The Relationship of Breastfeeding Self-Efficacy to Breastfeeding Duration and Breastfeeding Exclusivity of Full-Term Infants in the Neonatal Intensive Care Unit: A Mixed Method Study

Background Research demonstrates better health outcomes for both women and their infants when infants are breast-fed. There is evidence that an increasing number of full-term, normal birth weight infants are being admitted to the Neonatal Intensive Care Unit (NICU) and that these infants receive less breast milk than their well full-term and preterm infant counter parts. The effect of short-term admission of full-term infants to the NICU on maternal breastfeeding self-efficacy and breastfeeding exclusivity and duration, and the facilitators of and barriers to breastfeeding success reported by these mothers, has not been well explored. Purpose The purpose of this study was to explore the relationship of breast feeding self-efficacy to breastfeeding duration and breastfeeding exclusivity of full-term infants discharged from the NICU and to explore the facilitators and barriers that influence breastfeeding success for a woman with a full-term infant in the NICU. Factors that may affect the breastfeeding self-efficacy of mothers with a full-term infant in the NICU were also explored. Method This was a mixed method study where quantitative and qualitative data were collected concurrently. The Critical Incident Technique (CIT) was used to identify the facilitators and barriers to breastfeeding success. The breastfeeding self-efficacy scale for preterm and ill infants (BFSE-SF-IP) was used to measure the mothers’ breastfeeding self-efficacy. One week after the infant’s discharge, the researcher contacted the mothers, who completed the BSFE and described what they thought facilitated or hindered their breastfeeding success. Mothers were contacted three weeks later to ascertain breastfeeding status and formula usage. Data on other maternal and infant variables were also collected. All data was interpreted and integrated to form a phenomenon of a successful mother breastfeeding a full-term infant in the NICU. Results The sample was comprised of 41 ethnically diverse postpartum women who were predominately married, well educated, first-time mothers, and delivered by cesarean section. Most had no prior breastfeeding experience. The Cronbach’s alpha of the BSEF-SF-IP in this sample was .953. Regression analyses using the BFSE score and other factors revealed the BFSE to be the only significant predictor of breastfeeding duration and exclusivity at four weeks after discharge and accounted for 47 percent of the variance in the amount of formula used at four weeks. There was a positive correlation between breastfeeding experience, number of live births, breastfeeding at one and four weeks and BFSE scores. There was also a strong negative correlation between breastmilk pumping at one week, formula usage at one and four weeks and BFSE scores. Mothers identified 67 critical incidents as facilitators for and barriers to breastfeeding success in the NICU and one week postpartum. The most frequently cited facilitators in the NICU were nurses/lactation consultant support, and breastfeeding skills. The most common cited barriers to breastfeeding success were feeding the infant formula, separation from the baby, scheduled feedings and not enough breastmilk. After the baby was home for one week, mothers most often reported the facilitators to be family support, determination, and staying with the baby. Not having enough milk and infant not taking the breast were the most frequently cited barriers to breastfeeding success at one week. Integration Women with a moderate to high BFSE score were more likely to be exclusively breastfeeding one-week post discharge. These women generally were experienced mothers with other children. They identified the use of formula, scheduled feedings, and separation from their infants as barriers to breastfeeding success in the NICU. Family support and determination was their key to facilitators for breastfeeding success at one-week at home time frame. First time mothers with a moderate to high BFSE identified facilitators for breastfeeding success in the NICU as the nurse/lactation consultant support and developing breastfeeding skills. They had a fear of not producing enough milk in the NICU and at home. They also spoke of determination and support as a facilitator to breastfeeding success. Mothers with a lower BFSE scores, were predominately first-time mothers. They all reported not enough milk as a barrier to successful breastfeeding. The majority of these mothers also reported the infant not latching. First-time mothers were also the only ones in the study who identified physically not feeling well or having a cesarean section as a barrier to successful breastfeeding in the NICU. Summary and Recommendations This study demonstrated positive breastfeeding self-efficacy can determine successful breastfeeding at one and four weeks after discharge. The research and practice implications of this study suggest that breastfeeding self-efficacy enhances breastfeeding success and warrants further study

A Metrics Framework for Customer-Focused Quality,

Although nearly everyone agrees that the collection and analysis of metrics is highly beneficial to software development and maintenance organizations, this process remains difficult for many of those organizations. The purpose of this paper is to describe a practical set of metrics that are focused on customer satisfaction and that are easily understood by both customer and developer organizations. The goals and concepts related to these metrics are presented in a framework designed to establish compliance mapping with the Software Engineering Institute\u27s (SEI) Capability Maturity Model (CMM®) for software

A nationwide survey of pharmacy students’ knowledge and perceptions regarding medical cannabis

Objective The primary objective of this study was to compare knowledge and perceptions of medical cannabis (MC) between pharmacy students who attended schools where MC was legal and illegal. Design A nationwide anonymous survey regarding MC was distributed to pharmacy students. The survey consisted of the following sections: (1) demographics and personal factors, (2) knowledge assessment of indications and adverse effects of MC, and (3) perceptions assessment. Setting and participants Equal numbers of pharmacy schools were selected and sent surveys based on geographical regions, private versus public universities, and the state’s legal status of MC for first through fourth-year pharmacy students to complete. Outcome measures Student knowledge of MC indications and adverse effects were treated as quizzes. Median percentage correct and whether students passed the quizzes (≥ 70%) were evaluated based on the state’s legal status. Students’ perceptions were similarly compared. Results A total of 629 students accessed the survey. Most students who completed the survey attended pharmacy schools where MC was illegal (55%), were female (68%), and had personally tried cannabis (53%). Overall, 91% of students believed that MC should be legalized nationally. A low number of students correctly identify approved indications with 14.8% of students in states with MC legalization scoring greater than 70% compared with 15.9% of students in states without MC legalization (P = 0.748). Similar findings were seen in the side effects quiz with only 6.1% of students in states with legal MC scoring greater than 70% compared with 7.4% of students where MC is illegal (P = 0.569) There were minimal differences in students’ perceptions of MC based on the states’ legal status. Conclusion Our study continues to highlight that pharmacy students lack knowledge and preparation to counsel and educate on MC. With increasing state legalizations, pharmacy schools need to address this knowledge gap to ensure optimal patient care

Introducing the need to use technology as a tool, and not as a master

We have all been horrified and saddened as the full story of the Post Office case has unfolded in the public domain. We hear about harms to sub postmasters, to their families and their health and we wonder how it was possible for this injustice to occur at such a scale. Many are pointing to the kinds of collusions which have typically characterised the ‘crimes of the powerful’. The lies, the evasions, and the brazen cover-ups on the part of post office managers, the abject failure of politicians to exercise due diligence and the rewards given by the establishment to those who treated the postmasters so appallingly. However, there is a bigger picture that also needs to be considered, which we call out in McGuire and Renaud (2023). Technology powers everything we do: airplanes, devices we use to communicate globally, and our home appliances, to mention just a few. We, as a society, have embraced the convenience and functionality offered by technology, but very few people understand how it works, even fewer understand that technology is not infallible and far fewer still appreciate the subversive power technology has acquired to regulate our lives. Fundamental to this hegemonic technological order is an unquestioning docility, one spawned by a shift in the very way we think about the world. What the great theorist of technology Herbert Marcuse termed ‘technological rationality’ is nothing less than a cognitive colonisation, a reshaping of our minds along technical, rather than human lines

Education and referral criteria: impact on oncology referrals to palliative care.

OBJECTIVE: To describe a quality improvement project involving education and referral criteria to influence oncology provider referrals to a palliative care service. METHODS: A single group post-test only quasi-experimental design was used to evaluate palliative care service (PCS) referrals following an intervention consisting of a didactic presentation, education outreach visits (EOV) to key providers, and referral criteria. Data on patient demographics, cancer types, consult volume, reasons for referral, pre-consult length of stay, overall hospital stay, and discharge disposition were collected pre-intervention, then post-intervention for 7.5 months and compared. SETTING AND SAMPLE: Attending oncologists, nurse practitioner, and house staff from the solid tumor division at a 700-bed urban teaching hospital participated in the project. Two geriatricians, a palliative care nurse practitioner, and rotating geriatric fellows staffed the PCS. RESULTS: The percentage of oncology referrals to PCS increased significantly following the intervention (χ(2) = 6.108, p = .013). 24.9% (390) patients were referred in the 4.6 years pre-intervention and 31.5% (106) patients were referred during 7.5 months post-intervention. The proportion of consults for pain management was significantly greater post-intervention (χ(2) = 5.378, p = .02), compared to pre-intervention, when most referrals were related to end-of-life issues. Lung, pancreatic, and colon were the most common cancer types at both periods, and there were no significant differences in patient demographics, pre-referral length of hospitalization or overall hospital days. There was a trend toward more patients being discharged alive following the intervention. CONCLUSION: A quality improvement project supported the use of education and referral criteria to influence both the frequency and reasons for palliative care referral by oncology providers

Synergistic Antitumor Activity of Vitamins C and K3 on Human Bladder Cancer Cell Lines

Copyright © 2013 Karen McGuire et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Exponentially growing cultures of human bladder tumor cells (RT4 and T24) were treated with Vitamin C (VC) alone, Vitamin K3 (VK3) alone, or with a VC:VK3 combination continuously for 5 days or treated with vitamins for 1 h, washed with PBS and then incubated in culture medium for 5 days. Co-administration of the vitamins enhanced the antitumor activity 12- to 24-fold for the RT-4 cells and 6- to 41-fold for the T24 cells. Flow cytometry of RT4 cells ex-posed to the vitamins revealed a growth arrested population and a population undergoing cell death. Growth arrested cells were blocked near the G0/G1-S-phase interface, while cell death was due to autoschizis. Catalase treatment abro-gated both cell cycle arrest and cell death which implicated hydrogen peroxide (H2O2) in these processes. The H2O2 production resulted in a moderate increase in lipid peroxidation and depletion of cell thiol levels. Analysis of cellular ATP levels revealed a transient increase in ATP production for VC and the VC:VK3 combination, but decreased ATP levels following VK3 treatment. Lipid peroxidation, thiol depletion and ATP modulation occurred at a 17-fold lower concentration in the vitamin combination than with either vitamin alone. These results suggested that the increased cy-totoxicity of the vitamin combination was due to redox cycling and increased oxidative stress

Attachment Aware Schools:Working with Families to Enhance Parental Engagement and Home-School Relationships

Background:- Application of attachment theory in school contexts lacks empirical evidence. The Attachment Aware Schools pilot project was commissioned by two Local Authorities in England to improve the educational outcomes of Looked After Children, and to build an evidence base. Informed by attachment research, Attachment Aware Schools programs provide a coherent and integrated theoretical framework, discourse, and practice for all practitioners working with children and young people. Objective:- The primary focus was to provide whole school and targeted attachment-based strategies to support children’s well-being, behaviour, and academic attainment. This paper; however, documents a secondary objective, which was to facilitate collaborative partnerships with families. Method:- As part of the mixed methods approach to the Attachment Aware Schools project, a series of case studies were collected and thematically coded. The case studies were generated by practitioners using an outcomes-based framework. Results:- Although the case study sample size is small (N=10), the case studies presented here illustrate how Attachment Aware Schools programs can promote increased home-school engagement and shared practice between home and school. Outcomes include improved home-school relationships, reductions in behavioral incidents, and improved family dynamics. Conclusion:- Attachment Aware Schools can be a vehicle for facilitating supportive home-school collaborative partnerships with positive outcomes for vulnerable children and young people

The Effect of COVID-19 On Antibiotic Resistance

Over three years have passed since the beginning of the COVID-19 pandemic. During these times we have experienced significant changes in all areas of our life. In healthcare, more attention was focused on COVID-19 than other concerns. An unexpected consequence of the pandemic was a silent progression of an increased spread of multi-resistant pathogens. While antibiotic use during the pandemic varied across healthcare settings, antibiotics were prescribed for COVID-19 patients, even though antibiotics are known not to be effective against viruses.1 In dentistry, antibiotics were prescribed to prevent potential dental infections, since many dental offices were not open. Antimicrobial resistance was one of our greatest public health concerns prior to the COVID-19 pandemic, and it remains so

Assessment of Maine\u27s Long-Term Care Needs Baseline Report: Demographics and Use of Long Term Care Services in Maine

In 2006, the Office of Elder Services requested the assistance of the Muskie School in developing an assessment of long term care service use in Maine. This report provides baseline information on the demographic characteristics, participant characteristics and service use trends for people accessing long term care services in this State. For purposes of this report, we have excluded people with MR/DD. Long term care services do not include community support services for people with mental illness. In this report, long term care services include: Nursing Facility Services Private Non-medical Institutions Consumer Directed Attendant Services Day Health Services Elder and Adult Waiver Services Home Health Services Hospice Services Personal Care Services Physically Disabled Waiver Services Private Duty Nursing Facility Service

Older Adults and Adults with Disabilities: Population and Service Use Trends in Maine, 2012 Edition

This Chartbook is an update to the Chartbook: Older Adults and Adults with Physical Disabilities: Population and Service Use Trends in Maine 2010. With the aging of Maine’s population and its status as the “oldest” state in the nation, the use of long term services continues to be a critical public policy issue in the State and nationally. The information in this Chartbook is provided to help inform state policy makers, legislators, providers, advocates and others with an interest in this subject