Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 7 Articles
Infants born to mothers with gestational diabetes mellitus (GDM) are at greater risk of adverse metabolic sequelae\nperinatally, in childhood and later life. An infant of a diabetic mother is a baby who is born to a mother with diabetes. Infants\nborn to mothers with glucose intolerance are at an increased risk of morbidity and mortality related to respiratory distress,\ngrowth abnormalities (large for gestational age [LGA], small for gestational age [SGA]), hyperviscosity secondary to\npolycythemia, hypoglycemia, congenital malformations, hypocalcemia, hypomagnesemia and iron abnormalities. These infants\nare likely to be born by cesarean delivery for many reasons, among which are such complications as shoulder dystocia with\npotential brachial plexus injury related to the infant's large size. This can be diagnosed by ultrasound performed on the mother\nin the last few months of pregnancy (baby large for gestational age), CBC count, glucose concentration (serum or whole-blood)\nmagnesium concentration (serum) calcium concentration (serum, ionized or total levels) after birth of the child. Treatment\nusually requires maintaining euglycemia, electrolyte management, respiratory or cardiac management if needed. This paper is a\ncase report of an immediate newborn with comorbidities due to glycemic instability....
Introduction: Despite the proven risks associated with not breastfeeding, few mothers\nexclusively breastfeed their babies for six months as recommended by the World Health\nOrganization. This study was conducted to compare the effect of breastfeeding\npromotion interventions on exclusive BMF among primiparous women. Methods: This\nquasi-experimental study was conducted on a sample of 93 primiparous women who\nwere referred to health care centres, Mashhad, Iran, in 2010. Health care centres were\nselected by multistage sampling method, and then randomly allocated into two\nintervention groups (peer support group and health care provider�s education group)\nand one control group. Primigravidae aged 18-35 years old, with singleton pregnancy,\nwith gestational age of 35-36 weeks, and intending to breastfeed their children were\nrandomly selected out of health care centres. The peer support group participants\nreceived supports from their peers four times and education group�s participants\nreceived 4 training sessions by health care providers. The control group received only\nroutine cares. Exclusive BMF duration and rate assessed at 4 and 8 weeks postpartum\nand collected data were analysed using SPSS (ver.11.5) software. Results: There were no significant differences in exclusive BMF duration at 4 and 8\nweeks among the 3 groups (P=0.993, P=0.904). Exclusive BMF rate at 4 and 8 weeks\nafter birth was significantly different among the 3 groups (P=0.043, P=0.023). No\nsignificant difference was found between peer support and healthcare provider�s\neducation groups with respect to BMF rate at 4 weeks (P=0.111), but the difference was\nsignificant at 8 weeks (P=0.027). Conclusion: All women should be offered education\nand peer support to breastfeed their babies to increase the exclusive breastfeeding rate.\nBut to continue exclusive breastfeeding, and increase its duration, help of family is more\nimportant than education and peer support. Support that is only offered reactively, in\nwhich women are expected to initiate the contact, is unlikely to be effective; women\nshould be offered ongoing support so they can predict that support will be available.\nSupport should be tailored to the needs of the setting and the population group....
Background: To explore the current models of practice in centres delivering specialist care for children with\ndisorders of sex development (DSD), an international survey of 124 clinicians, identified through DSDnet and\nthe I-DSD Registry, was performed in the last quarter of 2014.\nResults: A total of 78 (63 %) clinicians, in 75 centres, from 38 countries responded to the survey. A formal\nnational network for managing DSD was reported to exist in 12 (32 %) countries. The paediatric specialists\nroutinely involved in the initial evaluation of a newborn included: endocrinologist (99 %), surgeon/urologist\n(95 %), radiologist (93 %), neonatologist (91 %), clinical geneticist (81 %) and clinical psychologist (69 %).\nA team consisting of paediatric specialists in endocrinology, surgery/urology, clinical psychology, and nursing\nwas only possible in 31 (41 %) centres. Of the 75 centres, 26 (35 %) kept only a local DSD registry and 40\n(53 %) shared their data in a multicentre DSD registry. Attendance in local, national and international DSDrelated\neducational programs was reported by 69, 78 and 84 % clinicians, respectively. Participation in audits/quality\nimprovement exercises in DSD care was reported by 14 (19 %) centres. In addition to complex biochemistry and\nmolecular genetic investigations, 40 clinicians (51 %) also had access to next generation sequencing. A genetic test\nwas reported to be more preferable than biochemical tests for diagnosing 5-alpha reductase deficiency and 17-beta\nhydroxysteroid dehydrogenase 3 deficiency by 50 and 55 % clinicians, respectively.\nConclusion: DSD centres report a high level of interaction at an international level, have access to specialist staff and\nare increasingly relying on molecular genetics for routine diagnostics. The quality of care provided by these centres\nlocally requires further exploration...
Background: The value of health information technology (IT) ultimately depends on end users accepting and\nappropriately using it for patient care. This study examined pediatric intensive care unit nurses� perceptions,\nacceptance, and use of a novel health IT, the Large Customizable Interactive Monitor.\nMethods: An expanded technology acceptance model was tested by applying stepwise linear regression to data\nfrom a standardized survey of 167 nurses.\nResults: Nurses reported low-moderate ratings of the novel IT�s ease of use and low to very low ratings of\nusefulness, social influence, and training. Perceived ease of use, usefulness for patient/family involvement, and\nusefulness for care delivery were associated with system satisfaction (R2 = 70%). Perceived usefulness for care\ndelivery and patient/family social influence were associated with intention to use the system (R2 = 65%). Satisfaction\nand intention were associated with actual system use (R2 = 51%).\nConclusions: The findings have implications for research, design, implementation, and policies for nursing\ninformatics, particularly novel nursing IT. Several changes are recommended to improve the design and\nimplementation of the studied IT....
Background: High fidelity simulation has been executed to allow the evaluation of technical and non-technical\nskills of health caregivers. Our objective was to assess technical and non-technical performances of low level\nhospitals health caregivers who attended a Neonatal Resuscitation course using high fidelity simulation in a\nstandard-setting scenario.\nMethods: Twenty-three volunteers were asked to manage a simple scenario (infant with secondary apnea) after the\ncourse. Technical and non-technical skills were assessed by using previously published scores. Performances were\nassessed during the scenario and after 2 months by filmed video recordings.\nResults: Sixteen (69.5%) participants failed to pass the minimum required technical score. Staff experience and\nparticipation in previous courses were associated to higher score in technical and non-technical skills, while\nworking in level I or II hospitals did not affect the scores. Previous experience in neonatal resuscitation requiring\npositive pressure ventilation was associated to better non-technical performance. Technical and non-technical\nscores were significantly correlated (r = 0.67, p = 0.0005). Delayed and direct evaluation of technical skills provided\nthe same scores.\nConclusions: A neonatal resuscitation course, performed by using a high fidelity simulation manikin, had a limited\nimpact on technical and non-technical skills of participants working in low level hospitals. Training programs should\nbe tailored to the participants� professional background and to the more relevant sessions....
Background: Adolescent mothers are at a much higher risk for maternal mortality compared to mothers aged\n20 years and above. Newborns born to adolescent mothers are also more likely to have low birth weight, with the\nrisk of long-term effects such as early onset of adult diabetes than newborns of older mothers. Few studies have\ninvestigated the determinants of adequate quality maternal and child healthcare services to pregnant adolescents.\nThis study was conducted to gain an understanding of nursesâ�� and midwivesâ�� intentions to provide maternal and\nchild healthcare and family planning services to adolescents in South Africa.\nMethods: A total of 190 nurses and midwives completed a cross-sectional survey. The survey included components\non demographics, knowledge of maternal and child healthcare (MCH) and family planning (FP) services, attitude\ntowards family planning services, subjective norms regarding maternal and child healthcare and family planning\nservices, self-efficacy with maternal and child healthcare and family planning services, and intentions to provide\nmaternal and child healthcare and family planning services to adolescents. Pearsonâ��s correlation analysis was\nconducted to determine the association between knowledge, attitude, subjective norms, self-efficacy, and intention\nvariables for FP and MCH services. A 2-step linear regression analysis was then conducted for both FP and MCH\nservices to predict the intentions to provide FP and MCH services to adolescents.\nResults: Self-efficacy to conduct MCH services (�² = 0.55, p < 0.01) and years of experience as a nurse- midwife\n(�² = 0.14, p < 0.05) were associated with stronger intentions to provide the services. Self-efficacy to provide FP\nservices (�² = 0.30, p < 0.01) was associated with stronger intentions to provide FP services.\nConclusions: Self-efficacy has a strong and positive association with the intentions to provide both MCH and FP\nservices, while there is a moderate association with attitude and norms. There is a need to improve and strengthen\nnursesâ�� and midwivesâ�� self-efficacy in conducting both MCH and FP services in order to improve the quality and\nutilization of the services by adolescents in South Africa....
Background: Neonatal mortality remains a serious health issue especially in low resource countries, where 99% of\nneonatal deaths occur. Doctors with Africa CUAMM is an Italian non-governmental organization in the field of\nhealthcare that has been working in Africa since 1955. In Mozambique, at the Central Beira Hospital (CBH), it has a\nproject with the aim of supporting the neonatal intensive care unit (NICU) and the Obstetrical Department of the\nCBH through a multi-level intervention. Our aim was to evaluate the effectiveness of CUAMM continuous Quality\nImprovement intervention in terms of reduction of the overall neonatal mortality rate in the NICU of CBH.\nMethods: A baseline analysis was performed in order to assess the actual standard of neonatal care. Subsequently,\nthe intervention was focused on three main areas: infrastructure, equipment and clinical protocols improvement.\nA retrospective pre- (2013)/post- (2014) implementation analysis of clinical outcomes was performed.\nResults: Total population included 4,276 newborns, 2,118 (50%) born in 2013 and 2158 (50%) born after implementation.\nBaseline characteristics of the two groups were similar apart from a higher incidence of outborn neonates (33%\nvs 30%, p = 0.02) and a lower incidence of Apgar score < 7 at 5 min (37% vs 43%, p < 0.01). The rates of admissions for\nasphyxia (22% vs 30%), sepsis (4% vs 7%) and prematurity (18% vs 28%) increased between the two study period.\nMortality rate for each of these causes decreased from before to after the implementation: asphyxia (34% vs 19%,\np < 0.01), sepsis (39% vs 28%, p = 0.06) and prematurity (43% vs 33%, p < 0.01).\nConclusion: We found a reduction in mortality rate among newborns admitted to CBH�s NICU after the first year\nof CUAMM intervention. Most of this reduction can be attributed to the decrease in deaths for asphyxia, sepsis\nand prematurity. A Quality Improvement intervention based on infrastructural, equipment and clinical objectives\nwas associated with a reduction of neonatal mortality rate in a low-resource NICU....
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