651 research outputs found

    The Special Care Nursery

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    Providing services to high-risk infants and their families in the neonatal intensive care unit is a complex subspecialty of pediatric physical therapy requiring knowledge and skills beyond the competencies for entry into practice. The newborns in the neonatal intensive care unit (NICU) are among the most fragile patients that physical therapists will treat, and detrimental effects can occur as the result of routine caregiving procedures. Pediatric physical therapists (PTs) need advanced education in areas such as early fetal and infant development; infant neurobehavior; family responses to having a sick newborn; the environment of the NICU, physiologic assessment and monitoring; newborn pathologies, treatments, and outcomes; optimal discharge planning; and collaboration with the members of the health care team.256 This chapter describes the neonatal intensive care unit and the role of the physical therapist within this setting. Practice in this setting requires knowledge of neonatal physiology, development, and health complications including prematurity, pulmonary conditions, neurologic conditions, fetal alcohol syndrome, fetal abstinence syndrome, and pain. A framework for physical therapy examination, evaluation, prognosis, and interventions for infants in the special care nursery is presented. The follow-up of infants after discharge from the intensive care nursery is addressed. Two case studies are presented to apply knowledge to practice

    Retrospective Analysis of Obstetric Sepsis Screening

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    This project was designed to evaluate outcomes following implementation of routine screening for sepsis in the obstetric population. A retrospective analysis of the electronic medical record of 204 women who met sepsis criteria using obstetric-adjusted systemic inflammatory response syndrome (SIRS) criteria and a source of infection was the method used. Outcomes were evaluated for neonates born to the women who developed sepsis during labor. The incidence of sepsis was 0.401 per1,000 and included those with antepartum, intrapartum, or postpartum admissions. The setting was a tertiary center with 5,075 deliveries over the study period. There were 92 (45.2%) who had sepsis, 87 (42.6%) who had severe sepsis, and 25 (12.3%) who met septic shock criteria. There were no deaths and two ICU admissions. Mean lactic acid level for women with sepsis (N=203) was 2.4 +- 1.3 mmol/L. Fourteen combinations of positive SIRS criteria were present; no combination was uniquely associated with the severity of sepsis. An Apgar score of ≀ 6 at one- and five-minutes of age was more likely when the mother developed sepsis in labor, odds ratio 12.1 (95% confidence interval, 7.86, 18.61) for the one-minute Apgar, and 3.06 (95% confidence interval 1.40, 6.75) for the five-minute Apgar score. The use of a standardized process for screening for sepsis provided for early identification and timely treatment of obstetric women with sepsis. Neonates born to women who met sepsis criteria in labor were more likely to require resuscitation at the time of birth than those born to women without sepsis

    Incorporating Genomic Analysis In The Clinical Practice Of Hepatology

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    In the past two decades, whole-exome sequencing has been successfully demonstrated as an indispensable instrument in uncovering the genetic etiology underlying numerous types of unexplained liver disease. Characterization of these illnesses into distinct molecular disease entities has revolutionized understanding of pathophysiology and has translated into improved guidance on management, treatment and prognosis for patients. However, hepatologists have been slow to welcome the technology into their mainstream clinical practice, largely due to inadequate training in genomic medicine. There thus remains a pressing need to create various forums through which clinicians can gain better appreciation for the value of genetic analysis in the field of hepatology and amass the knowledge and confidence to incorporate genetic analysis into their own clinical practice. To address this need, we aimed to facilitate the dissemination of new information on liver disease with an underlying genetic etiology through a two-pronged approach: (1) the generation of an online database housing genotype-phenotype correlation information for diseases affecting the liver, and (2) the promotion of a multidisciplinary Hepatology Genome Rounds series. In this Thesis, we detail the creation of a comprehensive database focused on genetic liver diseases, reflecting the genotypic and phenotypic profiles of more than 7,500 individuals with genetic variants across 269 genes. This newly developed database will provide clinicians and researchers a centralized source for information on genotype-phenotype correlation to aid in diagnosis and education. In addition, we demonstrate that the Hepatology Genome Rounds series, which is an interdisciplinary forum highlighting hepatology cases of clinical interest and educational value, is an important venue for the distribution of genomic knowledge within the field of hepatology and for providing ongoing education to providers and trainees in genomic medicine. We describe our single-center experience, which has led to the reconsideration of diagnoses in two patients and an improved understanding of genotype-phenotype correlations across all cases. As the value of genetic analysis continues to emerge in understanding human disease and pathophysiology, we foresee similar approaches being adopted at other institutions and in additional specialties in coming years for further propagation of genomics in clinical medicine

    Interdisciplinarity in Translation Medicine: A Bibliometric Case Study.

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    Ph.D. Thesis. University of Hawaiʻi at Mānoa 2017

    We Have Arrived!: Magnet Status 2006

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    Report on Nursing, vol. 1, 2005 & 2006https://knowledgeconnection.mainehealth.org/annualreports/1001/thumbnail.jp

    Service readiness for inpatient care of small and sick newborns: Improving measurement in low- and middle-income settings

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    Background: In 2018, 2.5 million newborns died; mainly from prematurity, infections, and intrapartum events. Preventing these deaths requires health systems to provide routine and emergency care at birth, and quality inpatient care for small and sick newborns. Despite high potential impact, inpatient newborn care is not consistently measured. Methods: For this PhD, I conducted a bottleneck analysis using data from 12 national workshops regarding delivery of inpatient newborn care in low- and middle-income countries (LMIC). Using WHO guidelines, grey literature and expert consultation, I mapped the components required to deliver inpatient care and reviewed these against three health facility assessment tools. Finally, I carried out an online survey to elicit global practitioner opinions regarding levels of newborn care, paralleling those used for monitoring emergency obstetric care in LMIC. Results: In 12 high-burden countries in sub-Saharan Africa and Asia, health financing and workforce were identified as the greatest bottlenecks to scaling up quality inpatient care, followed by community ownership. My review identified 654 components required to deliver inpatient care. These are inconsistently measured by existing health facility assessments. The 262 survey respondents agreed on 12 interventions to comprise a package of care for small and sick newborns; selected levels of care varied by clinical background and experience in LMIC. Conclusion: Inpatient newborn care faces multiple health system challenges, particularly to ensure funding and skilled staffing. Standard facility numbers and staffing ratios by defined levels of care are important for countries to benchmark service delivery progress. Due to the large number of components required for delivering quality care, newborn “signal functions” could be selected by level of care to parallel emergency obstetric care indicators. Improved measurement of service readiness requires sustained focus on interoperability of routine measurement systems, and further research to better capture the experience of newborn inpatient care for families

    Development of a Graduate Nurse Residency Program in Women\u27s Services

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    Graduate nurses\u27 transition from school to the work place is challenging and often leads to burnout. There was no graduate nurse residency program in women\u27s services at the practicum facility. As a result, this facility had been unable to recruit or hire graduate nurses in the women\u27s services unit. The purpose of this project was to develop a nurse residency program in women\u27s services to address the lack of formal orientation for new graduate nurses at this facility. A graduate nurse residency program will provide further training for nurses to care for a more complicated population of pregnant women. Theoretical support for this project was Duchscher\u27s, theory of transition, which suggests that allowing graduates time to adjust within a context of support allows them to develop their thinking and practice and helps them move through the stages of professional role transition. The project included a review of literature, development of a nurse residency plan, all materials needed to operationalize the program in the institution, and plans for implementing and evaluating the program over time within the context of institutional challenges, goals, and strengths. Collaboration with institutional stakeholders helped to ensure the contextual relevance of the program and ongoing administrative ownership to provide momentum for the program to move forward following delivery of the products of the DNP project to the institution. In sum, the products of this project comprise a turn-key solution to the institutional need for a graduate nurse residency program in women\u27s services. Social change implications include possible improvement in the recruitment and retention of graduate nurses as well as the consistent development of competent and safe practitioners who will improve maternal and newborn outcomes at the facility

    Psychosocial Support, Newborn Readmissions, and Postpartum Follow-up

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    Background. Women and their infants are being discharged as soon as 24 hours after giving birth without proper follow-up care. The Maternity Department at San Antonio Community Hospital established the Family Care Center (HBFCC) in November 2000 in response to a higher than expected newborn readmission rate, shorter maternity hospitalizations, and a lack of postpartum follow-up. A comprehensive program was offered to support new families in the form of developmental assessment and intervention, breastfeeding, infant and toddler nutrition, health promotion and education, and referrals to appropriate agencies when indicated. In 2004, due to inadequate funding, the hospital reduced the intervention to a postpartum clinic that included limited breastfeeding support 2 weeks following birth. Purpose. The purpose of this study was to determine if there is a positive relationship between the degree of psychosocial support offered (comprehensive, limited, or none) by healthcare providers and the rate of normal newborn readmissions. In addition, a cost-benefit analysis was performed to compare the costs of the intervention to the costs for normal newborn readmissions to establish whether such interventions are worthwhile from an economic viewpoint. Design and Method. The study utilized an interrupted time series design with a partial reversal of the intervention. The study included a retrospective analysis of a secondary dataset of normal newborn readmissions at SACH at baseline, 1 year prior to the onset of a comprehensive psychosocial intervention for new mothers and babies (1999-2000), the 4 years during the comprehensive psychosocial intervention (2001- 2004), and 2 years post-intervention during a partial reversal or limited psychosocial intervention (2004-2006). The data were collected in fiscal years from July 1 - June 30 to coincide with the cost-benefit analysis. Participants included normal newborn births or a diagnosis related group (DRG) of 391 froom July 1,1999-June 30, 2006. A one-way ANOVA was conducted to determine if there were significant differences in average costs per patient across all three time periods. Results.There was a significantly lower readmission rate 1.0% (p \u3c .001) compared to baseline (2.3%), or during the limited psychosocial support intervention time period (2.3%). While there was no significant difference in the average cost per newborn readmitted across the three study time periods, during the comprehensive intervention time period, the average costs of a normal newborn readmission were significantly lower (4,180,p=.041)forthosewhoreceivedtheinterventioncomparedtothosewhodidnot(4,180,p = .041) for those who received the intervention compared to those who did not (5,338). The two-way ANOVA comparing the average costs per newborn readmission across all three time periods showed a significant interaction (p = .04) across limited and comprehensive time periods and whether or not the individual received the intervention. The average costs of normal newborn readmissions for those receiving the intervention during the limited time period was 4,845comparedtothosenotreceivingtheintervention(4,845 compared to those not receiving the intervention (3,785). There was a cost-benefit of 513,540duetofewerreadmissionsduringthecomprehensivepsychosocialsupporttimeperiodbutitdidnotexceedthecostoftheinterventionattributedtocareinthefirst28dayspostpartum(513,540 due to fewer readmissions during the comprehensive psychosocial support time period but it did not exceed the cost of the intervention attributed to care in the first 28 days postpartum (1,183,600). Significance to Health Education. With healthcare costs continuing to increase and early discharge programs following delivery a common practice, understanding the potential effects of psychosocial support in a postpartum program is essential. Providing comprehensive follow-up for new mothers in the postpartum period can reduce normal newborn readmissions and potentially lower the average charges for newborn readmissions for those who receive psychosocial support
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