Exploring acceptability and feasibility of a wearable device to facilitate home phototherapy treatment for newborn jaundice in rural Scotland: an interpretive description study.

Jaundice is a common condition in newborn infants, turning skin colour yellow due to the build-up of bilirubin. Internationally, jaundice continues to result in newborn infants' hospital admission, forcing separation of family units at the pivotal point for breastfeeding initiation and bonding. The aim of this research was to explore - with healthcare professionals and parents - the acceptability and feasibility of a wearable device to facilitate home phototherapy treatment for newborn jaundice in rural Scotland. The research was undertaken through qualitative interviews, using Interpretive Description to accommodate various perspectives influencing acceptability and feasibility of a wearable device to facilitate home phototherapy treatment. Participants were recruited via purposive sampling from one NHS board in Scotland. Semi- structured interviews were used with parental dyads (n=4) and mothers (n=6). Healthcare professionals (n=9) were recruited onto two focus groups conducted in different geographical locations (an urban and regional hospital) in NHS Grampian. The Framework approach was used to thematically analyse the data. Miranda Fricker's concept of epistemic injustice, which proposes inequity due to unequal power dynamics between people or systems, provided a theoretical perspective to interpret key findings. The study found that, although parents expressed a desire for wearable phototherapy devices to facilitate breastfeeding and comfort for the newborn infant, they primarily wanted home-based phototherapy treatment. Study participants described a 'one-size-fits-all' focus for newborn jaundice, centred around quickly reducing serum bilirubin levels. Furthermore, healthcare professionals assumed that parents would agree that the use of overhead phototherapy devices was worthwhile despite the distress to mothers and newborn infants, because it was an effective means of lowering serum bilirubin levels and facilitating timely discharge from care. Parents perceived postnatal care of newborn infants with jaundice to be paternalistic, which was interpreted by parents as being evidence of healthcare professionals' lack of trust in their parental capabilities. Moreover, healthcare professionals did not trust their clinical judgement to assess and manage newborn jaundice, due to the fear that they would be held clinically accountable for serum bilirubin levels not improving. This affected healthcare professionals' ability to trust parental capabilities. As a result, the rural aspect of the study became inconsequential. The study concluded that parents were willing to compromise on size, functions, and usability of phototherapy devices to facilitate home-based phototherapy treatment in the short term. However, epistemic injustice towards parents and midwives impacted shared decision-making within care teams, which in turn obstructed the acceptability and feasibility of both home-based phototherapy in general, and more specifically a wearable device that could facilitate home-based phototherapy

Newsletter, 1995-06, no. 16

The newsletter contains both association business and material of interest to midwives and related health care workers.The Association's name has changed several times based on the newsletter: from January 1992 - January 1997 it was The Alliance of Nurse-Midwives, Maternity and Neonatal Nurses, dropping the "Nurse-" after July 1994; from March 1997 - September 2000 it was Newfoundland and Labrador Midwives Association, and the issue numbering was reset; and in January 2001 it became Association of Midwives of Newfoundland and Labrador

Estimating the need for inpatient neonatal services: an iterative approach employing evidence and expert consensus to guide local policy in Kenya.

Universal access to quality newborn health services will be essential to meeting specific Sustainable Development Goals to reduce neonatal and overall child mortality. Data for decision making are crucial for planning services and monitoring progress in these endeavours. However, gaps in local population-level and facility-based data hinder estimation of health service requirements for effective planning in many low-income and middle-income settings. We worked with local policy makers and experts in Nairobi City County, an area with a population of four million and the highest neonatal mortality rate amongst counties in Kenya, to address this gap, and developed a systematic approach to use available data to support policy and planning. We developed a framework to identify major neonatal conditions likely to require inpatient neonatal care and identified estimates of incidence through literature review and expert consultation, to give an overall estimate for the year 2017 of the need for inpatient neonatal care, taking account of potential comorbidities. Our estimates suggest that almost 1 in 5 newborns (183/1000 live births) in Nairobi City County may need inpatient care, resulting in an estimated 24 161 newborns expected to require care in 2017. Our approach has been well received by local experts, who showed a willingness to work together and engage in the use of evidence in healthcare planning. The process highlighted the need for co-ordinated thinking on admission policy and referral care especially in a pluralistic provider environment helping build further appetite for data-informed decision making

Christ Church Canterbury University educational assessment report: Da Nang Hospital for Women and Children NICU/HDU, prepared for Newborns Vietnam

This report represents the findings of an educational assessment visit undertaken by Christ Church Canterbury University in March 2012, following a request to the Royal College of Nursing (RCN) by Newborns Vietnam (NBV) a charitable organisation working in partnership with the Da Nang Department of Health for assistance to advance neonatal care in central Vietnam. All parties recognised that nurses are critical to good neonatal care and assistance was sought to assess current skills, knowledge, working practices and to explore the potential to develop Vietnam’s first neonatal nurse training curriculum. NBV’s objective is to address the lack of a formal neonatal nurse training programme and through its fundraising activities provide sponsorship for additional nurses to improve the nurse baby ratio to facilitate the training and to provide the evidence base for advocacy for increased resources for neonatal care within Vietnam

From bedside to bench: Comroe and dripps revisited

Twenty-five years ago a paper published in Science by Julius Comroe and Robert Dripps purported to demonstrate that 41 per cent of all articles judged to be essential for later clinical advances were not clinically oriented at the time of the study and 62 per cent of key articles were the result of basic research. Since that analysis, support for basic research has increased in the G7 countries. In the UK, Research Council expenditure on basic research has increased from a low of £444 million (or 42 per cent of total civil R&D) in 1991/92 to £769 million (or 61 per cent of total civil R&D) in 1998/99. Although it would be difficult to argue that Comroe and Dripps were directly responsible for a strategic shift (or drift) in the type of science supported by research funders, their arguments are often cited (albeit at times implicitly) in support of the increased funding for basic biomedical research. In 1987 Richard Smith wrote a critical paper reassessing Comroe and Dripps. His main argument was that the original study was in itself ‘unscientific’ and that it should be “followed by bigger and better studies”. This study is, in part, an answer to that challenge. Given the increased support for basic research, and the apparent importance based on the work of Comroe and Dripps, we felt it was important to investigate Smith’s comments by replicating Comroe and Dripps’s study and at the same time try to improve upon the methodology. The current project had two objectives: 1. To see if the original Comroe and Dripps’s methodology was ‘replicable’. 2. To validate the key findings of Comroe and Dripps. By looking at neonatal intensive care (NIC), we concluded that Comroe and Dripps’ study – as reported – is not repeatable, reliable or valid, and thus is an insufficient evidence base for increased expenditure on basic biomedical research. We did, however, develop an alternative methodology which used bibliographic databases and bibliometric techniques to describe the research underpinning five of the most important clinical advances in NIC, as identified through a Delphi survey. Using the revised bibliometric protocol, we demonstrated that after a time-lag of about 17 years, between 2 and 21 per cent of research underpinning the clinical advances could be described as basic. This observation is at odds with Comroe and Dripps’s finding that 62 per cent of key research articles judged to be essential for latter clinical advance were the result of basic research. In reaching this conclusion we are acutely aware of the significant limitations to the revised methodology and, therefore, we caution against the over-interpretation of our results. However, we would argue that there needs to be a greater understanding of how basic research supports healthcare and hope this report will inform part of this wider debate.R&D Directorate of the NHS Executive London; Wellcome Trus

Understanding pregnancy-related morbidity and mortality among young women in Rajasthan

This report is the result of an exploratory study of the pregnancy-related morbidity and mortality experiences of women who delivered in adolescence and adulthood in Rajasthan, undertaken by the Population Council with support from the John D. and Catherine T. MacArthur Foundation