Timothy Disher

Understanding kangaroo care and its benefits to preterm infants

The holding of an infant with ventral skin-to-skin contact typically in an upright position with the swaddled infant on the chest of the parent, is commonly referred to as kangaroo care (KC), due to its simulation of marsupial care. It is recommended that KC, as a feasible, natural, and cost-effective intervention, should be standard of care in the delivery of quality health care for all infants, regardless of geographic location or economic status. Numerous benefits of its use have been reported related to mortality, physiological (thermoregulation, cardiorespiratory stability), behavioral (sleep, breastfeeding duration, and degree of exclusivity) domains, as an effective therapy to relieve procedural pain, and improved neurodevelopment. Yet despite these recommendations and a lack of negative research findings, adoption of KC as a routine clinical practice remains variable and underutilized. Furthermore, uncertainty remains as to whether continuous KC should be recommended in all settings or if there is a critical period of initiation, dose, or duration that is optimal. This review synthesizes current knowledge about the benefits of KC for infants born preterm, highlighting differences and similarities across low and higher resource countries and in a non-pain and pain context. Additionally, implementation considerations and unanswered questions for future research are addressed.

Pain-Relieving Interventions for Retinopathy of Prematurity: A Meta-analysis

Through the use of NMA, we identify optimal treatments and avenues for new research in this review. CONTEXT: Retinopathy of prematurity eye examinations conducted in the neonatal intensive care. OBJECTIVE: To combine randomized trials of pain-relieving interventions for retinopathy of prematurity examinations using network meta-analysis. DATA SOURCES: Systematic review and network meta-analysis of Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and the World Health Organization International Clinical Trials Registry Platform. All databases were searched from inception to February 2017. STUDY SELECTION: Abstract and title screen and full-text screening were conducted independently by 2 reviewers. DATA EXTRACTION: Data were extracted by 2 reviewers and pooled with random effect models if the number of trials within a comparison was sufficient. The primary outcome was pain during the examination period; secondary outcomes were pain after the examination, physiologic response, and adverse events. RESULTS: Twenty-nine studies (N = 1487) were included. Topical anesthetic (TA) combined with sweet taste and an adjunct intervention (eg, nonnutritive sucking) had the highest probability of being the optimal treatment (mean difference [95% credible interval] versus TA alone = −3.67 [−5.86 to −1.47]; surface under the cumulative ranking curve = 0.86). Secondary outcomes were sparsely reported (2–4 studies, N = 90–248) but supported sweet-tasting solutions with or without adjunct interventions as optimal. LIMITATIONS: Limitations included moderate heterogeneity in pain assessment reactivity phase and severe heterogeneity in the regulation phase. CONCLUSIONS: Multisensory interventions including sweet taste is likely the optimal treatment for reducing pain resulting from eye examinations in preterm infants. No interventions were effective in absolute terms.

Are guidelines for measurement of quality of life contrary to patient-centred care?

AIMS A discussion of how quality-adjusted life years are used to inform resource allocation decisions and highlight how assumptions underpinning the measurement of quality of life are contrary to the principles of patient-centred care. BACKGROUND Cost-effectiveness analyses (CEAs) can provide influential guidance for health resource allocation, particularly in the context of a budget-constrained public health insurance plan. Most national economic guideline bodies recommend that quality-adjusted life year weights for CEA be elicited indirectly (public preferences). This has potentially important implications for healthcare provision and research, as it discounts the ability of a person experiencing an illness to describe how it affects their quality of life. DESIGN Discussion paper. DATA SOURCES Guidelines for the conduct of health economic evaluations, influential methodological and theoretical texts, and a review of PubMed conducted in April 2017. IMPLICATIONS FOR NURSING Nurses are increasingly interested in leveraging methods from health economics to aid in decision-making and advocacy. In this analysis, we highlight how taken-for-granted approaches to the measurement of quality of life may discount the experience of patients and lead to decisions that are contrary to the principles of patient-centred care. Nurses conducting or reading research using these methods should consider whether the approach used to measure the quality of life are appropriate for the population under consideration. CONCLUSION Since patient and public health preferences can differ in both magnitude and direction, guideline bodies should re-evaluate their partiality for public preferences in the reference case.

Striving for Optimum Noise-Decreasing Strategies in Critical Care: Initial Measurements and Observations.

To identify baseline sound levels, patterns of sound levels, and potential barriers and facilitators to sound level reduction. The study setting was neonatal and pediatric intensive care units in a tertiary care hospital. Participants were staff in both units and parents of currently hospitalized children or infants. One 24-hour sound measurements and one 4-hour sound measurement linked to observed sound events were conducted in each area of the centers neonatal intensive care unit. Two of each measurement type were conducted in the pediatric intensive care unit. Focus groups were conducted with parents and staff. Transcripts were analyzed with descriptive content analysis and themes were compared against results from quantitative measurements. Sound levels exceeded recommended standards at nearly every time point. The most common code was related to talking. Themes from focus groups included the critical care context and sound levels, effects of sound levels, and reducing sound levels—the way forward. Results are consistent with work conducted in other critical care environments. Staff and families realize that high sound levels can be a problem, but feel that the culture and context are not supportive of a quiet care space. High levels of ambient sound suggest that the largest changes in sound levels are likely to come from design and equipment purchase decisions. L10 and Lmax appear to be the best outcomes for measurement of behavioral interventions.

Phenomenology of Illness by Havi Carel. Oxford University Press,

Carel0s goal in Phenomenology of Illness is twofold: to use phenomenology to better understand illness and to highlight the value of illness to philosophy. The result is a book that is relevant to two very different readers: the clinician or health researcher, and the philosopher. I approach this review as a registered nurse and doctoral student, and, thus, my reading of the book is seen through a clinician researcher lens. Those familiar with the history of phenomenology are likely to argue that a phenomenological treatment of illness is not novel, which Carel herself highlights when distinguishing her work from that of Merleau‐Ponty, Sartre, Toombs, Svenaeus, and others. She argues that these works have primarily focused on specific features of illness, as opposed to illness generally, whereas she seeks to develop a comprehensive phenomenology of illness. Carel states that an important part of this general framework is the ability to account for seemingly paradoxical phenomena such as traumatic growth wherein individuals report greater happiness after a brush with serious illness. Such a general framework is a worthy and valuable goal to both audiences of the text, and, in this effort, Carel largely succeeds.