enzyme in kidney homogenates was measured using a selective synthetic substrate. The number of immunolabeled CNT and CNT cells per cortex area gradually increased from day 5 to day 30. A similar rise in the content and activity of tissue kallikrein was observed when the enzyme levels were determined by radioimmunoassay or by the enzymatic method. In addition, the morphometric analysis showed that the distal end of CNT had larger cells that displayed a more intense tissue kallikrein staining than those present in the proximal end, suggesting that the postnatal development of CNT is induced from its juxtamedullary portion. Our results show that tissue kallikrein expression is very low in the newborn rat, increasing gradually with age to reach adult levels at day 30. This finding, together with the morphometric data, suggests immaturity of CNT cells in newborn rats, a fact that could contribute to explaining the high serum potassium levels reported at this stage. In addition, the contrasting behavior of kallikrein and renin in the postnatal development (kallikrein increasing and renin decreasing) could explain the gradual decrease in renal vascular resistance and increase in renal blood flow observed after birth.

Aging↗
PubMed1995

A missing link? Workforce demand as the link between two health care related markets.

Examines the links between workforce demand and two health care related markets, the first being the internal market between purchasers and providers of health care, and the second the market for education expressed between colleges of education as providers and NHS Trusts as purchasers of the courses. Workforce demand has to take account of the numbers of people on courses, but also specialist skills required to enable NHS Trusts to deliver changing health care needs of the future.

Education, Nursing↗