Impact of the design of neonatal intensive care units on neonates, staff, and families: A systematic literature review

Newborn intensive care is for critically ill newborns requiring constant and continuous care and supervision. The survival rates of critically ill infants and hospitalization in neonatal intensive care units (NICUs) have improved over the past 2 decades because of technological advances in neonatology. The design of NICUs may also have implications for the health of babies, parents, and staff. It is important therefore to articulate the design features of NICU that are associated with improved outcomes. The aim of this study was to explore the main features of the NICU design and to determine the advantages and limitations of the designs in terms of outcomes for babies, parents, and staff, predominately nurses. A systematic review of English-language, peer-reviewed articles was conducted for a period of 10 years, up to January 2011. Four online library databases and a number of relevant professional Web sites were searched using key words. There were 2 main designs of NICUs: open bay and single-family room. The open-bay environment develops communication and interaction with medical staff and nurses and has the ability to monitor multiple infants simultaneously. The single-family rooms were deemed superior for patient care and parent satisfaction. Key factors associated with improved outcomes included increased privacy, increased parental involvement in patient care, assistance with infection control, noise control, improved sleep, decreased length of hospital stay, and reduced rehospitalization. The design of NICUs has implications for babies, parents, and staff. An understanding of the positive design features needs to be considered by health service planners, managers, and those who design such specialized units. © 2012 Wolters Kluwer | Lippincott Williams & Wilkins

Intravitreal Fasudil Combined with Bevacizumab for Treatment of Refractory Diabetic Macular Edema; a Pilot Study

Purpose To evaluate the effect of intravitreal injection of a Rho-associated protein kinase (ROCK) inhibitor (Fasudil, Asahi Kasei Pharma Corporation, Tokyo, Japan) combined with intravitreal bevacizumab (IVB) on refractory diabetic macular edema (DME). Methods: This prospective, interventional case series included 15 eyes of 15 patients with DME unresponsive to previous IVB injections. Eligible eyes underwent intravitreal injection of 0.025 mg Fasudil and 1.25 mg bevacizumab. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated before and 4 weeks after treatment. Results: Mean age was 64.6±7.3 (range, 49-79) years and mean number of previous IVB injections was 2.8. Mean pre-injection BCVA was 0.84±0.35 LogMAR, which was improved to 0.49±0.29 LogMAR four weeks after intervention (P=0.003). Mean CMT was decreased from 448±123 µm before treatment, to 347±76 µm at four weeks (P=0.001); no adverse event was observed during the study period. Conclusion: Intravitreal ROCK inhibitors seem to entail structural and visual benefits in eyes with DME refractory to IVB monotherapy

Twitter Sentiment Mining: A Multi Domain Analysis

Microblogging such as Twitter provides a rich source of information about products, personalities, and trends, etc. We proposed a simple methodology for analyzing sentiment of users in Twitter. First, we automatically collected Twitter corpus in positive and negative tweets. Second, we built a simple sentiment classifier by utilizing the Naive Bayes model to determine the positive and negative sentiment of a tweet. Third, we tested the classifier against a collection of users’ opinions from five interesting domains of Twitter, i.e., news, finance, job, movies, and sport. The experimental results show that it is feasible to use Twitter corpus alone to classify new tweet for a certain domain applications

Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU.

OBJECTIVE: To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU. METHODS: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre-established voting thresholds. No industry funding was associated with the guideline development. RESULTS: The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and Population, Intervention, Comparison, Outcome question development. The systematic review search yielded 4,158 reports after deduplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low, and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice. CONCLUSIONS: These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care

Impact of family integrated care on infants’ clinical outcomes in two children’s hospitals in China: a pre-post intervention study

© 2018 The Author(s). Background: Most Neonatal Intensive Care Units (NICUs) in China have restricted visiting policies for parents. This also implicates that parents are not involved in the care of their infant. Family Integrated Care (FIC), empowering parents in direct care delivery and decisions, is becoming the standard in NICUs in many countries and can improve quality-of-life and health outcomes of preterm infants. The aim of this study was to evaluate the impact of a FIC intervention on the clinical outcomes of preterm infants with Bronchopulmonary Dysplasia (BPD). Methods: A pre-post intervention study was conducted at NICUs in two Chinese children's hospitals. Infants with BPD were included: pre-intervention group (n = 134) from December 2015 to September 2016, post-intervention (FIC) group (n = 115) and their parents from October 2016 to June 2017. NICU nurses were trained between July and September 2016 to deliver the FIC intervention, including parent education and support. Parents had to be present and care for their infant minimal three hours a day. The infants' outcome measures were length-of-stay, breastfeeding, weight gain, respiratory and oxygen support, and parent hospital expenses. Results: Compared with control group (n = 134), the FIC group (n = 115) had significantly increased breastfeeding rates (83% versus 71%, p = 0.030), breastfeeding time (31 days versus 19 days, p < 0.001), enteral nutrition time (50 days versus 34 days, p < 0.001), weight gain (29 g/day versus 23 g/day, p = 0.002), and significantly lower respiratory support time (16 days versus 25 days, p < 0.001). Oxygen Exposure Time decreased but not significant (39 days versus 41 days p = 0.393). Parents hospital expenses in local Chinese RMB currency was not significant (84 K versus 88 K, p = 0.391). Conclusion: The results of our study suggests that FIC is feasible in two Chinese NICUs and might improve clinical outcomes of preterm infants with BPD. Further research is needed to include all infants admitted to NICUs and should include parent reported outcome measures. Our study may help other NICUs with limited parental access to implement FIC to enhance parental empowerment and involvement in the care of their infant

The Comparison of Balance of Dominant and Non-Dominant Legs in Soccer Players, Gymnasts, Swimmers and Basketball Players

The aim of this study was to compare static and dynamic balance of dominant and non-dominant legs in gymnasts, soccer players, basketball players and swimmers. For this purpose, 40 female athletes with 5 years of athletic experience (gymnasts n=10, age 14.50±0.31 years, height 155.20±7.75cm, weight 49.70±3.91 kg), soccer players (n=10, age 22.80±1.47 years, height 160.60±5.12 cm, weight 52.95±4.87 kg), swimmers (n=10, age 23.30±1.63 years, height 163.5±5.46 cm, weight 55.50±4.42 kg) and basketball players (n=10, age 21.60±1.07 years, height 165.5±6.75 cm, weight 57.43±6.27 kg) participated in this study as subjects. Static balance was assessed using the balance error scoring system (BESS) and dynamic balance was assessed using the star excursion balance test (SEBT). Data were analyzed by paired – sample t test (P? 0.05). Results showed no significant difference in static balance as well as dynamic balance between dominant and non-dominant legs (p>0.05) and it is not necessary to stand on the dominant leg to achieve the highest balance. This finding is particularly interesting for the clinicians who commonly use single leg postural control evaluations to assess an athletes’ progress in rehabilitation programs

The Effect of a 3-Week Neuromuscular Training Program and Its Retention on the Movement Pattern of Drop Vertical Jump in Active Girls with Knee Valgus

Dynamic knee valgus during deceleration and drop landing in sport activities can be the cause of many acute and chronic knee injuries in female athletes. This study examined the effect of 3 weeks of neuromuscular training and its retention after 3 months on the movement pattern of drop vertical jump in 15-18-year-old active girls with dynamic knee valgus. Volunteers were screened by double legged squat test and finally, 24 subjects with dynamic knee valgus (12 subjects in the training group and 12 subjects in the control group) were selected as the sample. Knee valgus and flexion angles were calculated using two dimensional evaluation method with two video cameras (CASIO-Ex-F1, made in Japan) before and immediately after the training program in both groups and knee valgus angle was again calculated 3 months later during drop vertical jump test. Repeated measures was used to compare knee valgus and flexion angles before and immediately after and 3 months after the training intervention in control and training groups. In case of significance, independent and dependent t tests were used to recognize within- and between-group differences. The results showed that knee valgus angle mean decreased after training in the training group and this difference was significant (P=0.001). Also, knee flexion angle mean in the training group increased significantly (P=0.04). The results of paired sample t test showed a significant increase in this variable after the training and 3 months later in knee valgus angle in the training group (P=0.05). Results showed that although a 3-week neuromuscular training intervention improved movement pattern of drop vertical jump in active female students, the retention of the effect of this training decreased after 3 months

A Comparison of Range of Motion of Joints and Isometric Strength of Lower Extremity Muscles in Female Athletes with and without Dynamic Knee Valgus

The aim of this study was to compare isometric strength and range of motion (ROM) of lower extremity in female athletes with and without dynamic knee valgus. 48 healthy female athletes (age range 15-18 years) in two groups: those with dynamic knee valgus during squat movement that was corrected by a heel lift (n=24) and those with no dynamic knee valgus (n=24 as the control group) with no injury in the past participated in this study. Maximum isometric strength was measured in kilograms using a hand-held dynamometer and active ROM was measured in degrees with a standard plastic goniometer. Independent t test and MANOVA were used to analyze data (P≤0.05). The results showed that the group with dynamic knee valgus had significantly lower mean ankle dorsiflexion ROM (with right knee) (F1.46=5.503, P=0.023) and isometric strength of ankle plantar flexion (F1.46=4.187, P=0.046) than the control group. No other significant differences were observed between the groups. The subjects with dynamic knee valgus exhibited tight and weak lateral and medial gastrocnemius muscles. This result indicated that decreased ankle dorsiflexion ROM as a factor affecting the alteration of movement pattern of lower extremity and consequently a risk factor for knee injuries must receive the attention of clinicians and trainers

Lower extremity Malalignment and its linear relation with Q angle in female athletes

AbstractLower extremity alignment has been proposed as a risk factor for acute and chronic lower extremity injuries. The aim of this study was to determine the extent to which select lower extremity alignment characteristics are related to the Q angle. One hundred and thirty female athletes were examined for navicular drop, Q angle, genu recurvatum, femoral anteversion, T-F angle, tibiofemoral angle, dorsiflextion, hip internal and external rotation and general join laxity. The results showed greater tibiofemoral angle, femoral anteversion and hip internal rotation were significant predictors of greater Q angle (p<0.05). greater femoral anteversion, hip internal rotation and tibiofemoral angle results in greater Q angle, with changes in tibiofemoral angle having a substantially greater impact on the magnitude of the Q angle compared with femoral anteversion and hip internal rotation. Thus identifying the postural factors that influence Q angle, excessive stress and potential injury is of considerable importance. Clinically this has implications for both preseason screening and clinical treatment of subjects or patients