Co-bedding as a Comfort measure For Twins undergoing painful procedures (CComForT Trial)

<p>Abstract</p> <p>Background</p> <p>Co-bedding, a developmental care strategy, is the practice of caring for diaper clad twins in one incubator (versus separating and caring for each infant in separate incubators), thus creating the opportunity for skin-to-skin contact and touch between the twins. In studies of mothers and their infants, maternal skin-to-skin contact has been shown to decrease procedural pain response according to both behavioral and physiological indicators in very preterm neonates. It is uncertain if this comfort is derived solely from maternal presence or from stabilization of regulatory processes from direct skin contact. The intent of this study is to compare the comfort effect of co-bedding (between twin infants who are co-bedding and those who are not) on infant pain response and physiologic stability during a tissue breaking procedure (heelstick).</p> <p>Methods/Design</p> <p>Medically stable preterm twin infants admitted to the Neonatal Intensive Care Unit will be randomly assigned to a co-bedding group or a standard care group. Pain response will be measured by physiological and videotaped facial reaction using the Premature Infant Pain Profile scale (PIPP). Recovery from the tissue breaking procedure will be determined by the length of time for heart rate and oxygen saturation to return to baseline. Sixty four sets of twins (n = 128) will be recruited into the study. Analysis and inference will be based on the intention-to-treat principle.</p> <p>Discussion</p> <p>If twin contact while co-bedding is determined to have a comforting effect for painful procedures, then changes in current neonatal care practices to include co-bedding may be an inexpensive, non invasive method to help maintain physiologic stability and decrease the long term psychological impact of procedural pain in this high risk population. Knowledge obtained from this study will also add to existing theoretical models with respect to the exact mechanism of comfort through touch.</p> <p>Trial registration</p> <p>NCT00917631</p

Patterns of paediatric end-of-life care: a chart review across different care settings in Switzerland.

Paediatric end-of-life care is challenging and requires a high level of professional expertise. It is important that healthcare teams have a thorough understanding of paediatric subspecialties and related knowledge of disease-specific aspects of paediatric end-of-life care. The aim of this study was to comprehensively describe, explore and compare current practices in paediatric end-of-life care in four distinct diagnostic groups across healthcare settings including all relevant levels of healthcare providers in Switzerland. In this nationwide retrospective chart review study, data from paediatric patients who died in the years 2011 or 2012 due to a cardiac, neurological or oncological condition, or during the neonatal period were collected in 13 hospitals, two long-term institutions and 10 community-based healthcare service providers throughout Switzerland. Ninety-three (62%) of the 149 reviewed patients died in intensive care units, 78 (84%) of them following withdrawal of life-sustaining treatment. Reliance on invasive medical interventions was prevalent, and the use of medication was high, with a median count of 12 different drugs during the last week of life. Patients experienced an average number of 6.42 symptoms. The prevalence of various types of symptoms differed significantly among the four diagnostic groups. Overall, our study patients stayed in the hospital for a median of six days during their last four weeks of life. Seventy-two patients (48%) stayed at home for at least one day and only half of those received community-based healthcare. The study provides a wide-ranging overview of current end-of-life care practices in a real-life setting of different healthcare providers. The inclusion of patients with all major diagnoses leading to disease- and prematurity-related childhood deaths, as well as comparisons across the diagnostic groups, provides additional insight and understanding for healthcare professionals. The provision of specialised palliative and end-of-life care services in Switzerland, including the capacity of community healthcare services, need to be expanded to meet the specific needs of seriously ill children and their families

[Pre-eclampsia and its psychosocial sequelae]

In the present work some psychosomatic conditions in the setting of preeclampsia are described. The important psychosocial consequences for women suffering from this disease and the drawback for their partners will be elucidated. Preeclampsia as a disease including hypertension, proteinuria and generalized edema is often associted with generalized seizures occuring most commonly at the end of the second trimenon of pregnancy. The disease bears a heavy risk for the mothers as well as for her unborn child. Until now the exact pathophysiological basis of the disease has not been entirely elucidated. For the pregnant woman and her psychosocial surrounding the outbreak of the disease is in most cases unexpected. During development of the disease she has to face a role change from a so far normal pregnancy to a high-risk situation. This may change also the attitude to the unborn child by herself and her partner. The preterm delivery induced therapeutically, together with the succeeding problems for the newborn complete the high psychosocial stress related to the entire situation. Therefore it is useful and important to offer psychosocial support to the mother as well as to her parter during the illness and the time after delivery

Development of new health provision models by advanced practice midwives - The Master of Science in Midwifery at the Bern University of Applied Sciences (BFH) - an educational concept for the future

Background: The increase in chronic diseases, dealing with a diverse clientele, the rapidly developing digitalization in healthcare as well as the demand for interprofessionalism poses complex demands on the midwifery as profession. Within this context institutions of higher education are expected to train midwives as trendsetters in the development of new, integrated healthcare models which can meet the health needs of mothers and their families. Goal: The goal of the master course in midwifery is to increase awareness of the relevance of current challenges in maternity care. Midwives are prepared to competently deal with current health issues, using innovative healthcare models, by taking on advanced and specialized roles. Methods: The course imparts knowledge and know-how for midwives who wish to prepare to take on duties in modern obstetric and maternity care. Midwifery master students complete interprofessional course modules, such as Ethics, Advanced Practice or Health Policy and Health Economics, conjointly with fellow students of nursing, physiotherapy as well as nutrition and dietetics degrees. Three profession-specific course modules focus on the challenges imposed by complex processes in perinatal care. Results: The case study of a 5th semester student shows how the course supports the development of the new role of an Advanced Practice Midwife (APM) in the field of perinatal mental health. As an assignment within the profession-specific course module Perinatal Mental Health the student developed a concept draft for an APM role. She presented the concept in her own field of work, where she was charged with further developing and advancing the project. Furthermore, the student focused her Transfer Course modules on the project and deepened her skills in mental health and research skills through work shadowing in a research department and mental health ward, also called ,,Crisis lntervention Centre", in a university psychiatric clinic. Based on the APN model she finally developed how to establish the APM role in her master thesis. To conduct the needs assessment for mentally ill pregnant women and mothers she is conducting a secondary data analysis of a research project of the Division of Midwifery of BFH. Relevance: The establishment of integrated and intersectoral healthcare models is currently being discussed in Switzerland. The models require specific skills in healthcare professionals. The interprofessionally oriented master studies at BFH teach midwives to meet the requirements of needs-based, family-centred perinatal healthcare and strengthen its quality. Recommendations/Conclusions: The interlocking of master studies and practice offers the unique opportunity to further develop innovative healthcare models which are aimed at addressing present and future challenges in healthcare delivery and which are based on research.Hintergrund: Die Zunahme chronischer Erkrankungen, der Umgang mit einer diversifizierten Klientel, die rasch fortschreitende Digitalisierung in der Gesundheitsversorgung sowie die Forderungen nach lnterprofessionalität stellen komplexe Anforderungen an die Profession der Hebammen. ln diesem Kontext sind Hochschulen darin gefordert, Hebammen als Schrittmacherinnen in der Entwicklung neuer integrierter Versorgungsmodelle auszubilden, die den Gesundheitsbedürfnissen von Mutter, Kind und Familie gerecht werden. Ziel: Ziel des Master-Studiengangs Hebammen ist, das Bewusstsein für die Relevanz aktueller geburtshilflicher Herausforderungen zu schärfen. Hebammen sollen durch die Übernahme erweiterter und spezialisierter Rollen darauf vorbereitet werden, aktuelle Gesundheitsprobleme mit innovativen Versorgungsmodellen kompetent anzugehen. Methodik: Das Studium vermittelt Wissen und Können für Hebammen, die sich im Rahmen von Advanced-Midwifery-Practice-Rollen auf die Übernahme von Aufgaben in einer zeitgemässen geburtshilflichen Versorgung vorbereiten wollen. Sie absolvieren gemeinsam mit Master-Studierenden der Pflege, Physiotherapie sowie Ernährung und Diätetik Forschungsmodule und interprofessionelle Module, wie angewandte Ethik, Advanced Practice oder Gesundheitspolitik und -ökonomie. Drei professionsspezifische Module fokussieren auf die Herausforderungen komplexer Prozesse in der perinatalen Versorgung. Ergebnisse: Das Fallbeispiel einer Studentin im 5. Semester zeigt, wie das Studium die konkrete Entwicklung einer neuen Rolle ,,Advanced Practice Midwife" (APM) im Bereich der perinatalen psychischen Gesundheit unterstützt. lm Rahmen des Kompetenznachweises im professionsspezifischen Modul «Perinatale psychische Gesundheit» erarbeitet die Studentin eine Konzeptskizze für die APM-Rolle. Sie präsentiert das Konzept im eigenen Praxisarbeitsfeld, wo sie den Zuschlag für die Weiterentwicklung und das Vorantreiben des Projekts erhält. Die Studentin richtet ihre zwei Transfermodule darauf aus und vertieft gezielt ihre Fertigkeiten im Arbeitsfeld ,,Forschung" und ,,Psychiatrie" durch Hospitationen in einer Forschungsabteilung und im Kriseninterventionszentrum einer psychiatrischen Uniklinik. Ausgehend vom APN Modell plant sie in ihrer Masterthesis die Etablierung einer spezialisierten Rolle als Hebamme. Die Daten für die Bedarfserhebung psychisch kranker Schwangeren und Mütter nutzt sie in einer Sekundäranalyse die Daten eines Forschungsprojekts der Abteilung Geburtshilfe BFH. Relevanz: Die Etablierung integrierter und sektorenübergreifender Gesundheitsversorgungsmodelle wird in der Schweiz zurzeit diskutiert. Diese Modelle verlangen nach spezifischen Fähigkeiten des Gesundheitsfachpersonals. lm interprofessionell ausgerichteten Masterstudium an der BFH werden Hebammen dazu ausgebildet, den Anforderungen einer bedarfsgerechten, familienzentrierten perinatalen Versorgung gerecht zu werden und deren Qualität zu stärken. Sie werden zudem zu einer hohen Kommunikations- und Erklärungskompetenz befähigt. Empfehlungen/Schlussfolgerung: Die Verzahnung von Masterstudium und Praxis bietet eine einmalige Chance für die Weiterentwicklung von innovativen Versorgungsmodellen, die auf aktuelle und zukünftige Herausforderungen der Gesundheitsversorgung ausgerichtet und wissenschaftlich fundiert sind