Balancing life and death during the golden minute – midwives’ experiences of performing newborn resuscitation

Brendan McCormack - ORCID: 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Purpose: To explore midwives’ experiences in performing newborn resuscitation on maternity wards.Patients and Methods: It was a qualitative study, using a phenomenological hermeneutic approach. Individual interviews with 16 clinical midwives working in Norwegian maternity wards were conducted from August 2018 to January 2019.Results: The complexity underlying how midwives balance responsibility and vulnerability when performing newborn resuscitation during the Golden Minute was revealed. Midwives described the stress they experienced during resuscitation events and their need for support and confirmation after performing newborn resuscitation.Conclusion: The vulnerability and responsibility that midwives bear for mothers and newborns simultaneously affected midwives in several ways. We saw that midwives need support and confirmation to be prepared for newborn resuscitation. We also found that a lack of knowledge, skills and experience were barriers to midwives feeling prepared. Simulation training, including tailored programs, are suggested to improve midwives’ skills and help them feel prepared for real-life resuscitations. The importance of midwives’ assessment during the Golden Minute and further investigation from other perspectives are needed to understand fully this clinical complexity.https://doi.org/10.2147/JMDH.S2689592020pubpub1

Omega-3 fatty acids decrease CRYAB, production of oncogenic prostaglandin E-2 and suppress tumor growth in medulloblastoma

Aims: Medulloblastoma (MB) is one of the most common malignant central nervous system tumors of childhood. Despite intensive treatments that often leads to severe neurological sequelae, the risk for resistant relapses remains significant. In this study we have evaluated the effects of the omega 3-long chain polyunsaturated fatty acids (omega 3-LCPUFA) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) on MB cell lines and in a MB xenograft model.Main methods: Effects of omega 3-LCPUFA treatment of MB cells were assessed using the following: WST-1 assay, cell death probes, clonogenic assay, ELISA and western blot. MB cells were implanted into nude mice and the mice were randomized to DHA, or a combination of DHA and EPA treatment, or to control group. Treatment effects in tumor tissues were evaluated with: LC-MS/MS, RNA-sequencing and immunohistochemistry, and tumors, erythrocytes and brain tissues were analyzed with gas chromatography.Key findings: omega 3-LCPUFA decreased prostaglandin E2 (PGE(2)) secretion from MB cells, and impaired MB cell viability and colony forming ability and increased apoptosis in a dose-dependent manner. DHA reduced tumor growth in vivo, and both PGE(2) and prostacyclin were significantly decreased in tumor tissue from treated mice compared to control animals. All omega 3-LCPUFA and dihomo-gamma-linolenic acid increased in tumors from treated mice. RNA-sequencing revealed 10 downregulated genes in common among omega 3-LCPUFA treated tumors. CRYAB was the most significantly altered gene and the downregulation was confirmed by immunohistochemistry.Significance: Our findings suggest that addition of DHA and EPA to the standard MB treatment regimen might be a novel approach to target inflammation in the tumor microenvironment

Omega-3 fatty acids in the treatment of childhood cancer

Childhood cancer is the primary cause of deaths among Swedish children. Advances in treatment regimens have improved cure rate considerably in the latest decades. Consequently, childhood cancer survivors are a growing population with a significant risk of long-term side effects such as neurocognitive decline, endocrine dysfunction, risk of relapse or a second malignancy. The embryonal tumors neuroblastoma and medulloblastoma are heterogenous childhood tumors arising in the peripheral nervous system and cerebellum, respectively. While low-risk subsets of neuroblastoma and medulloblastoma have a good prognosis with survival rates above 90%, high-risk subsets have poor prognosis with survival rates below 50% despite intensified treatment. The polyunsaturated omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) exhibit anti-tumor and anti-inflammatory properties in various cancers including neuroblastoma. In contrast, the pro-inflammatory metabolite prostaglandin E2 (PGE2), derived from the omega-6 fatty acid arachidonic acid (AA) is known to induce inflammation and immune suppression in the tumor microenvironment. Inhibition of PGE2 formation has been identified as an attractive therapeutic approach in malignancies including medulloblastoma and neuroblastoma. This thesis is based on preclinical and clinical studies aiming to promote better treatment for children with cancer using the omega-3 fatty acids EPA and DHA and in particular investigate effects on medulloblastoma and neuroblastoma. The investigations in paper I revealed that omega-3 supplementation reduced tumor growth, PGE2 production, and CRYAB expression in preclinical models of medulloblastoma. Omega- 3 supplementation modulated neuroblastoma tumor microenvironment by increasing the chemoattractant CCL3 and reducing AA-derived metabolites, including PGE2. Additionally, the AA-derived metabolites correlated with the infiltration of regulatory T cells in the tumors. Available gene expression data sets indicate that low CCL3 expression is associated with high-risk subgroups, metastatic disease, and poor overall survival in neuroblastoma (paper II). Several studies of omega-3 supplementation have been performed in adults and children of various ages and size but without reaching consensus regarding appropriate dosing so far. To pave way for future clinical studies and elucidate a dosing strategy, a dose-finding study of EPA and DHA supplementation was performed (paper III). Children aged 3-16 years in clinical remission after concluded cancer therapy received EPA and DHA supplementation based on the body surface area for 90 days. No severe adverse events were observed and the participants exhibited high adherence to the supplementation regardless of dose. Our findings suggest an EPA +DHA dose of about 1500 mg/m2 body surface area for further studies based on a sufficient incorporation of EPA and DHA in erythrocytes, a decrease of the omega- 6:omega-3 ratios, and the observed unpredictability of fatty acid incorporation at the highest doses. While the main aim of this study was to guide dosing for future clinical trials, immunomonitoring of the patients during the supplementation was included as a secondary aim revealing an increase in activated NK cells (paper IV). In summary, this thesis provides insight into the inhibitory effect of omega-3 fatty acids on the AA-derived metabolites in medulloblastoma and neuroblastoma tumor tissue and, additionally, proposes a dosing strategy for omega-3 fatty acid supplementation for comparative studies in pediatric oncology

The effects of training skilled birth attendants in newborn resuscitation in Tanzania. A literature review.

Introduction: Millions of newborns die every year worldwide. Prevention of newborn deaths is a huge challenge in developing countries. Objective: This literature review reports the effects of training skilled birth attendants in new-born resuscitation in Tanzania by answering the following review question; What effects are reported by training skilled birth attendants in newborn resuscitation in Tanzania? Design: A literature review. Systematic searches were conducted in the period of January to June 2016. Participants and settings: 113 807 newborns are included from rural to urban settings in Tan-zania. The number of birth attendants are not mentioned. Findings: The seven included studies indicate reduction in early neonatal deaths and fresh stillbirths after training skilled birth attendants in newborn resuscitation. Overall increased knowledge, skills and performance is reported, and action within “the golden minute” is needed. Additionally, a highly cost-effective training program is documented. Implications for practice: Training in newborn resuscitation of skilled birth attendants is re-ported to be beneficial, but not strongly enough in itself to make a difference for newborn re-suscitation in Tanzania. Key conclusions: No training is stronger than its’s weakest factor, and extensive challenges in Tanzania are reported at several levels. The reported challenges are lack of human resources, knowledge, supplies, humanization and dignity in maternity wards. Additionally, hospitals of-ten have neither water nor soap. Further training, action and research are needed to improve skilled birth attendant’s possibilities to save millions of newborn lives

"Keep It Simple"-Co-Creation of a Tailored Newborn Resuscitation Course for Midwifery Students

Purpose: To develop a tailored newborn resuscitation course for midwifery students. Patients and Methods: A qualitative study using an explorative, abductive approach was applied. Co-creation through workshops was facilitated to develop a tailored newborn resuscitation course for midwifery students. Four workshops with midwifery students and midwives were conducted from May to October 2020. Twenty participants attended one workshop of their choice. Five out of Norway’s six midwifery education programmes participated, and included midwives from across Norway. All workshops were held digitally via the Zoom platform. A seven-step framework analysis method was applied to analyse the workshop data. Results: We identified four themes: 1) practice guidance, 2) technical skills 3) non-technical skills 4) innovative methods. Conclusion: Findings emphasize the importance of practice guidance, technical skills, non-technical skills and innovative methods to facilitate the learning process. However, these skills cannot be acquired without the context to facilitate them, and thus a supportive culture is essential to sustain newborn resuscitation expertise as a midwife/midwifery student. We found that midwives expressed the same need to learn, train and prepare themselves for newborn resuscitation as midwifery students. The importance of facilitating the learning of newborn resuscitation with low-dose, high-frequency training in a supportive culture thus matters to both midwifery students and expert midwives.publishedVersio

"Keep It Simple"-Co-Creation of a Tailored Newborn Resuscitation Course for Midwifery Students

Purpose: To develop a tailored newborn resuscitation course for midwifery students. Patients and Methods: A qualitative study using an explorative, abductive approach was applied. Co-creation through workshops was facilitated to develop a tailored newborn resuscitation course for midwifery students. Four workshops with midwifery students and midwives were conducted from May to October 2020. Twenty participants attended one workshop of their choice. Five out of Norway’s six midwifery education programmes participated, and included midwives from across Norway. All workshops were held digitally via the Zoom platform. A seven-step framework analysis method was applied to analyse the workshop data. Results: We identified four themes: 1) practice guidance, 2) technical skills 3) non-technical skills 4) innovative methods. Conclusion: Findings emphasize the importance of practice guidance, technical skills, nontechnical skills and innovative methods to facilitate the learning process. However, these skills cannot be acquired without the context to facilitate them, and thus a supportive culture is essential to sustain newborn resuscitation expertise as a midwife/midwifery student. We found that midwives expressed the same need to learn, train and prepare themselves for newborn resuscitation as midwifery students. The importance of facilitating the learning of newborn resuscitation with low-dose, high-frequency training in a supportive culture thus matters to both midwifery students and expert midwives

An exploration of midwives’ perceptions of newborn resuscitation programmes for midwifery students

From Elsevier via Jisc Publications RouterBrendan McCormack - ORCID: 0000-0001-8525-8905 https://orcid.org/0000-0001-8525-8905Item not available in this repository.100pubpu

"Keep It Simple"-Co-Creation of a Tailored Newborn Resuscitation Course for Midwifery Students

Purpose: To develop a tailored newborn resuscitation course for midwifery students. Patients and Methods: A qualitative study using an explorative, abductive approach was applied. Co-creation through workshops was facilitated to develop a tailored newborn resuscitation course for midwifery students. Four workshops with midwifery students and midwives were conducted from May to October 2020. Twenty participants attended one workshop of their choice. Five out of Norway’s six midwifery education programmes participated, and included midwives from across Norway. All workshops were held digitally via the Zoom platform. A seven-step framework analysis method was applied to analyse the workshop data. Results: We identified four themes: 1) practice guidance, 2) technical skills 3) non-technical skills 4) innovative methods. Conclusion: Findings emphasize the importance of practice guidance, technical skills, non-technical skills and innovative methods to facilitate the learning process. However, these skills cannot be acquired without the context to facilitate them, and thus a supportive culture is essential to sustain newborn resuscitation expertise as a midwife/midwifery student. We found that midwives expressed the same need to learn, train and prepare themselves for newborn resuscitation as midwifery students. The importance of facilitating the learning of newborn resuscitation with low-dose, high-frequency training in a supportive culture thus matters to both midwifery students and expert midwives

The impact of skilled birth attendants trained on newborn resuscitation in Tanzania: A literature review

Millions of newborns die every year worldwide. Prevention of newborn deaths is a huge challenge in developing countries. Objective: This literature review reports the impacts of training skilled birth attendants in newborn resuscitation in Tanzania by answering the review question. Design: Systematic searches were conducted in the period of January to June 2016 from following databases: PubMed, Cochrane Library, Cinahl and Maternity and Infant Care. Participants and settings: 113,807 newborns are included from rural to urban settings in Tanzania. “Skilled birth attendants” include midwives, doctors and nurses, who have been trained to manage childbirths and perform immediate newborn care. Findings: The seven included studies indicate reduction in early neonatal deaths and fresh stillbirths after training skilled birth attendants in newborn resuscitation. Overall increased knowledge, skills and performance is reported, and action within “the golden minute” is needed. Additionally, a highly cost-effective training program is documented. Implications for practice: Training in newborn resuscitation of skilled birth attendants is reported to be beneficial, but not strongly enough in itself to make a difference for newborn resuscitation in Tanzania. Key conclusions: No training is stronger than it’s weakest factor, and extensive challenges in Tanzania are reported at several levels. The reported challenges are lack of human resources, knowledge, supplies, humanization and dignity in maternity wards. Additionally, hospitals often have neither water nor soap. Further training, action and research are needed to improve skilled birth attendant’s possibilities to save millions of newborn lives

An exploration of midwives' perceptions of newborn resuscitation programmes for midwifery students

Around the world, significant issues are reported in midwifery education regarding newborn resuscitation. These issues are similar to those raised two decades earlier (Halamek et al., 2000); for example, in 2000, Halamek et al. reported that the newborn manikin's lack of fidelity compared to a newborn baby for realistic training was a major limitation—20 years later, we see the same issue in newborn resuscitation simulation training. Though there has been progress in newborn care, mission has been claimed uncompleted and more work is necessary (Halamek, 2016). A focus on the remaining tasks has therefore been called for, to initiate a cultural change underpinning the essential components regarding the provision of care to all newborns worldwide, every day (Halamek, 2016). One way to implement this cultural change is to draw on a person-centred nursing framework, as its foundation is composed of the core values guiding this paper (McCormack and McCance, 2017)