Comparison of Neonates’ Positions in SnuggleUp™ Wraps Prior to and Following Education

Executive Summary Problem According to the Synactive Theory of Newborn Behavioral Organization and Development, the adaption of preterm infant to the NICU environment is determined by his/her ability to change their behavior in response to a stimulus, to achieve a self-regulated balance, and to maintain the energy required to sustain life (Als, 1986). When positioning is not done well, it can cause damage due to immaturity that can generate body alignment complications. Preterm infants do not have the muscle tone to move themselves out of an uncomfortable position. Therefore, the NICU team is responsible for the preterm infant’s alignment, posture and movement (Santos et al., 2017). Purpose There has been a multitude of studies investigating and discussing the benefits of developmental positioning on infants’ stability. The purpose of this study was to investigate if quality and consistency of infants’ positions in SnuggleUp™ wraps improved following education. Evidence-based practice is constantly evolving in the NICU and has become the foundation for patient-centered care; NNPs and RNs should be working together to improve patient outcomes, (Smith et al, 2009). At the end of the day, when providing patient care, it is not what was done or how it was done, but did we make a difference? (Assi, 2015). Goals The goal of this study is to improve the quality and consistency of developmental positioning in infants born 25 0/7 weeks to 34 6/7. This will be achieved by evaluating the use of the positioning aid, the SnuggleUp™ wrap, develop proper education, educate the staff and re-evaluate the use of the SnuggleUp™ wraps. Objectives The objective of this Quality Improvement Project (QI) was to improve the quality and consistency of developmental positioning utilizing the SnuggleUp™ wrap following education via the present form of education used in the unit, the Occupational Competency Index (OCI). Plan Pre-education and post-education were both collected in 4 week periods in a total of 7 data collection sessions; two of these data collection sessions occurred on weekend days. Observations were made up to 3 times per 12 hour shift on each baby. Education and training on both the use of this product and proper developmental positioning was provided to the nursing staff for one month via the Occupational Competency Index, the unit’s current preferred mode of education. Staff was also provided with 4 baby dolls positioned in SnuggleUp™ wraps per manufacturer guidelines to facilitate tactile learning. Outcomes Though the data showed that there was not statistically significant change in position prior to and following education, there was data that showed that there was an improvement in positioning infants correctly, with the correct size of SnuggleUp™ with no extra blanket for infants who are 33 – 34 6/7 weeks gestation at birth. There were also correlations between the increased gestational age at collection and the decrease in use of extra blankets in the SnuggleUp™ Wraps

Non-Equilibrium Surface Diffusion Measurements in Systems with Interactions

Diffusion in surface overlayers with adsorbate-adsorbate interactions is described in terms of coverage-dependent diffusion coefficients. The measured phenomenological Arrhenius parameters (activation energy and prefactor) depend on the initial configuration of the system. Since different experimental methods probe the system in different states, the measured diffusion coefficients depend on the method used. Experimental results demonstrating this dependence are presented for O/W(110) -p(2x1) + p(2x2) and Ag/Si(111) -√3 x √3 R30°. They were measured during the evolution of the system to attain a new equilibrium state of different symmetry. In addition, simulations on lattice gas models with interactions, modeling other surface diffusion techniques (Laser-lnduced-Desorption, fluctuation, non-equilibrium kinetics) support the configuration-dependent results

Mitochondrial encephalocardio-myopathy with early neonatal onset due to TMEM70 mutation

Objective Mitochondrial disturbances of energy-generating systems in childhood are a heterogeneous group of disorders. The aim of this multi-site survey was to characterise the natural course of a novel mitochondrial disease with ATP synthase deficiency and mutation in the TMEM70 gene. Methods Retrospective clinical data and metabolic profiles were collected and evaluated in 25 patients (14 boys, 11 girls) from seven European countries with a c. 317-2A -> G mutation in the TMEM70 gene. Results Severe muscular hypotonia (in 92% of newborns), apnoic spells (92%), hypertrophic cardiomyopathy (HCMP; 76%) and profound lactic acidosis (lactate 5-36 mmol/l; 92%) with hyperammonaemia (100-520 mu mol/l; 86%) were present from birth. Ten patients died within the first 6 weeks of life. Most patients surviving the neonatal period had persisting muscular hypotonia and developed psychomotor delay. HCMP was non-progressive and even disappeared in some children. Hypospadia was present in 54% of the boys and cryptorchidism in 67%. Increased excretion of lactate and 3-methylglutaconic acid (3-MGC) was observed in all patients. In four surviving patients, life-threatening hyperammonaemia occurred during childhood, triggered by acute gastroenteritis and prolonged fasting. Conclusions ATP synthase deficiency with mutation in TMEM70 should be considered in the diagnosis and management of critically ill neonates with early neonatal onset of muscular hypotonia, HCMP and hypospadias in boys accompanied by lactic acidosis, hyperammonaemia and 3-MGC-uria. However, phenotype severity may vary significantly. The disease occurs frequently in the Roma population and molecular-genetic analysis of the TMEM70 gene is sufficient for diagnosis without need of muscle biopsy in affected children

Experiences of stigma and discrimination faced by family caregivers of people with schizophrenia in India.

Stigma associated with schizophrenia significantly affects family caregivers, yet few studies have examined the nature and determinants of family stigma and its relationship to their knowledge about the condition. This paper describes the experiences and determinants of stigma reported by the primary caregivers of people living with schizophrenia (PLS) in India. The study used mixed methods and was nested in a randomised controlled trial of community care for people with schizophrenia. Between November 2009 and October 2010, data on caregiver stigma and functional outcomes were collected from a sample of 282 PLS-caregiver dyads. In addition, 36 in-depth-interviews were conducted with caregivers. Quantitative findings indicate that 'high caregiver stigma' was reported by a significant minority of caregivers (21%) and that many felt uncomfortable to disclose their family member's condition (45%). Caregiver stigma was independently associated with higher levels of positive symptoms of schizophrenia, higher levels of disability, younger PLS age, household education at secondary school level and research site. Knowledge about schizophrenia was not associated with caregiver stigma. Qualitative data illustrate the various ways in which stigma affected the lives of family caregivers and reveal relevant links between caregiver-stigma related themes ('others finding out', 'negative reactions' and 'negative feelings and views about the self') and other themes in the data. Findings highlight the need for interventions that address both the needs of PLS and their family caregivers. Qualitative data also illustrate the complexities surrounding the relationship between knowledge and stigma and suggest that providing 'knowledge about schizophrenia' may influence the process of stigmatisation in both positive and negative ways. We posit that educational interventions need to consider context-specific factors when choosing anti-stigma-messages to be conveyed. Our findings suggest that messages such as 'recovery is possible' and 'no-one is to blame' may be more helpful than focusing on bio-medical knowledge alone

The effectiveness and cost-effectiveness of lay counsellor-delivered psychological treatments for harmful and dependent drinking and moderate to severe depression in primary care in India: PREMIUM study protocol for randomized controlled trials.

BACKGROUND: The leading mental health causes of the global burden of disease are depression in women and alcohol use disorders in men. A major hurdle to the implementation of evidence-based psychological treatments in primary care in developing countries is the non-availability of skilled human resources. The aim of these trials is to evaluate the effectiveness and cost-effectiveness of two psychological treatments developed for the treatment of depression and alcohol use disorders in primary care in India. METHODS/DESIGN: This study protocol is for parallel group, randomized controlled trials (Healthy Activity Program for moderate to severe depression, Counselling for Alcohol Problems for harmful and dependent drinking) in eight primary health centres in Goa, India. Adult primary care attendees will be screened with the Patient Health Questionnaire for depression and, in men only, the Alcohol Use Disorders Identification Test for drinking problems. Screen-positive attendees will be invited to participate; men who screen positive for both disorders will be invited to participate in the Counselling for Alcohol Problems trial. Those who consent will be allocated in a 1:1 ratio to receive either the respective psychological treatment plus enhanced usual care or enhanced usual care only using a computer generated allocation sequence, stratified by primary health centre and, for depression, by sex. The enhanced usual care comprises providing primary health centre doctors with contextualized World Health Organization guidelines and screening results. Psychological treatments will be delivered by lay counsellors, over a maximum period of three months. Primary outcomes are severity of disorder and remission rates at three months post-enrolment and, for the Counselling for Alcohol Problems trial, drinking and the impact of drinking on daily lives. Secondary outcomes include severity of disorder and remission rates at 12 months, disability scores, suicidal behaviour and economic impact, and cost-effectiveness at three and 12 months. 500 participants with depression and 400 participants with harmful drinking will be recruited. Primary analyses will be intention-to-treat. DISCUSSION: These trials may offer a new approach for the treatment of moderate-severe depression and drinking problems in primary care that is potentially scalable as it relies on delivery by a single pool of lay counsellors. TRIAL REGISTRATION: Both trials are registered with the International Society for the Registration of Clinical Trials (Healthy Activity Programme registration number ISRCTN95149997; Counselling for Alcohol Problems registration number ISRCTN76465238)

Experiences of stigma and discrimination of people with schizophrenia in India.

Stigma contributes greatly to the burden of schizophrenia and is a major obstacle to recovery, yet, little is known about the subjective experiences of those directly affected in low and middle income countries. This paper aims to describe the experiences of stigma and discrimination of people living with schizophrenia (PLS) in three sites in India and to identify factors influencing negative discrimination. The study used mixed methods and was nested in a randomised controlled trial of community care for schizophrenia. Between November 2009 and October 2010, data on four aspects of stigma experienced by PLS and several clinical variables were collected from 282 PLS and 282 caregivers and analysed using multivariate regression. In addition, in-depth-interviews with PLS and caregivers (36 each) were carried out and analysed using thematic analysis. Quantitative findings indicate that experiences of negative discrimination were reported less commonly (42%) than more internalised forms of stigma experience such as a sense of alienation (79%) and significantly less often than in studies carried out elsewhere. Experiences of negative discrimination were independently predicted by higher levels of positive symptoms of schizophrenia, lower levels of negative symptoms of schizophrenia, higher caregiver knowledge about symptomatology, lower PLS age and not having a source of drinking water in the home. Qualitative findings illustrate the major impact of stigma on 'what matters most' in the lives of PLS and highlight three key domains influencing the themes of 'negative reactions' and 'negative views and feelings about the self', i.e., 'others finding out', 'behaviours and manifestations of the illness' and 'reduced ability to meet role expectations'. Findings have implications for conceptualising and measuring stigma and add to the rationale for enhancing psycho-social interventions to support those facing discrimination. Findings also highlight the importance of addressing public stigma and achieving higher level social and political structural change

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8–13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05–6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50–75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. Funding Pfizer, Amgen, Merck Sharp & Dohme, Sanofi–Aventis, Daiichi Sankyo, and Regeneron

Registered nurses’ perceptions of their knowledge and skills towards clinical supervision of preregistration nursing students, during clinical placement in hospital settings

Background Clinical placement (also known as workplace experience) is an integral part of nursing education training programs worldwide. The successful completion of stipulated hours of clinical placement under the direct supervision of a registered nurse is a requirement for students to be eligible for nursing registration. To ensure students have an optimal clinical experience and are ready to practice when they enter the workforce, they should be supervised by nurses who have the appropriate clinical supervision knowledge and skill set for the role. There are no clear criteria for choosing who should be assigned to supervise students. It is expected that every registered nurse is able to supervise students during their shift, as clinical supervision is considered an inherent role of the nurses’ Standard of Practice. However, evidence from the available literature suggests that some registered nurses who supervise nursing students during clinical placements do not have the appropriate knowledge or skills to undertake the role. Most of the available evidence is based on students’ evaluations of their clinical placement experience, with few studies focusing on bedside nurses, the majority of whom undertake this important role. Aim The aim of this study was to investigate registered nurses’ perceptions of their knowledge and skills towards supervising students, during clinical placement in a hospital setting and identify the association between their knowledge and skills and professional characteristics. Methods A descriptive cross-sectional self-administered survey was administered to registered Nurses working at a metropolitan tertiary referral and teaching hospital in NSW. The modified Clinical Supervision Self-Assessment Tool (mCSAT) comprising of 30 mCSAT–knowledge items and 30 mCSAT–skill items was used to collect data. Each item was scored on a 5-point likert scale from strongly agree to strongly disagree, and the minimum and maximum scores obtainable for knowledge and skills were 30 to 150 respectively. SPSS software version 22 was used for data analysis. Data were summarised using descriptive statistics. A one-way analysis of variance was used to identify the association between professional characteristics and knowledge and skills for clinical supervision. Results A total of 232 registered nurses participated in this study for a response rate of 58%. The mean age of the participants was 38.5 years (SD± 11.3) and 77.7% (n=178), were female. Approximately 36.6% of the nurses (n=85) had not completed any formal clinical supervision training. The mean scores for overall knowledge was 116.59 (SD ±20.49) and for skills was 115.60 (SD± 22.19). The mean scores on the subscale of facilitating was 36.21 (SD ±5.47) for knowledge and 35.90 (SD± 5.74) for skill. The mean scores for the subscale of problem-solving was 39.28 (SD± 6.57) for knowledge and 39.29 (SD± 6.85) for skill. The mean scores on the subscale of evaluating learning was 41.62 (SD± 8.62) for knowledge and 41.62 (SD± 8.76) for skill. A one-way analysis of variance yielded significant differences in mCSAT–knowledge and mCSAT–skill based on the type of clinical supervision training. Nurses who had completed a hospital-based in-service program (M = 119.86 ± 18.95, 95% CI [116.16, 123.57]) had significantly higher mCSAT–knowledge scores than those who had no previous training in clinical supervision (M = 110.15 ± 19.80, 95% CI [105.86, 114.45]), p \u3c 0 001. Similarly, participants who had completed a hospital-based in-service clinical supervision training program (M = 119. 60 ± 20.00, 95% CI [115. 67, 123.53]) had significantly higher mCSAT–skill scores than those who had no previous training in clinical supervision (M = 109.12 ± 21.73, 95% CI [104.35, 113.89]), p \u3c 0 001. No other professional characteristics yielded any significant association with nurses’ knowledge or skills of clinical supervision Conclusion The study results demonstrated that having clinical supervision training was a significant factor for gaining knowledge and for the development of skills relating to clinical supervision. Given that 36% of the nurses did not have any clinical supervision training it is important that universities and health service providers develop collaborative strategies and opportunities for ongoing professional development in relation to knowledge and skills for clinical supervision for nurses. Further multicentre studies across various settings using larger samples are warranted to substantiate the results of this study