This review found that Kangaroo Mother Care (KMC), which involves continuous skin-to-skin contact between a mother and premature baby, substantially reduces neonatal mortality and morbidity compared to conventional care. The review included 15 studies with over 10,000 participants. It found that KMC reduced the risk of death by 51% based on randomized trials and 32% based on observational studies. It also reduced the risk of serious health issues like respiratory distress by 66%. While some results depended on modeling assumptions, the authors concluded KMC is highly effective in improving outcomes for preterm babies.
Human Touch vs. Axillary Digital Thermometry for Detection of Neonatal Hypoth...Siddharth Agarwal
We examined the diagnostic accuracy of human touch (HT) method in assessing hypothermia against
axillary digital thermometry (ADT) by a trained non-medical field investigator (who supervised
activities of community health volunteers) in seven villages of Agra district, Uttar Pradesh, India. Body
temperature of 148 newborns born between March and August 2005 was measured at four points in time
for each enrolled newborn (within 48 h and on days 7, 30 and 60) by the field investigator under the
axilla using a digital thermometer and by HT method using standard methodology. Total observations
were 533. Hypothermia assessed by HT was in agreement with that assessed by ADT (<36.5
C) in 498
observations. Hypothermia assessed by HT showed a high diagnostic accuracy when compared against
ADT (kappa 0.65–0.81; sensitivity 74%; specificity 96.7%; positive predictive value 22; negative
predictive value 0.26). HT is a simple, quick, inexpensive and programmatically important method.
However, being a subjective assessment, its reliability depends on the investigator being adequately
trained and competent in making consistently accurate assessments. There is also a need to assess
whether with training and supervision even the less literate mothers, traditional birth attendants and
community health volunteers can accurately assess mild and moderate hypothermia before promoting
HT for early identification of neonatal risk in community-based programs.
This systematic review analyzed 10 prospective studies on the clinical signs of pediatric bacterial meningitis. Several clinical features were found to accurately predict meningitis, including bulging fontanelle, neck stiffness, seizures outside of fever, and reduced feeding. No single sign was diagnostic on its own. The combination of multiple signs provided the most accurate diagnosis. The review aimed to identify the likelihood ratios of clinical signs to determine their value in assessing the probability of meningitis and deciding if further testing is needed.
The document discusses the importance of causal frameworks and artificial intelligence (AI) for health research. It provides examples of how causal diagrams (DAGs) have been useful in health research by correcting an analytic mistake and evaluating survival bias. The document also presents a simulation study examining potential collider bias in racial disparities in stroke risk between middle and late life. The simulation compares different causal structures and finds bias only in structures where an unmeasured factor influences both mortality and stroke risk.
Thank You for referencing this work, if you find it useful!
Citation of a related scientific book:
Wac, K., Wulfovich, S. (2021). Quantifying Quality of Life, Series: Health Informatics, Springer Nature, Cham, Switzerland. The talk details:
Katarzyna Wac, “Remote quality of life assessment: ‘What is always speaking silently is the body'”. Digital Health Connect Conference, Sion, Switzerland
Video: https://www.digitalhealthconnect.ch/en/
This document summarizes key points from a conference on interrelated autoimmune diseases. It discusses the challenges of determining drug efficacy in clinical trials versus effectiveness in real-world use. For psoriasis treatments, clinical trials only provide a short-term view of efficacy, whereas effectiveness looks at long-term outcomes. A study on psoriasis patients found lower response rates in clinical practice than trials. For IBD treatments, combination therapy with immunosuppressants was more effective than monotherapy in one trial. Clinical trials also show the need for continuous high-dose biologic treatment to reduce antibody development and maintain response.
10 MCQs in Epidemiology & Biostatistics: How much can you score? (Medical Boo...Dr. Aryan (Anish Dhakal)
This document contains 10 multiple choice questions related to epidemiology concepts. The questions cover topics such as diagnostic test accuracy and characteristics, predictive values, likelihood ratios, biases in studies, relative risk, attributable risk, and sensitivity and specificity. An answer key is provided at the end with the correct response for each question.
This study assessed the prevalence of neonatal sepsis and associated risk factors among neonates admitted to neonatal intensive care units (NICUs) at two hospitals in Ethiopia from February 2016 to February 2017. The overall prevalence of neonatal sepsis was found to be 77.9%. Age of neonates, birth asphyxia, and use of oxygen via mask were significantly associated with increased risk of neonatal sepsis. The study recommends focusing prevention efforts on modifiable risk factors to reduce neonatal sepsis.
A study to develop and evaluate the effectiveness of informationAlexander Decker
This study evaluated the effectiveness of an information booklet on emergency contraception in increasing women's knowledge about the topic. 50 women were surveyed before and after reading the booklet. The results showed that the booklet significantly increased women's knowledge across all domains, with post-test scores being significantly higher than pre-test scores. The booklet was also found to have high acceptability and be useful for enhancing women's knowledge of emergency contraception. The researchers concluded that the information booklet was effective in improving knowledge, but that further studies with larger sample sizes are needed.
Human Touch vs. Axillary Digital Thermometry for Detection of Neonatal Hypoth...Siddharth Agarwal
We examined the diagnostic accuracy of human touch (HT) method in assessing hypothermia against
axillary digital thermometry (ADT) by a trained non-medical field investigator (who supervised
activities of community health volunteers) in seven villages of Agra district, Uttar Pradesh, India. Body
temperature of 148 newborns born between March and August 2005 was measured at four points in time
for each enrolled newborn (within 48 h and on days 7, 30 and 60) by the field investigator under the
axilla using a digital thermometer and by HT method using standard methodology. Total observations
were 533. Hypothermia assessed by HT was in agreement with that assessed by ADT (<36.5
C) in 498
observations. Hypothermia assessed by HT showed a high diagnostic accuracy when compared against
ADT (kappa 0.65–0.81; sensitivity 74%; specificity 96.7%; positive predictive value 22; negative
predictive value 0.26). HT is a simple, quick, inexpensive and programmatically important method.
However, being a subjective assessment, its reliability depends on the investigator being adequately
trained and competent in making consistently accurate assessments. There is also a need to assess
whether with training and supervision even the less literate mothers, traditional birth attendants and
community health volunteers can accurately assess mild and moderate hypothermia before promoting
HT for early identification of neonatal risk in community-based programs.
This systematic review analyzed 10 prospective studies on the clinical signs of pediatric bacterial meningitis. Several clinical features were found to accurately predict meningitis, including bulging fontanelle, neck stiffness, seizures outside of fever, and reduced feeding. No single sign was diagnostic on its own. The combination of multiple signs provided the most accurate diagnosis. The review aimed to identify the likelihood ratios of clinical signs to determine their value in assessing the probability of meningitis and deciding if further testing is needed.
The document discusses the importance of causal frameworks and artificial intelligence (AI) for health research. It provides examples of how causal diagrams (DAGs) have been useful in health research by correcting an analytic mistake and evaluating survival bias. The document also presents a simulation study examining potential collider bias in racial disparities in stroke risk between middle and late life. The simulation compares different causal structures and finds bias only in structures where an unmeasured factor influences both mortality and stroke risk.
Thank You for referencing this work, if you find it useful!
Citation of a related scientific book:
Wac, K., Wulfovich, S. (2021). Quantifying Quality of Life, Series: Health Informatics, Springer Nature, Cham, Switzerland. The talk details:
Katarzyna Wac, “Remote quality of life assessment: ‘What is always speaking silently is the body'”. Digital Health Connect Conference, Sion, Switzerland
Video: https://www.digitalhealthconnect.ch/en/
This document summarizes key points from a conference on interrelated autoimmune diseases. It discusses the challenges of determining drug efficacy in clinical trials versus effectiveness in real-world use. For psoriasis treatments, clinical trials only provide a short-term view of efficacy, whereas effectiveness looks at long-term outcomes. A study on psoriasis patients found lower response rates in clinical practice than trials. For IBD treatments, combination therapy with immunosuppressants was more effective than monotherapy in one trial. Clinical trials also show the need for continuous high-dose biologic treatment to reduce antibody development and maintain response.
10 MCQs in Epidemiology & Biostatistics: How much can you score? (Medical Boo...Dr. Aryan (Anish Dhakal)
This document contains 10 multiple choice questions related to epidemiology concepts. The questions cover topics such as diagnostic test accuracy and characteristics, predictive values, likelihood ratios, biases in studies, relative risk, attributable risk, and sensitivity and specificity. An answer key is provided at the end with the correct response for each question.
This study assessed the prevalence of neonatal sepsis and associated risk factors among neonates admitted to neonatal intensive care units (NICUs) at two hospitals in Ethiopia from February 2016 to February 2017. The overall prevalence of neonatal sepsis was found to be 77.9%. Age of neonates, birth asphyxia, and use of oxygen via mask were significantly associated with increased risk of neonatal sepsis. The study recommends focusing prevention efforts on modifiable risk factors to reduce neonatal sepsis.
A study to develop and evaluate the effectiveness of informationAlexander Decker
This study evaluated the effectiveness of an information booklet on emergency contraception in increasing women's knowledge about the topic. 50 women were surveyed before and after reading the booklet. The results showed that the booklet significantly increased women's knowledge across all domains, with post-test scores being significantly higher than pre-test scores. The booklet was also found to have high acceptability and be useful for enhancing women's knowledge of emergency contraception. The researchers concluded that the information booklet was effective in improving knowledge, but that further studies with larger sample sizes are needed.
Precision Medicine is now a funded NIH initiative and an organic movement in the clinic and at the research institute. Based on work with Genomics England, multiple large pharmaceutical firms, and research hospitals, attendees will learn about the best practices for epidemiology, signal detection, research, and the clinical diagnostics associated with Precision Medicine, including the development of high-scale bio-repositories that link traditional patient data with genomic information. Come hear about how leadership, collaboration, consent, and compute can lead to success or failure in your Precision Medicine initiative, and how to bring your stakeholders together for an aligned mission response.
This study examined the attitudes of healthcare workers at a Greek hospital towards influenza vaccination.
A survey of 293 healthcare workers found that only 38.6% had received the influenza vaccine in the past. While 62.8% agreed vaccination was necessary, only 55.3% thought it was safe and 44.7% thought it effective. The main reasons for not vaccinating were distrust of vaccines, neglect, concerns about side effects and effectiveness.
Predictors of future vaccination included previous vaccination, belief in necessity, and trust in the vaccine. The low vaccination rate among healthcare workers poses a risk and needs to be addressed, though mandating vaccination also requires consideration.
This document provides diagrams (DAGs) summarizing various biases and causal structures in epidemiology, including:
1) Unreliable measures bias from using an imperfect measure of a confounder like depression.
2) Confounding bias from not adjusting for a confounder like depression between unemployment and mortality.
3) Immortal time bias in studies where follow-up starts after an event that guarantees exposure.
4) Mediator-outcome confounding bias when adjusting for a mediator that has confounders.
5) Difference-in-differences designs that use fixed effects to control for time and group confounding.
The DAGs are used to visualize biases and identify appropriate adjustment or study design
1) The study examined factors associated with compliance with follow-up appointments after psychiatric hospital discharge when system responsiveness was partially controlled.
2) They found that 33.8% of patients missed their first follow-up appointment. Patients with a primary substance-related diagnosis were most likely to miss appointments, as were uninsured patients.
3) There was a trend for patients not previously involved with outpatient care to miss appointments. Despite efforts to control system responsiveness, compliance with aftercare remained suboptimal, influenced by both client vulnerability and uncontrolled system factors.
Lessons learned in polygenic risk research | Grand Rapids, MI 2019Cecile Janssens
1. Fifteen years of polygenic risk research has shown that while polygenic risk scores can statistically significantly associate with complex diseases, the association does not necessarily predict disease risk well enough to be useful in healthcare.
2. To improve prediction, both data and models need to be improved to better reflect the underlying biological complexity. Additionally, predictive performance must be properly evaluated in the intended population and clinical utility determined.
3. Complex diseases are too complex and influenced by many factors to be perfectly predicted by current polygenic risk models. However, prediction does not need to be perfect to be useful, depending on the intended clinical application.
Presentation to class at University of Notre Dame who are creating website and materials in honor of Amanda Abbiehl. Amanda died of a PCA-related incident and would have been attending college if she was alive.
— Female genital tuberculosis is one of the major etiological factors of female infertility. Diagnosis of genital tuberculosis is very important in such cases. So this comparative observational type of study was carried out on infertile women to compare the diagnostic effectively of ultrasonograpgy (USG), genital tuberculosis, Tuberculin test, Nucleic acid amplification test (PCR), histopathology and hysteroscopy & laparoscopy (DHL) assuming culture as gold standard. It was observed that the 28% of infertile cases were found positive for genital tuberculosis on culture. Sensitivity of PCR 64.28%, DHL 92.85%, USG 42.85%, Histopathology 60.71% and Tuberculin Test 64.28%. So sensitivity was found with significant variation ranging from 42.85% with ultrasonography (USG) to 92.85% with DHL. Specificity of PCR 52.77%, DHL 55.55%, USG 98.61%, Histopathology 91.66% and Tuberculin Test 36.11%. So specificity was also found with significant variation being found maximum with USG (98.61%) and minimum with tuberculin test (36.11%). Positive predictive value (PPV) was found maximum (92.3%) with USG and minimum (28.12%) with tuberculin test and negative predictive value (NPV) was found maximum (95.23%) with DHL and minimum (72.22%) with tuberculin test. Diagnostic effectively of diagnosing GTB with various studied modalities vary with significant variation.
This document discusses Caitlin English's library database assignment on fall prevention. It summarizes her searches on fall prevention in the CINAHL database and evaluation of relevant articles. She found over 260 results when searching "fall prevention AND nursing" and analyzed two articles in depth, citing them in APA format. She explained how CINAHL is useful for finding nursing evidence and how limiting searches improves relevancy. Caitlin also evaluated websites from the CDC and Medscape on fall prevention criteria and chose the CDC site for her brochure due to its open access to information.
This study examined the association between obstetrician forceps volume and maternal and neonatal outcomes using data from 2,369 forceps deliveries over 4 years at a single hospital. The key findings were:
1) Physicians in the highest quartile of annual forceps volume performed a median of 11.5 forceps deliveries per year compared to 1.3 for the lowest quartile.
2) Bivariate analysis found higher rates of severe perineal lacerations among physicians in the highest volume quartile, but no differences in adverse neonatal outcomes.
3) After adjusting for patient characteristics, there was no significant association between physician volume quartile and severe perineal lacerations or adverse
This study evaluated the pharmacokinetics of dapivirine, an antiretroviral drug, in lactating women using a dapivirine vaginal ring for 14 days. The study found:
1) Dapivirine was present at low concentrations in breast milk and plasma compared to cervicovaginal fluid.
2) The median estimated daily infant exposure to dapivirine through breast milk was 74.3 ng/kg/day (less than 1 microgram per day).
3) Use of the dapivirine vaginal ring was well-tolerated with few adverse events reported, none requiring ring removal.
This study evaluated the relationship between physician experience and accuracy of developmental screening documentation in electronic medical records. The study reviewed records of 591 pediatric patients screened using the SWYC and M-CHAT tools. It found that only 45% of SWYC and 52% of M-CHAT screening results were documented, and only 73% of documented results were accurate. More experienced attending physicians did not differ from resident physicians in documenting SWYC screening results. Resident physicians were more likely than attendings to document M-CHAT results but less accurate in developmental screening documentation overall. The study highlights the need to improve standardized developmental screening documentation practices to facilitate early intervention.
This document summarizes a study that surveyed labor and delivery nurses on their perceptions of postpartum blood loss measurement. The study found that nurses currently estimate blood loss visually rather than using quantified measurement by weighing. After education on AWHONN guidelines recommending quantified measurement, nurses agreed it provided a more accurate measurement and could improve maternal outcomes. However, nurses identified barriers like lack of education, staffing, equipment and time that currently prevent implementing quantified measurement. The study concludes nurses recognize quantified measurement as optimal but barriers need to be addressed for implementation.
This document discusses a workshop on translating meta-analyses into clinical practice. It provides an example of a meta-analysis on intensive insulin treatment that pooled data from 7 randomized controlled trials including 11,425 patients. While an early trial suggested intensive insulin reduced mortality, the meta-analysis found it did not and actually increased the risk of hypoglycemia. The document emphasizes that single studies should not dictate practice changes and that meta-analyses provide more powerful and precise estimates of treatment effects.
This review of literature summarizes several studies related to perineal tears during childbirth. Some key findings include:
1) Studies found higher rates of anal incontinence and impaired pelvic floor structures in women who experienced undiagnosed or missed perineal tears compared to diagnosed tears.
2) Techniques like warm compresses, perineal massage, and hands-off positioning were found to reduce rates of severe perineal tearing in some studies.
3) Operative vaginal deliveries and midline episiotomies were associated with higher risks of anal sphincter injuries and severe perineal trauma in several studies.
4) Implementation of checklists and
This document provides a summary of recent multiple sclerosis (MS) research updates presented by Dr. Monique Canonico at the University of Hawaii John A. Burns School of Medicine. It discusses: 1) New oral medications approved by the FDA to treat MS, including Aubagio, Gilenya, and Tecfidera; 2) Ongoing clinical trials investigating new treatments and the potential role of diet and exercise in managing MS symptoms; and 3) Resources for patients, including assistive technology centers and support organizations.
Cost-Effectiveness of the National HIV/AIDS Strategy (NHAS) Goal of Increasin...CDC NPIN
Achieving the NHAS goal of increasing the proportion of newly diagnosed HIV-infected persons entering care within 3 months of diagnosis from 65% to 85% would:
1) Increase average life expectancy of HIV-infected individuals from 32.9 years to 34.1 years.
2) Reduce the average number of new HIV transmissions per 10,000 HIV-infected persons from 20.6 to 23.7.
3) Have an incremental cost-effectiveness ratio of $51,950 per quality-adjusted life year gained, below the typical willingness-to-pay threshold of $100,000 per QALY.
Pediatric Hospital Medicine Top 10 (ish) 2014rdudas
The article "The survival time of chocolates on hospital wards: covert observational study" studied how long chocolates lasted on hospital wards before being eaten. Researchers covertly placed chocolates in hospital wards and recorded how long they remained. On average, chocolates lasted only 75 minutes before being consumed, with large variations based on ward type and time of day. The study highlights issues around food security and integrity on hospital wards.
Mother and Baby Friendly Care: Baby friendly careSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
Application of Kangaroo Mother Care Database, Dominican Republic, 2014Brianna A. Casciello
The KMC program in the Dominican Republic piloted an electronic database to track indicators for premature and low birthweight newborns receiving KMC services. Over four years, the database was tested in four KMC program sites and standardized data collection across sites. Key lessons included fostering a culture of data collection, stakeholder involvement, and maintaining a solutions-oriented approach when issues arose. The Access database proved easy to use and generated accurate reports to inform follow up care, though financial and human resource constraints impacted database implementation and use in some facilities. Evaluation of the database's impact on the KMC program is needed.
Mother and Baby Friendly Care: Practice of kangaroo mother careSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker. This was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
Precision Medicine is now a funded NIH initiative and an organic movement in the clinic and at the research institute. Based on work with Genomics England, multiple large pharmaceutical firms, and research hospitals, attendees will learn about the best practices for epidemiology, signal detection, research, and the clinical diagnostics associated with Precision Medicine, including the development of high-scale bio-repositories that link traditional patient data with genomic information. Come hear about how leadership, collaboration, consent, and compute can lead to success or failure in your Precision Medicine initiative, and how to bring your stakeholders together for an aligned mission response.
This study examined the attitudes of healthcare workers at a Greek hospital towards influenza vaccination.
A survey of 293 healthcare workers found that only 38.6% had received the influenza vaccine in the past. While 62.8% agreed vaccination was necessary, only 55.3% thought it was safe and 44.7% thought it effective. The main reasons for not vaccinating were distrust of vaccines, neglect, concerns about side effects and effectiveness.
Predictors of future vaccination included previous vaccination, belief in necessity, and trust in the vaccine. The low vaccination rate among healthcare workers poses a risk and needs to be addressed, though mandating vaccination also requires consideration.
This document provides diagrams (DAGs) summarizing various biases and causal structures in epidemiology, including:
1) Unreliable measures bias from using an imperfect measure of a confounder like depression.
2) Confounding bias from not adjusting for a confounder like depression between unemployment and mortality.
3) Immortal time bias in studies where follow-up starts after an event that guarantees exposure.
4) Mediator-outcome confounding bias when adjusting for a mediator that has confounders.
5) Difference-in-differences designs that use fixed effects to control for time and group confounding.
The DAGs are used to visualize biases and identify appropriate adjustment or study design
1) The study examined factors associated with compliance with follow-up appointments after psychiatric hospital discharge when system responsiveness was partially controlled.
2) They found that 33.8% of patients missed their first follow-up appointment. Patients with a primary substance-related diagnosis were most likely to miss appointments, as were uninsured patients.
3) There was a trend for patients not previously involved with outpatient care to miss appointments. Despite efforts to control system responsiveness, compliance with aftercare remained suboptimal, influenced by both client vulnerability and uncontrolled system factors.
Lessons learned in polygenic risk research | Grand Rapids, MI 2019Cecile Janssens
1. Fifteen years of polygenic risk research has shown that while polygenic risk scores can statistically significantly associate with complex diseases, the association does not necessarily predict disease risk well enough to be useful in healthcare.
2. To improve prediction, both data and models need to be improved to better reflect the underlying biological complexity. Additionally, predictive performance must be properly evaluated in the intended population and clinical utility determined.
3. Complex diseases are too complex and influenced by many factors to be perfectly predicted by current polygenic risk models. However, prediction does not need to be perfect to be useful, depending on the intended clinical application.
Presentation to class at University of Notre Dame who are creating website and materials in honor of Amanda Abbiehl. Amanda died of a PCA-related incident and would have been attending college if she was alive.
— Female genital tuberculosis is one of the major etiological factors of female infertility. Diagnosis of genital tuberculosis is very important in such cases. So this comparative observational type of study was carried out on infertile women to compare the diagnostic effectively of ultrasonograpgy (USG), genital tuberculosis, Tuberculin test, Nucleic acid amplification test (PCR), histopathology and hysteroscopy & laparoscopy (DHL) assuming culture as gold standard. It was observed that the 28% of infertile cases were found positive for genital tuberculosis on culture. Sensitivity of PCR 64.28%, DHL 92.85%, USG 42.85%, Histopathology 60.71% and Tuberculin Test 64.28%. So sensitivity was found with significant variation ranging from 42.85% with ultrasonography (USG) to 92.85% with DHL. Specificity of PCR 52.77%, DHL 55.55%, USG 98.61%, Histopathology 91.66% and Tuberculin Test 36.11%. So specificity was also found with significant variation being found maximum with USG (98.61%) and minimum with tuberculin test (36.11%). Positive predictive value (PPV) was found maximum (92.3%) with USG and minimum (28.12%) with tuberculin test and negative predictive value (NPV) was found maximum (95.23%) with DHL and minimum (72.22%) with tuberculin test. Diagnostic effectively of diagnosing GTB with various studied modalities vary with significant variation.
This document discusses Caitlin English's library database assignment on fall prevention. It summarizes her searches on fall prevention in the CINAHL database and evaluation of relevant articles. She found over 260 results when searching "fall prevention AND nursing" and analyzed two articles in depth, citing them in APA format. She explained how CINAHL is useful for finding nursing evidence and how limiting searches improves relevancy. Caitlin also evaluated websites from the CDC and Medscape on fall prevention criteria and chose the CDC site for her brochure due to its open access to information.
This study examined the association between obstetrician forceps volume and maternal and neonatal outcomes using data from 2,369 forceps deliveries over 4 years at a single hospital. The key findings were:
1) Physicians in the highest quartile of annual forceps volume performed a median of 11.5 forceps deliveries per year compared to 1.3 for the lowest quartile.
2) Bivariate analysis found higher rates of severe perineal lacerations among physicians in the highest volume quartile, but no differences in adverse neonatal outcomes.
3) After adjusting for patient characteristics, there was no significant association between physician volume quartile and severe perineal lacerations or adverse
This study evaluated the pharmacokinetics of dapivirine, an antiretroviral drug, in lactating women using a dapivirine vaginal ring for 14 days. The study found:
1) Dapivirine was present at low concentrations in breast milk and plasma compared to cervicovaginal fluid.
2) The median estimated daily infant exposure to dapivirine through breast milk was 74.3 ng/kg/day (less than 1 microgram per day).
3) Use of the dapivirine vaginal ring was well-tolerated with few adverse events reported, none requiring ring removal.
This study evaluated the relationship between physician experience and accuracy of developmental screening documentation in electronic medical records. The study reviewed records of 591 pediatric patients screened using the SWYC and M-CHAT tools. It found that only 45% of SWYC and 52% of M-CHAT screening results were documented, and only 73% of documented results were accurate. More experienced attending physicians did not differ from resident physicians in documenting SWYC screening results. Resident physicians were more likely than attendings to document M-CHAT results but less accurate in developmental screening documentation overall. The study highlights the need to improve standardized developmental screening documentation practices to facilitate early intervention.
This document summarizes a study that surveyed labor and delivery nurses on their perceptions of postpartum blood loss measurement. The study found that nurses currently estimate blood loss visually rather than using quantified measurement by weighing. After education on AWHONN guidelines recommending quantified measurement, nurses agreed it provided a more accurate measurement and could improve maternal outcomes. However, nurses identified barriers like lack of education, staffing, equipment and time that currently prevent implementing quantified measurement. The study concludes nurses recognize quantified measurement as optimal but barriers need to be addressed for implementation.
This document discusses a workshop on translating meta-analyses into clinical practice. It provides an example of a meta-analysis on intensive insulin treatment that pooled data from 7 randomized controlled trials including 11,425 patients. While an early trial suggested intensive insulin reduced mortality, the meta-analysis found it did not and actually increased the risk of hypoglycemia. The document emphasizes that single studies should not dictate practice changes and that meta-analyses provide more powerful and precise estimates of treatment effects.
This review of literature summarizes several studies related to perineal tears during childbirth. Some key findings include:
1) Studies found higher rates of anal incontinence and impaired pelvic floor structures in women who experienced undiagnosed or missed perineal tears compared to diagnosed tears.
2) Techniques like warm compresses, perineal massage, and hands-off positioning were found to reduce rates of severe perineal tearing in some studies.
3) Operative vaginal deliveries and midline episiotomies were associated with higher risks of anal sphincter injuries and severe perineal trauma in several studies.
4) Implementation of checklists and
This document provides a summary of recent multiple sclerosis (MS) research updates presented by Dr. Monique Canonico at the University of Hawaii John A. Burns School of Medicine. It discusses: 1) New oral medications approved by the FDA to treat MS, including Aubagio, Gilenya, and Tecfidera; 2) Ongoing clinical trials investigating new treatments and the potential role of diet and exercise in managing MS symptoms; and 3) Resources for patients, including assistive technology centers and support organizations.
Cost-Effectiveness of the National HIV/AIDS Strategy (NHAS) Goal of Increasin...CDC NPIN
Achieving the NHAS goal of increasing the proportion of newly diagnosed HIV-infected persons entering care within 3 months of diagnosis from 65% to 85% would:
1) Increase average life expectancy of HIV-infected individuals from 32.9 years to 34.1 years.
2) Reduce the average number of new HIV transmissions per 10,000 HIV-infected persons from 20.6 to 23.7.
3) Have an incremental cost-effectiveness ratio of $51,950 per quality-adjusted life year gained, below the typical willingness-to-pay threshold of $100,000 per QALY.
Pediatric Hospital Medicine Top 10 (ish) 2014rdudas
The article "The survival time of chocolates on hospital wards: covert observational study" studied how long chocolates lasted on hospital wards before being eaten. Researchers covertly placed chocolates in hospital wards and recorded how long they remained. On average, chocolates lasted only 75 minutes before being consumed, with large variations based on ward type and time of day. The study highlights issues around food security and integrity on hospital wards.
Mother and Baby Friendly Care: Baby friendly careSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
Application of Kangaroo Mother Care Database, Dominican Republic, 2014Brianna A. Casciello
The KMC program in the Dominican Republic piloted an electronic database to track indicators for premature and low birthweight newborns receiving KMC services. Over four years, the database was tested in four KMC program sites and standardized data collection across sites. Key lessons included fostering a culture of data collection, stakeholder involvement, and maintaining a solutions-oriented approach when issues arose. The Access database proved easy to use and generated accurate reports to inform follow up care, though financial and human resource constraints impacted database implementation and use in some facilities. Evaluation of the database's impact on the KMC program is needed.
Mother and Baby Friendly Care: Practice of kangaroo mother careSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker. This was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
This document presents a concept paper on studying the relationship between video games and social/learning behaviors in teens and young adults. It outlines a problem statement on contradictory research regarding violent video games and behaviors. It then proposes research questions on whether video games can influence positive social behaviors or cause learned social behaviors. A quantitative, correlational study design is suggested to examine relationships between behaviors and virtual environments.
Mother and Baby Friendly Care: Principles of kangaroo mother careSaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: mother-friendly care in pregnancy, a modern approach to normal labour, skin-to-skin care of infants, encouraging breastfeeding, a baby-friendly nursery.
This document discusses kangaroo mother care (KMC), an intervention where low birthweight infants have skin-to-skin contact with their mothers. It provides background on the origins and history of KMC, as well as statistics on neonatal and infant mortality globally and in Malawi. Current KMC practices at Zomba Central Hospital in Malawi are described. Challenges to implementing KMC include poor monitoring, lack of resources and follow-up after discharge. Evidence shows KMC reduces infection risk, promotes growth and development, and is more effective than conventional care. Recommendations include improving follow-up systems and prioritizing KMC as a basic neonatal health service.
The document outlines a presentation on Kangaroo Mother Care (KMC). KMC involves prolonged skin-to-skin contact between a mother and her premature or low birth weight infant. The presentation covers causes of newborn deaths, the contribution of prematurity to deaths, elements of KMC including positioning and breastfeeding, evidence that KMC reduces mortality and improves outcomes, and country experiences implementing KMC.
1) A concept paper outlines a research project by describing the topic, research question, importance, and methodology in 1-5 pages.
2) It identifies what is known about the topic, formulates a research question, and explains why answering it is valuable.
3) The concept paper also describes the planned data collection, analysis, how this will answer the question, and any ethical issues.
This document describes a study that examined practice variation in the diagnosis and treatment of chorioamnionitis among US obstetricians. The study involved distributing a survey to 500 obstetricians querying their demographics, practice setting, and chorioamnionitis management strategies. 212 surveys were analyzed. The results found wide variation in diagnostic criteria, antibiotic regimens, and postpartum treatment duration. Specifically, over 25 different antibiotic regimens were reported, with 30% using a single agent. Postpartum treatment duration ranged from no treatment to 48 hours. No practitioner characteristics were independently associated with diagnostic or treatment strategies. This variation may reflect a lack of high-quality evidence on best practices for chorio
This document discusses evidence-based medicine and its advantages. It explains that evidence-based medicine involves integrating the best available medical research with clinical expertise and patient values and preferences. This is superior to past practices of relying solely on physician experience and judgment. Evidence-based medicine can help improve quality and safety, more quickly incorporate research findings into practice, and potentially reduce healthcare costs.
This study conducted a systematic review and meta-analysis of randomized controlled trials on the use of therapeutic clowns in pediatrics. It found 19 eligible studies and included 16 in the meta-analysis. The main findings were:
1) Clown therapy significantly reduced anxiety in children based on a pooled standardized mean difference of -0.83 favoring clown therapy.
2) Clown therapy significantly reduced state anxiety in parents based on a pooled standardized mean difference of -0.46 favoring clown therapy.
3) Clown therapy did not significantly reduce pain levels in children or the need for anxiolytic drugs.
This study compared same day sputum microscopy (two sputum samples collected one hour apart) to conventional sputum microscopy (spot sample and early morning sample collected over two days) for tuberculosis diagnosis in Chhattisgarh, India. The study found that same day microscopy missed 17% of smear-positive tuberculosis cases compared to 1% missed by conventional microscopy. Additionally, same day microscopy had a lower proportion of presumptive tuberculosis patients providing both required samples and had a lower proportion of samples with good quality. These findings suggest that same day microscopy may not be as effective as conventional microscopy for tuberculosis diagnosis in this setting.
This meta-analysis evaluated the performance of the Bacterial Meningitis Score by aggregating data from 8 validation studies including over 5000 children. The Bacterial Meningitis Score had a high sensitivity of 99.3% for identifying bacterial meningitis. It also had moderate specificity of 62.1% for ruling out bacterial meningitis. This clinical prediction rule could assist clinicians in managing children with cerebrospinal fluid pleocytosis by accurately identifying those at very low risk of bacterial meningitis.
Factors Associated with Antenatal Care Service Utilization among Women with C...YogeshIJTSRD
Maternal and neonatal mortality remains a public health burden around the globe most especially in developing countries. A well utilized antenatal care ANC is however among the identified interventions to reduce this burden of maternal and neonatal mortality rates. A lot of factors therefore predispose, enable and cause mothers to identify the need to utilize this service ANC .This study employed descriptive cross sectional survey design. A semi structured questionnaire consisting of demographic profile of the respondents, their knowledge about ANC services and the level of ANC utilization. Logistic regression analysis techniques and chi square were used for the categorical variables to examine the associations between the dependent and independent variables. Data analysis was done using the Statistical Package for Social Science software SPSS version 22. Majority 87 of postpartum mothers in the Sunyani municipality attended ANC at least once during their last pregnancy of which 95.6 had four or more visits and 77.1 initiated their ANC attendance within their first trimester. It was further observed that 97.3 of the mothers had good knowledge about ANC. Marital status and ANC knowledge were found to be significantly associated with ANC attendance. Stephen Owusu Sekyere | Kodua Freda "Factors Associated with Antenatal Care Service Utilization among Women with Children under Five Years in Sunyani Municipality, Ghana" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-3 , April 2021, URL: https://www.ijtsrd.com/papers/ijtsrd39882.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/39882/factors-associated-with-antenatal-care-service-utilization-among-women-with-children-under-five-years-in-sunyani-municipality-ghana/stephen-owusu-sekyere
Systematic Review and Meta-Analysis of the Association between β-Blocker Use ...daranisaha
β-blockers are drugs frequently prescribed for various indications in cardiology and for which anticancer properties have been suggested. We aimed to evaluate the association between the use of β-blockers and survival of women with OC.
1.2. Methods: A systematic literature search of relevant databases through September 2020 was conducted to identify studies assessing the association between β-blockers use and prognostic in women with OC. The inverse variance weighting method with random-effects model was used to calculate pooled hazard ratios (HR) and 95% confidence intervals (95% CI). We assessed the risk of immortal time bias (ITB) and the quality of the studies with the Newcastle–Ottawa scale. Subanalyses were performed based on quality scores and the risk for ITB.
Systematic Review and Meta-Analysis of the Association between β-Blocker Use...semualkaira
β-blockers are drugs frequently prescribed for various indications in cardiology and for which anticancer properties have been suggested. We aimed to evaluate the association between the use of β-blockers and survival of women with OC.
1.2. Methods: A systematic literature search of relevant databases through September 2020 was conducted to identify studies assessing the association between β-blockers use and prognostic in women with OC. The inverse variance weighting method with random-effects model was used to calculate pooled hazard ratios (HR) and 95% confidence intervals (95% CI). We assessed the risk of immortal time bias (ITB) and the quality of the studies with the Newcastle–Ottawa scale. Subanalyses were performed based on quality scores and the risk for ITB
Systematic Review and Meta-Analysis of the Association between β-Blocker Use ...eshaasini
β-blockers are drugs frequently prescribed for various indications in cardiology and for which anticancer properties have been suggested. We aimed to evaluate the association between the use of β-blockers and survival of women with OC.
1.2. Methods: A systematic literature search of relevant databases through September 2020 was conducted to identify studies assessing the association between β-blockers use and prognostic in women with OC. The inverse variance weighting method with random-effects model was used to calculate pooled hazard ratios (HR) and 95% confidence intervals (95% CI). We assessed the risk of immortal time bias (ITB) and the quality of the studies with the Newcastle–Ottawa scale. Subanalyses were performed based on quality scores and the risk for ITB.
Systematic Review and Meta-Analysis of the Association between β-Blocker Use...semualkaira
β-blockers are drugs frequently prescribed for various indications in cardiology and for which anticancer properties have been suggested. We aimed to evaluate the association between the use of β-blockers and survival of women with OC.
1.2. Methods: A systematic literature search of relevant databases through September 2020 was conducted to identify studies assessing the association between β-blockers use and prognostic in women with OC. The inverse variance weighting method with random-effects model was used to calculate pooled hazard ratios (HR) and 95% confidence intervals (95% CI). We assessed the risk of immortal time bias (ITB) and the quality of the studies with the Newcastle–Ottawa scale. Subanalyses were performed based on quality scores and the risk for I
Systematic Review and Meta-Analysis of the Association between β-Blocker Use...semualkaira
β-blockers are drugs frequently prescribed for various indications in cardiology and for which anticancer properties have been suggested. We aimed to evaluate the association between the use of β-blockers and survival of women with OC.
1.2. Methods: A systematic literature search of relevant databases through September 2020 was conducted to identify studies assessing the association between β-blockers use and prognostic in women with OC. The inverse variance weighting method with random-effects model was used to calculate pooled hazard ratios (HR) and 95% confidence intervals (95% CI). We assessed the risk of immortal time bias (ITB) and the quality of the studies with the Newcastle–Ottawa scale. Subanalyses were performed based on quality scores and the risk for ITB.
This document describes the development of a predictive model to identify premature infants born between 33-35 weeks gestational age that are at highest risk of hospitalization due to respiratory syncytial virus (RSV) infection. The model was developed using risk factor data from a Spanish case-control study of 183 infants hospitalized with RSV compared to 371 non-hospitalized controls. Discriminant function analysis identified an initial model using 15 risk factors that discriminated between the two groups with 72% accuracy. Further refinement resulted in a final 7 variable model that predicted risk with 71% accuracy and could help optimize use of RSV prophylaxis for higher risk infants in Europe.
Evaluation of factors that contributes to post-partum haemorrhage in Pregnant...PUBLISHERJOURNAL
Postpartum haemorrhage (PPH) is the world’s leading cause of maternal death and accounts for an estimated 127,000 deaths each year. Identification of some of the risk factors such as; previous postpartum haemorrhage, multiple pregnancies, macrosomia, induction of labour, operative vaginal deliveries and cesarean section would help in preventing PPH. The aim of this research was to assess the factors contributing to postpartum haemorrhage (PPH) among pregnant women who attend delivery services in Kampala International University Teaching Hospital (KIU-TH). This study used a cross-sectional descriptive design where by a cross-section of respondents involving 68 respondents were sampled to represent the target population, in these case women who received maternity service from KIU-TH. Only quantitative methods of data collection using questionnaires with closed ended questions were employed for both mothers and health workers. During the study period, 58 women who delivered in the unit and 20 women developed postpartum haemorrhage giving the frequency of postpartum haemorrhage 34.6%. The majority of the women 30% were between 30-34 years of age. Among the women who developed PPH retained placental tissues was the most common cause 50% followed by uterine atony which was 30%. The rest of the causes of PPH were laceration 20%. Postpartum haemorrhage is still a leading but preventable cause of maternal morbidity and mortality in our country due to underutilization of health facilities, the major cause is retained placental tissues followed by uterine atony.
Keywords: post-partum haemorrhage, pregnant women, delivering, Uganda
Evaluation of factors that contributes to post-partum haemorrhage in Pregnant...PUBLISHERJOURNAL
Postpartum haemorrhage (PPH) is the world’s leading cause of maternal death and accounts for an estimated 127,000 deaths each year. Identification of some of the risk factors such as; previous postpartum haemorrhage, multiple pregnancies, macrosomia, induction of labour, operative vaginal deliveries and cesarean section would help in preventing PPH. The aim of this research was to assess the factors contributing to postpartum haemorrhage (PPH) among pregnant women who attend delivery services in Kampala International University Teaching Hospital (KIU-TH). This study used a cross-sectional descriptive design where by a cross-section of respondents involving 68 respondents were sampled to represent the target population, in these case women who received maternity service from KIU-TH. Only quantitative methods of data collection using questionnaires with closed ended questions were employed for both mothers and health workers. During the study period, 58 women who delivered in the unit and 20 women developed postpartum haemorrhage giving the frequency of postpartum haemorrhage 34.6%. The majority of the women 30% were between 30-34 years of age. Among the women who developed PPH retained placental tissues was the most common cause 50% followed by uterine atony which was 30%. The rest of the causes of PPH were laceration 20%. Postpartum haemorrhage is still a leading but preventable cause of maternal morbidity and mortality in our country due to underutilization of health facilities, the major cause is retained placental tissues followed by uterine atony.
Keywords: post-partum haemorrhage, pregnant women, delivering, Uganda
Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoeaUtai Sukviwatsirikul
This systematic review and meta-analysis evaluated the effectiveness of Saccharomyces boulardii in preventing antibiotic-associated diarrhea in children and adults based on 21 randomized controlled trials involving 4780 participants. The administration of S. boulardii compared to placebo or no treatment reduced the risk of antibiotic-associated diarrhea from 18.7% to 8.5%. S. boulardii was effective in reducing the risk of antibiotic-associated diarrhea in both children and adults. It also reduced the risk of Clostridium difficile-associated diarrhea in children but not adults. Overall, the results confirm that S. boulardii is effective for preventing antibiotic-associated diarrhea in children and adults.
Systematic review with meta-analysis: Saccharomyces boulardii in the preventi...Utai Sukviwatsirikul
This systematic review and meta-analysis evaluated the effectiveness of Saccharomyces boulardii in preventing antibiotic-associated diarrhea in children and adults based on 21 randomized controlled trials involving 4780 participants. The administration of S. boulardii compared to placebo or no treatment reduced the risk of antibiotic-associated diarrhea from 18.7% to 8.5%. S. boulardii was effective in reducing the risk of antibiotic-associated diarrhea in both children and adults. It also reduced the risk of Clostridium difficile-associated diarrhea in children. The quality of evidence was rated as moderate to low based on limitations in the design and reporting of the included studies. This meta-analysis confirms the effectiveness of
This document discusses various study designs used in medical research. It describes descriptive study designs like case reports, case series, ecological studies, and cross-sectional studies which are used to describe characteristics of subjects. It also describes analytical study designs like case-control studies and cohort studies which are used to analyze associations between exposures and outcomes. Experimental study designs like randomized controlled trials are also discussed which are used to evaluate interventions. Key aspects of each study design like their strengths, weaknesses and steps are highlighted.
Critical Research Appraisal AssignmentNUR501 PhilosophiMargenePurnell14
Critical Research Appraisal Assignment
NUR501: Philosophical & Theoretical, Evidence-Based Research
Dr. Corzo-Sanchez
June 24, 2022
Critical Research Appraisal Assignment
Nursing research uncovers new knowledge to help build the foundation of clinical practice. Research can help prevent diseases and disabilities, help manage symptoms, establish new treatment plans and improve nursing skills. This is why nurses need to be able to participate in and analyze research, as this can bring positive outcomes to their careers and the health of their patients. There are two different types of research, quantitative and qualitative, that provide information and data. For this assignment, I chose one qualitative research that focuses on the stress and burnout experienced by nursing professionals and one quantitative analysis that explores nurses’ knowledge regarding hand hygiene. Each study will be evaluated thoroughly and analyzed.
Qualitative Research
The definition of qualitative research can be challenging. Qualitative research involves collecting and analyzing non-numerical data to understand concepts, opinions, or experiences (Morgan et al., 2021). This form of research explores deeper insights into real-world problems in an emergent and holistic way. Qualitative data can be collected using various methods such as interviews, focus groups, observations, and documentation analysis (Hoover, 2021). Qualitative research has been used in nursing for many years, but it was not the first method used in nursing. Before quantitative research, philosophical methods such as hermeneutics and phenomenology were the only options for professional inquiry (Butts & Rich, 2017). However, it was changed to qualitative research because its ways were incompatible with science. There are three major approaches to qualitative research, (1) ethnography, based on anthropology, (2) phenomenology, drawn from philosophy; and (3) grounded theory, drawn from sociology (Morgan et al., 2021). The use of qualitative studies is common due to its many strengths, such as providing multiple methods of data collection, more detailed information, and how it can refine and strengthen quantitative research. However, some of the limitations of this form of research are difficulty analyzing and collecting data while being more time-consuming.
Evaluating and Analyzing a Selected Qualitative Study
For the example of the qualitative study, I chose Luis M. Dos Santos's study, which focused on the effects of stress, burnout, and low self-efficacy in nursing professionals. The quantitative research aimed to understand and explore how social and environmental factors influence nursing professionals’ self-efficacy. In the study, the Social Cognitive Theory was used to define how each subject was affected based on their thoughts, behaviors, feeling, and personal beliefs (Dos Santos, 2020). For this research study, the phenomenological approach and analysis were used thought the survey to collec ...
This document provides an introduction and tables for determining sample sizes in various health studies. It covers one-sample situations like estimating a population proportion with absolute or relative precision and hypothesis tests for a population proportion. Two-sample situations covered include estimating the difference between two population proportions and hypothesis tests for two population proportions. It also addresses case-control studies, cohort studies, lot quality assurance sampling, and incidence-rate studies. Tables of minimum sample sizes are provided for each situation.
Similar to Ovid 'kangaroo mother care' to prevent neonatal deaths due to preterm birth complications (structured abstract). (20)
Ovid 'kangaroo mother care' to prevent neonatal deaths due to preterm birth complications (structured abstract).
1. Ovid: 'Kangaroo mother care' to prevent neonatal deaths due to preterm bir... http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi
Database of Abstracts of Reviews of Effects
Issue: Volume (1), 2013, [no page #]
Copyright: Copyright 2013 University of York
Publication Type: [Abstracts of quality assessed systematic reviews]
Accession: 00125498-100000000-24133
Keywords: Female, Humans, Male, Breast Feeding, Child Rearing, development, Infant, Newborn, Infant, Premature, growth & development, Infant Care, methods, Infant
Mortality, Parent-Child Relations, Physical Stimulation, Premature Birth, Randomized Controlled Trials as Topic
[Abstracts of quality assessed systematic reviews]
'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications (Structured abstract)
Centre for Reviews and Dissemination
Author Information
NHS Centre for Reviews and Dissemination. University of York, York, U.K.
Source Reference
Abstract and Commentary for:Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. 'Kangaroo mother care' to prevent neonatal deaths due to preterm birth
complications. International Journal of Epidemiology. 2010;39(Supplement 1):.
CRD summary
This review investigated the effects of Kangaroo Mother Care in preventing neonatal
deaths due to preterm birth complications and concluded that it substantially reduced
neonatal mortality among preterm babies in hospital and was highly effective in reducing
severe morbidity. Overall, the review was well conducted and the conclusion appears
reliable and an accurate reflection of the evidence presented.
Authors' objectives
To update a 2003 Cochrane review to investigate the effects of Kangaroo Mother
Care (KMC) in preventing neonatal deaths due to preterm birth complications.
Searching
PubMed, LILACS, African Medicus, EMRO, World Health Organisation Regional
Databases and The Cochrane Library were searched for studies published in any language
between 1968 and 8 September 2009. Proceedings from major conferences were
searched online for unpublished literature. Search terms used were reported.
Study selection
Eligible studies needed to have a patient population of neonates (defined as babies
less than 28 days old who weighed less than 2,000g) and the intervention had to be KMC
(defined as continuous skin-to-skin contact and support for exclusive breastfeeding or
other appropriate feeding and early recognition and response to complication). KMC had
to be commenced within one week of birth. The comparator (where relevant) had to be
conventional care such as incubator care or more limited care. Eligible studies needed to
report neonatal mortality due to complications of preterm birth or serious neonatal
morbidity related to prematurity (such as respiratory distress syndrome, pneumonia and
septicaemia). Any study design was eligible for inclusion. Where outcomes were reported
for a broader age group that included neonates, study authors were contacted for
outcomes that related only to the neonate subgroup. Studies used to assess mortality
outcomes : These studies all took place in hospitals. Study locations included Bangladesh,
Colombia, Ecuador, Ethiopia, India, Indonesia, Mexico, Mozambique, South Africa and
Zimbabwe. Definitions of low birth weight ranged from less than 1,600g to less than
2,000g. Median time of commencing KMC ranged from four hours to 12.4 days from birth.
There was some variability in mortality outcome definitions (mortality was assessed from
pre-discharge to 12 months). Studies used to determine morbidity outcomes: Comparable
details were not provided. It appeared that more than one reviewer performed the initial
and final screening for study selection.
Validity assessment
1 de 4 21/02/2013 10:03 a.m.
2. Ovid: 'Kangaroo mother care' to prevent neonatal deaths due to preterm bir... http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi
Validity was assessed using a Child Health Epidemiology Reference Group (CHERG)
checklist based on an adaptation of the Grading of Recommendations Assessment,
Development and Evaluation (GRADE). The number of reviewers involved in this stage of
the review process was not reported.
Data extraction
Two reviewers independently extracted data required to calculate risk ratios (RRs)
with 95% confidence intervals (CIs) for the outcomes of morbidity and mortality on a
standardised form. Where required, authors were contacted for additional data.
Methods of synthesis
The review stated that a priori the authors planned to conduct three meta-analyses
producing pooled risk ratio estimates: one that compared mortality outcomes from RCTs
only; a second that compared mortality outcomes from observational studies only; and a
third that compared morbidity outcomes from RCTs only. I2 values were used to assess
heterogeneity. Where heterogeneity was considered significant (threshold of p<0.10 in
the associated Q tests), it appeared that a random-effects model was used to pool data
instead of a Mantel-Haenszel fixed-effect model.
Results of the review
Fifteen studies were included in the review: nine RCTs and six observational studies.
The authors stated that most of the RCTs had minor limitations. None of the five RCTs
that assessed mortality were blinded. Mortality outcomes (RCTs): Three studies were
included (n=988). There was a statistically significant reduction in mortality risk with KMC
compared to standard care (RR 0.49, 95% CI 0.29 to 0.82 using a fixed-effect model,
I2=0%). Mortality outcomes (observational studies): Three studies were included
(n=8,257). Mortality risk was statistically significantly reduced compared with standard
incubator care (RR 0.68, 95% CI 0.58 to 0.79 model used not reported, I2=54.4%).
Morbidity outcomes (RCTs): Five studies were included (n=1,520). The risk was
statistically significantly lower in the KMC group compared with the standard care group
(RR 0.34, 95% CI 0.17 to 0.65 using a random-effects model, I2=69.7%). Sensitivity
analyses for mortality outcomes: Including studies with later initiation of KMC brought
the RR closer to one, but the difference was still statistically significant (RR 0.64, 95% CI
0.42 to 0.96, model details not specified). Including a study with incomplete population
details did not affect the results. Using a random-effects model changed the results from
statistically significant to statistically insignificant (RR 0.68, 95% CI 0.38 to 1.22).
Cost information
This review addressed a clear review question using appropriate and clearly stated
study selection criteria. The search strategy was clearly reported and appeared
comprehensive and clearly reported; a large number of databases were searched without
date or language restrictions and search terms were reported. It appeared that study
selection and other stages of the review process such as data extraction were conducted
in duplicate to reduce risks of reviewer error and bias. Reporting of primary study
characteristics appeared appropriate. Validity was assessed, but results were not fully
reported in the paper (the review stated that supplementary tables were available online
but these could not be obtained on 29/9/2010). The method of synthesis appeared
appropriate and comprehensive, although the authors appeared to suggest that random-
effects Mantel-Haenszel meta-analyses were possible when they were not. The results
were comprehensively and clearly reported. One of the sensitivity analyses explored the
effect of using a random-effects rather than fixed-effect model and indicated that the
statistical significance of some results may have been sensitive to modelling assumptions.
Overall the authors' conclusion appears reliable and to accurately reflect the evidence
presented.
Authors' conclusions
2 de 4 21/02/2013 10:03 a.m.
3. Ovid: 'Kangaroo mother care' to prevent neonatal deaths due to preterm bir... http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi
Kangaroo Mother Care substantially reduced neonatal mortality among preterm
babies in hospital and was highly effective in reducing severe morbidity.
CRD commentary
This review addressed a clear review question using appropriate and clearly stated
study selection criteria. The search strategy was clearly reported and appeared
comprehensive and clearly reported; a large number of databases were searched without
date or language restrictions and search terms were reported. It appeared that study
selection and other stages of the review process such as data extraction were conducted
in duplicate to reduce risks of reviewer error and bias. Reporting of primary study
characteristics appeared appropriate. Validity was assessed, but results were not fully
reported in the paper (the review stated that supplementary tables were available online
but these could not be obtained on 29/9/2010). The method of synthesis appeared
appropriate and comprehensive, although the authors appeared to suggest that random-
effects Mantel-Haenszel meta-analyses were possible when they were not. The results
were comprehensively and clearly reported. One of the sensitivity analyses explored the
effect of using a random-effects rather than fixed-effect model and indicated that the
statistical significance of some results may have been sensitive to modelling assumptions.
Overall the authors' conclusion appears reliable and to accurately reflect the evidence
presented.
Implications of the review for practice and research
Practice: The authors stated that KMC should be used routinely in facilities for all
stable babies less than 2,000g at birth. Research: The authors stated that there was need
for further assessment of KMC in settings with no medical care for all except the smallest
babies and a need for analysis of potential cost savings on nursing time and length of
in-patient stay.
Funding
Bill and Melinda Gates Foundation (Grant 43386, Grant 50124); UNICEF; Save the
Children USA; Global Alliance for Prevention of Prematurity and Stillbirths.
URL for original research
http://ije.oxfordjournals.org/content/39/suppl_1/i144.abstract
Other publications of related interest
Cande-Agudelo A, az-Rossello JL, Belizan JM. Kangaroo mother care to reduce
morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2003; 2:
CD002771
Record status
This is a critical abstract of a systematic review that meets the criteria for inclusion
on DARE. Each critical abstract contains a brief summary of the review methods, results
and conclusions followed by a detailed critical assessment on the reliability of the review
and the conclusions drawn.
CRD database number
DARE-12010003310
3 de 4 21/02/2013 10:03 a.m.
4. Ovid: 'Kangaroo mother care' to prevent neonatal deaths due to preterm bir... http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi
Index terms
Medical Subject Headings (MeSH)
[Subject indexing assigned by CRD]
Female; Humans; Male; Breast Feeding; Child Rearing; development; Infant,
Newborn; Infant, Premature/growth & development; Infant Care/methods; Infant
Mortality; Parent-Child Relations; Physical Stimulation; Premature Birth; Randomized
Controlled Trials as Topic
Copyright (c) 2000-2012 Ovid Technologies, Inc.
Terms of Use Support & Training About Us Contact Us
Version: OvidSP_UI03.08.00.103, SourceID 57329
4 de 4 21/02/2013 10:03 a.m.