Evaluation of 24-h urine containers for urine copper measurement by inductively coupled plasma mass spectrometry.

OBJECTIVE: To determine the necessity for acid-washed containers for 24-h urine copper analysis. METHODS: Copper solutions, with concentrations relevant to clinical decision limits, were prepared by spiking both assay diluent and unknown urine samples with the copper calibrator. Samples were split between plain and acid-washed 24-h urine containers, and copper analysis was performed using inductively coupled mass spectrometry (ICP-MS). RESULTS: Measurement of copper in both spiked diluent and spiked urine samples showed minimal concentration bias between acid-washed and plain 24-h urine containers. CONCLUSIONS: Acid-washed containers are not required for the measurement of copper in 24-h urine samples.

Non-reassuring results in agreement trial comparing glass and plastic capillary tubes for neonatal blood gas sampling.

AIM: To determine agreement between neonatal capillary blood gases taken with plastic and glass tubes. METHODS: An agreement study was carried out in a regional tertiary neonatal unit. Inpatient babies ≥1 kg were recruited to the study when parents gave consent. After taking the routine glass capillary tube sample, a plastic tube sample was taken and run if the heel continued to bleed. Successful sample pairs were recorded and analysed against pre-defined acceptable differences. Assessment was also made of differences in failure rates between tube types for each parameter. RESULTS: Twenty-eight babies provided 135 blood gas pairs, of which five pairs were excluded. Successful pairing of results was achieved for pH in 105 valid samples. There were more failed plastic samples than glass, reaching significance for almost all parameters. pH, pO2 and pCO2 showed poor agreement (<80%) between glass and plastic tubes. On limited analysis of one successful blood gas pair per neonate to minimise bias, results remained non-reassuring. CONCLUSION: The findings of this study do not advocate switching from glass to plastic capillary tubes in our Newborn Intensive Care Unit. Further studies are required to assess agreement of glass and plastic capillary tubes for neonatal blood gas sampling.

Towards a biomarker panel for the assessment of AKI in children receiving intensive care.

BACKGROUND: Critically ill children and neonates are at high risk of developing acute kidney injury (AKI). AKI is associated with short- and long-term renal impairment and increased mortality. Current methods of diagnosing AKI rely on measurements of serum creatinine, which is a late and insensitive marker. Few studies to date have assessed AKI biomarkers in a heterogeneous patient cohort. METHODS: We conducted a prospective feasibility study in a paediatric intensive care setting over a 6-month period to describe the relationship between AKI (defined according to pRIFLE criteria) and new AKI biomarkers. RESULTS: In total, 49 patients between the ages of 16 days and 15 years were recruited for measurement of plasma cystatin C (Cys-C) and neutrophil gelatinase-associated lipocalin (pNGAL) concentrations, as well as for urinary kidney injury molecule-1 (KIM-1) and urinary NGAL (uNGAL) concentrations. Almost one-half (49 %) of the patient cohort experienced an AKI episode, and Cys-C and pNGAL were the strongest candidates for the detection of AKI. Our data suggest that the widely used estimated baseline creatinine clearance value of 120 mL/min/1.73 m(2) underestimates actual baseline function in patients admitted to paediatric intensive care units. CONCLUSIONS: This investigation demonstrates the feasibility of new AKI biomarker testing in a mixed patient cohort and provides novel biomarker profiling for further evaluation.

Ethics of abortion: the arguments for and against.

In England, Scotland and Wales legislation has facilitated the process of procuring an abortion to the point at which, in 2007, it appears to have been effectively assimilated into contemporary life. However, despite the legal acceptance of abortion it remains an ethically contentious subject. Arguments in favour of, or in opposition to, abortion can arouse vociferous and, on occasions, extreme reactions. At the heart of the abortion debate lie questions concerning rights, autonomy and the way in which society views disability (if a pregnancy is terminated for this reason alone). It is important that health professionals comprehend the basis of the abortion debate, from the perspective of their profession, society as a whole and the individual woman who may have had or is considering an abortion or has been affected by the subject in some way. This article examines some of the key ethical issues concerning abortion.

An introduction to ethics in nursing.

Ethics is concerned with 'right and wrong', although agreeing what is 'right' can be challenging. An understanding of ethics is essential to the delivery of skilled professional care. It is vital that nurses appreciate the value of ethics in their work. Ethics is relevant to clinical, practice-based issues and affects all areas of the professional nursing role. To apply ethics effectively, nurses must develop reasoning skills and understand the concepts and principles that assist ethical analysis. This article, the first in a series of articles relating to ethics and nursing, offers an introduction to ethics, primarily focusing on their application in clinical nursing practice. Throughout the article, the terms 'ethical' and 'moral' are used interchangeably.