Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 5 Articles
Objective\nTo evaluate the efficacy, safety, and maternal satisfaction of a newly established integrative\npostpartum community-based clinic providing comprehensive support for mothers during\nthe first month after discharge from the hospital. Our primary interests were breastfeeding\nrates, readmission and patient satisfaction.\nMethods\nA randomized controlled trial was conducted in Ottawa, Canada, where 472 mothers were\nrandomized via a 1:2 ratio to either receive standard of care (n = 157) or to attend the postpartum\nbreastfeeding clinic (n = 315). Outcome data were captured through questionnaires\ncompleted by the participants at 2, 4, 12 and 24 weeks postpartum. Unadjusted and\nadjusted logistic regression models were conducted to determine the effect of the intervention\non exclusive breastfeeding at 12 weeks (primary outcome). Secondary outcomes\nincluded breastfeeding rate at 2, 4 and 24 weeks, breastfeeding self-efficacy scale, readmission\nrate, and satisfaction score.\nResults\nMore mothers in the intervention group (n = 195, 66.1%) were exclusively breastfeeding at\n12 weeks compared to mothers in the control group (n = 81, 60.5%), however no statistically\nsignificant difference was observed (OR = 1.28; 95% CI:0.84ââ?¬â??1.95)). The rate of emergency\nroom visits at 2 weeks for the intervention group was 11.4% compared to the standard of\ncare group (15.2%) (OR = 0.69; 95% CI: 0.39ââ?¬â??1.23). The intervention group was significantly\nmore satisfied with the overall care they received for breastfeeding compared to the\ncontrol group (OR = 1.96; 95% CI: 3.50ââ?¬â??6.88)). Conclusion\nThis new model of care did not significantly increase exclusive breastfeeding at 12 weeks.\nHowever, there were clinically meaningful improvements in the rate of postnatal problems\nand satisfaction that support this new service delivery model for postpartum care. A community-\nbased multidisciplinary postpartum clinic is feasible to implement and can provide\nappropriate and highly satisfactory care to mother-baby dyads. This model of care may be\nmore beneficial in a population that is not already predisposed to breastfeed....
Objectives: To examine age- and gender-specific presentations and assess clinicians� subjective prognosis and outcome of illnesses of critically ill neonates in the emergency room.\n\nDesign: A hospital-based retrospective appraisal of medical records of neonates in emergency room. Participants: Neonates admitted into the emergency room of a second-tier pediatric hospital in Lagos, Nigeria, between March 2005 and February 2007.\n\nIntervention: Appraisal of the medical records of newly-born ill infants.\n\nResults: There was no statistically significant difference in the mean weight of the neonates in each age group (df=4, p=0.5). Failure-to-cry (23.3%) and fever (37%, 52%, 54.2%, and 70%) were the main presentations in the first day of life and in all other age groups respectively. The most frequent diagnosis among the day old was birth asphyxia (21/30; 70%); among those 2-7 days old was neonatal jaundice (66/135; 48.9%); among those 8-14 days old (17/25, 68.0%) and those 15-21 days old (23/24, 92.0%) was neonatal septicemia and among those 22-28 days old was bronchopneumonia (5/10, 50.0%) respectively. Full blood count was the most repeated laboratory investigation requested for and antibiotics the most frequently-prescribed medication. Overall, there was a positive correlation (r=0.28, p=0.00) between clinicians� subjective prognosis and outcome of illness although this was not reflected among the day-old neonates. The highest mortality rate (30.0%) was among the day-old neonates.\n\nConclusion: Birth asphyxia was the dominant illness that brought 24-hour old neonates to the Intensive Care Unit in the health facility of study. Mortality was also highest in this age group. Jaundice, septicemia and bronchopneumonia were other leading causes of neonatal morbidity and mortality according to the age group. Clinicians� prognosis directly correlated with disease outcome...
Attention-deficit/hyperactivity disorder (ADHD) has become a major aspect of the work of child and adolescent\npsychiatrists and paediatricians in the UK. In Scotland, Child and Adolescent Mental Health Services were required\nto address an increase in referral rates and changes in evidence-based medicine and guidelines without additional\nfunding. In response to this, clinicians in Dundee have, over the past 15 years, pioneered the use of integrated psychiatric,\npaediatric, nursing, occupational therapy, dietetic and psychological care with the development of a clearly\nstructured, evidence-based assessment and treatment pathway to provide effective therapy for children and adolescents\nwith ADHD. The Dundee ADHD Clinical Care Pathway (DACCP) uses standard protocols for assessment, titration\nand routine monitoring of clinical care and treatment outcomes, with much of the clinical work being nurse led.\nThe DACCP has received international attention and has been used as a template for service development in many\ncountries. This review describes the four key stages of the clinical care pathway (referral and pre-assessment; assessment,\ndiagnosis and treatment planning; initiating treatment; and continuing care) and discusses translation of the\nDACCP into other healthcare systems. Tools for healthcare professionals to use or adapt according to their own clinical\nsettings are also provided....
Background: Reminder systems in electronic patient records (EPR) have proven to affect both health care\nprofessionalsââ?¬â?¢ behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the\neffects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care\nin the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nursesââ?¬â?¢ (RNsââ?¬â?¢)\nself-reported adherence to the guideline. An additional aim was to study the relationship between contextual\nfactors and the outcomes of the intervention.\nMethods: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of\nPVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms\nof PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNsââ?¬â?¢ adherence to a PVC\nguideline, collected through a questionnaire that also included RNsââ?¬â?¢ perceived work context, as measured by the\nAlberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots\nfrom each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded.\nThe intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at\nbaseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention.\nResults: No significant effect was found for the computer reminders on PVC-related complications nor on RNsââ?¬â?¢\nadherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 %\n(95 % confidence interval (CI) 36.7ââ?¬â??44.5) and 41.9 % (95 % CI 38.0ââ?¬â??45.8), for the intervention group and 40.3 % (95 % CI\n36.8ââ?¬â??44.0) and 46.9 % (95 % CI 43.1ââ?¬â??50.7) for the control. In general, RNsââ?¬â?¢ self-rated work context varied from moderately\nlow to moderately high, indicating that conditions for a successful implementation to occur were less optimal.\nConclusions: The reminders might have benefitted from being accompanied by a tailored intervention that targeted\nspecific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC\nsites, and the lack of regular feedback to the RNs....
Introduction. Studies about epilepsy are more associated with physiological aspects and drug therapy and far too little attention\nhas been paid to psychological and social care, especially in teens. Hence, the present study aimed to assess relationship between\nself-efficacy and psychosocial care in adolescents with epilepsy. Methods. A cross-sectional association study was conducted on 74\nconsecutive adolescents aged 10 to 18 years with general attacks of epilepsy referred to Pediatric Neurology Clinics affiliated with the\nTabriz University of Medical Sciences in 2013. Data were collected by interview using multisegment tools including demographic\ncharacteristics, self-efficacy scaling in children with epilepsy, and reporting tools for children psychosocial care. Results. Our study\nshowed a significant association of self-efficacy with ââ?¬Å?information receivedââ?¬Â (...
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