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Neonatal quality improvement

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https://www.readbyqxmd.com/read/28805889/oxytocin-injections-in-the-postpartal-period-affect-mammary-tight-junctions-in-sows
#1
C Farmer, M Lessard, C H Knight, H Quesnel
The potential impacts of injecting oxytocin (OXY) to sows in the early postpartum period on the quality of mammary tight junctions, milk composition, and immune status of sows and piglets were studied. Postparturient sows received i.m. injections of either saline (control [CTL]; = 10) or 75 IU of OXY ( = 10). Injections were given twice daily (0800 and 1630 h) starting on d 2 of lactation (i.e., between 12 and 20 h after birth of the last piglet), totaling 4 injections. Milk samples were obtained before the first injection (d 2 morning [AM]), before the second injection (d 2 afternoon [PM]), and on d 4 PM and d 5 PM...
August 2017: Journal of Animal Science
https://www.readbyqxmd.com/read/28803252/two-dimensional-echocardiography-estimates-of-fetal-ventricular-mass-throughout-gestation
#2
Christina Y L Aye, Adam James Lewandowski, Eric O Ohuma, Ross Upton, Alice Packham, Yvonne Kenworthy, Fenella Roseman, Tess Norris, Malid Molloholli, Sikolia Wanyonyi, Aris T Papageorghiou, Paul Leeson
BACKGROUND: Two-dimensional (2D) ultrasound quality has improved in recent years. Quantification of cardiac dimensions is important to screen and monitor certain fetal conditions. We assessed the feasibility and reproducibility of fetal ventricular measures using 2D echocardiography, reported normal ranges in our cohort, and compared estimates to other modalities. METHODS: Mass and end-diastolic volume were estimated by manual contouring in the four-chamber view using TomTec Image Arena 4...
August 12, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28802823/access-to-and-use-of-health-services-as-factors-associated-with-neonatal-mortality-in-the-north-northeast-and-vale-do-jequitinhonha-regions-brazil
#3
Cristiane B Batista, Márcia L de Carvalho, Ana Glória G Vasconcelos
OBJECTIVE: To analyze the factors associated with neonatal mortality related to health services accessibility and use. METHODS: Case-control study of live births in 2008 in small- and medium-sized municipalities in the North, Northeast, and Vale do Jequitinhonha regions, Brazil. A probabilistic sample stratified by region, population size, and information adequacy was generated for the choice of municipalities. Of these, all municipalities with 20,000 inhabitants or less were included in the study (36 municipalities), whereas the remainder were selected according to the probability method proportional to population size, totaling 20 cities with 20,001-50,000 inhabitants and 19 municipalities with 50,001-200,000 inhabitants...
August 9, 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28802350/improving-quality-improvement-in-neonatal-perinatal-care
#4
EDITORIAL
Munish Gupta, Heather C Kaplan
No abstract text is available yet for this article.
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802347/using-quality-improvement-tools-to-reduce-chronic-lung-disease
#5
REVIEW
Alan Peter Picarillo, Waldemar Carlo
Rates of chronic lung disease (CLD) in very low birthweight infants have not decreased at the same pace as other neonatal morbidities over the past 20 years. Multifactorial causes of CLD make this common morbidity difficult to reduce, although there have been several successful quality improvement (QI) projects in individual neonatal intensive care units. QI projects have become a mainstay of neonatal care over the past decade, with an increasing number of publications devoted to this topic. A specific QI project for CLD must be based on best available evidence in the medical literature, expert recommendations, or based on work by previous QI initiatives...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802344/creating-a-highly-reliable-neonatal-intensive-care-unit-through-safer-systems-of-care
#6
REVIEW
Patoula G Panagos, Stephen A Pearlman
Neonates requiring intensive care are at high risk for medical errors due to their unique characteristics and high acuity. Designing a safer work environment begins with safe processes. Creating a culture of safety demands the involvement of all organizational levels and an interdisciplinary approach. Adverse events can result from suboptimal communication and lack of a shared mental model. This chapter describes tools to promote better patient safety in the NICU through monitoring adverse events, improving communication and using information technology...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802343/using-statistical-process-control-to-drive-improvement-in-neonatal-care-a-practical-introduction-to-control-charts
#7
REVIEW
Munish Gupta, Heather C Kaplan
Quality improvement (QI) is based on measuring performance over time, and variation in data measured over time must be understood to guide change and make optimal improvements. Common cause variation is natural variation owing to factors inherent to any process; special cause variation is unnatural variation owing to external factors. Statistical process control methods, and particularly control charts, are robust tools for understanding data over time and identifying common and special cause variation. This review provides a practical introduction to the use of control charts in health care QI, with a focus on neonatology...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802342/improving-value-in-neonatal-intensive-care
#8
REVIEW
Timmy Ho, John A F Zupancic, DeWayne M Pursley, Dmitry Dukhovny
Work within the US health care system has sought to improve outcomes, decrease costs, and improve the patient experience. Combining those three elements leads to value-added care. Quality improvement within neonatology has focused primarily on the improvement of clinical outcomes without explicit consideration of cost. Future improvement efforts in neonatology should consider opportunities to decrease or eliminate waste, and improve outcomes. Consideration of how a change affects all stakeholders reveals potential cost-saving opportunities, and developing aims with value in mind facilitates understanding and goal-setting with senior administrative leaders...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802340/improving-neonatal-care-a-global-perspective
#9
REVIEW
Danielle Yerdon Ehret, Jacquelyn Knupp Patterson, Carl Lewis Bose
Each year, approximately 2.7 million babies die during the neonatal period; more than 90% of these deaths occur in developing countries, largely from preventable causes. The known, evidence-based, simple, low-cost interventions that may improve neonatal survival often have low or unknown baseline coverage rates. Gaps in coverage of essential interventions and in quality of care may be amenable to improvement strategies. However, often these gaps are not easily identified. A variety of international organizations have recommended key indicators of quality and established roadmaps for improving neonatal outcomes...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802339/family-involvement-in-quality-improvement-from-bedside-advocate-to-system-advisor
#10
REVIEW
Joanna F Celenza, Denise Zayack, Madge E Buus-Frank, Jeffrey D Horbar
Family involvement in newborn intensive care quality improvement dates back to the 1980s. In recent years, there has been an evolution of support for family partnerships at the bedside, transforming parents from being passively present to being active and engaged caregivers and team members. Through those same efforts, a transformational understanding of the power of the family perspective in system design and improvement has occurred. Even with the progression and deepening of this involvement, opportunities exist to learn from families and to improve the quality of neonatal care as a result of the unique family perspective...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802337/eliminating-undesirable-variation-in-neonatal-practice-balancing-standardization-and-customization
#11
REVIEW
Maya Balakrishnan, Aarti Raghavan, Gautham K Suresh
Consistency of care and elimination of unnecessary and harmful variation are underemphasized aspects of health care quality. This article describes the prevalence and patterns of practice variation in health care and neonatology; discusses the potential role of standardization as a solution to eliminating wasteful and harmful practice variation, particularly when it is founded on principles of evidence-based medicine; and proposes ways to balance standardization and customization of practice to ultimately improve the quality of neonatal care...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802336/the-hard-work-of-improving-outcomes-for-mothers-and-babies-obstetric-and-perinatal-quality-improvement-initiatives-make-a-difference-at-the-hospital-state-and-national-levels
#12
REVIEW
Patrick D Schneider, Bethany A Sabol, Patricia Ann Lee King, Aaron B Caughey, Ann E B Borders
Quality improvement efforts are an increasingly expanding focus for perinatal care providers across the United States. From successful hospital-level initiatives, there has been a growing effort to use and implement quality improvement work in substantive and meaningful ways. This article summarizes the foundations of maternal-focused, birth-focused, and neonatal-focused quality improvement initiatives to highlight the underpinnings and potential future directions of current state-level perinatal quality care collaboratives...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28802334/has-quality-improvement-really-improved-outcomes-for-babies-in-the-neonatal-intensive-care-unit
#13
REVIEW
Alan R Spitzer
During the past decade, the emergence of outcome measurement and quality improvement in the neonatal intensive care unit, far more than the introduction of new research approaches or novel therapies, has had a profound effect on improving outcomes for premature neonates. Collection of outcome data, review of those data, and strategies to identify and resolve problems using continuous quality improvement methods can dramatically improve patient outcomes. It is likely that further initiatives in quality improvement will continue to have additional beneficial effects for the neonate...
September 2017: Clinics in Perinatology
https://www.readbyqxmd.com/read/28777888/sildenafil-for-pulmonary-hypertension-in-neonates
#14
REVIEW
Lauren E Kelly, Arne Ohlsson, Prakeshkumar S Shah
BACKGROUND: Persistent pulmonary hypertension in the neonate (PPHN) is associated with high mortality. Currently, the therapeutic mainstay for PPHN consists of assisted ventilation and administration of inhaled nitric oxide (iNO). However, nitric oxide is costly, and its use may not be appropriate in resource-poor settings. Approximately 30% of patients fail to respond to iNO. High concentrations of phosphodiesterases in the pulmonary vasculature have led to the use of phosphodiesterase inhibitors such as sildenafil or milrinone...
August 4, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28771408/promoting-early-child-development-with-interventions-in-health-and-nutrition-a-systematic-review
#15
REVIEW
Tyler Vaivada, Michelle F Gaffey, Zulfiqar A Bhutta
CONTEXT: Although effective health and nutrition interventions for reducing child mortality and morbidity exist, direct evidence of effects on cognitive, motor, and psychosocial development is lacking. OBJECTIVE: To review existing evidence for health and nutrition interventions affecting direct measures of (and pathways to) early child development. DATA SOURCES: Reviews and recent overviews of interventions across the continuum of care and component studies...
August 2017: Pediatrics
https://www.readbyqxmd.com/read/28771289/screening-for-gestational-diabetes-mellitus-based-on-different-risk-profiles-and-settings-for-improving-maternal-and-infant-health
#16
REVIEW
Joanna Tieu, Andrew J McPhee, Caroline A Crowther, Philippa Middleton, Emily Shepherd
BACKGROUND: Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mothers and their infants in the short and long term. There is strong evidence to support treatment for GDM. However, there is uncertainty as to whether or not screening all pregnant women for GDM will improve maternal and infant health and if so, the most appropriate setting for screening. This review updates a Cochrane Review, first published in 2010, and subsequently updated in 2014...
August 3, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28764944/-incidence-of-hypoxic-ischaemic-encephalopathy-and-use-of-therapeutic-hypothermia-in-spain
#17
Juan Arnaez, Alfredo García-Alix, Gemma Arca, Eva Valverde, Sonia Caserío, M Teresa Moral, Isabel Benavente-Fernández, Simón Lubián-López
INTRODUCTION: There are no data on the incidence of hypoxic-ischaemic encephalopathy (HIE) and the implementation of therapeutic hypothermia (TH) in Spain. METHODS: This is a cross-sectional, national study, performed using an on-line questionnaire targeting level III neonatal care units in Spain. Participants were requested to provide data of all newborns ≥ 35 weeks of gestational age diagnosed with moderate-severe HIE over a two year-period (2012-2013), and of the implementation of TH up to June 2015...
July 29, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28748430/inicu-integrated-neonatal-care-unit-capturing-neonatal-journey-in-an-intelligent-data-way
#18
Harpreet Singh, Gautam Yadav, Raghuram Mallaiah, Preetha Joshi, Vinay Joshi, Ravneet Kaur, Suneyna Bansal, Samir K Brahmachari
Neonatal period represents first 28 days of life, which is the most vulnerable time for a child's survival especially for the preterm babies. High neonatal mortality is a prominent and persistent problem across the globe. Non-availability of trained staff and infrastructure are the major recognized hurdles in the quality care of these neonates. Hourly progress growth charts and reports are still maintained manually by nurses along with continuous calculation of drug dosage and nutrition as per the changing weight of the baby...
August 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28746750/the-emotional-impact-of-errors-or-adverse-events-on-healthcare-providers-in-the-nicu-the-protective-role-of-coworker-support
#19
Adrien M Winning, Jenna M Merandi, Dorcas Lewe, Lois M C Stepney, Nancy N Liao, Christine A Fortney, Cynthia A Gerhardt
AIMS: To examine the impact of errors or adverse events on emotional distress and professional quality of life in healthcare providers in the neonatal intensive care unit, as well as the moderating role of coworker support. BACKGROUND: Errors or adverse events can result in negative outcomes for healthcare providers. However, the role of coworker support in improving emotional and professional outcomes has not been examined. DESIGN: A cross-sectional online survey from a quality improvement initiative to train peer supporters in a neonatal intensive care unit...
July 26, 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/28746656/mortality-due-to-noncommunicable-diseases-in-brazil-1990-to-2015-according-to-estimates-from-the-global-burden-of-disease-study
#20
Deborah Carvalho Malta, Elisabeth França, Daisy Maria Xavier Abreu, Rosângela Durso Perillo, Maíra Coube Salmen, Renato Azeredo Teixeira, Valeria Passos, Maria de Fátima Marinho Souza, Meghan Mooney, Mohsen Naghavi
CONTEXT AND OBJECTIVE: Noncommunicable diseases (NCDs) are the leading health problem globally and generate high numbers of premature deaths and loss of quality of life. The aim here was to describe the major groups of causes of death due to NCDs and the ranking of the leading causes of premature death between 1990 and 2015, according to the Global Burden of Disease (GBD) 2015 study estimates for Brazil. DESIGN AND SETTING: Cross-sectional study covering Brazil and its 27 federal states...
May 2017: São Paulo Medical Journal, Revista Paulista de Medicina
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