Skin-to-skin contact after birth: developing a research and practice guideline

AIM

Skin-to-skin contact immediately after birth is recognized as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilized the World Health Organization guideline process to clarify best practice and improve the consistency of application.

METHODS

The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience.

RESULTS

The developed guideline received "strong recommendation" from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work delineated.

CONCLUSION

The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 grams with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favor of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for progression of newborns through their instinctive behaviors.

Healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease: a critical interpretive synthesis

Purpose: To establish literature regarding healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease.Method: A critical interpretive synthesis was conducted; CINAHL, PsychINFO and MEDLINE were searched between 1988 and August 2019, using MeSH headings and key terms. Reference lists of accepted papers were also searched. Qualitative, quantitative and mixed methods studies, written in English, including healthcare professionals' perceptions of pulmonary rehabilitation were included. The search yielded 133 papers which were assessed for eligibility; 20 met the inclusion criteria.Results: Two themes were identified, the first explored "Barriers to Pulmonary Rehabilitation" from a healthcare professional's perspective. This incorporated a lack of knowledge, a lack of resources, practical barriers, patient barriers, and healthcare professional's being unsure it is their role to refer. The second entitled "General Perceptions of Pulmonary Rehabilitation", highlighted ways in which the programme could be improved, the perceived positives and negatives, facilitators to referral, and perceptions of patients referred.Conclusions: This is the first systematic review to encompass the perceptions of healthcare professionals with ability to refer and those who deliver pulmonary rehabilitation. Referral was low, highlighting potential influencing factors such as a lack of programme knowledge, pulmonary rehabilitation beliefs, and communication skills. Given inclusion of studies from multiple geographical locations, the findings provide implications for any healthcare system that develops and delivers pulmonary rehabilitation. With respect of a lack of referrals to the programme, further research should highlight healthcare professionals' perceptions of the referral process, and the views of those in Secondary Care.Implications for rehabilitationChronic obstructive pulmonary disease:•Pulmonary rehabilitation is a proven cost-effective management strategy for patients with chronic obstructive pulmonary disease, which reduces associated hospital admissions and increases quality of life.•Due to a lack of knowledge and negative perceptions surrounding pulmonary rehabilitation, further training and education is required for healthcare professionals surrounding non-pharmacological management strategies.•Pulmonary rehabilitation programmes should consider ways to increase awareness of the service amongst those with chronic obstructive pulmonary disease.•Those delivering pulmonary rehabilitation should consider ways to support healthcare professionals referring to the programme.

Paradoxical vocal cord dysfunction in an infant with stridor and gastroesophageal reflux

This article presents the case history of a 4 month old infant diagnosed with Paradoxical Vocal Cord Dysfunction (PVCD) secondary to gastroesophageal reflux. The child presented with intermittent stridor which responded promptly to treatment of her reflux. This is believed to be the youngest person with PVCD reported in the literature and supports the concept that PVCD may be associated with multiple etiologies.

A microcomputer-based wearable biofeedback device to improve transfer of treatment in parkinsonian dysarthria

Achieving transfer of treatment outside the clinic is a problem for almost all individuals with speech disorders but has been particularly difficult in the treatment of patients with Parkinsonism. Given this situation and the frequency of vocal intensity problems in this population, we developed a wearable biofeedback device that could provide a patient with information about speech intensity outside the clinic. Auditory-perceptual and acoustic analyses were performed on audiotaped samples of reading and spontaneous speech recorded in the clinic pre- and posttreatment and at 10- and 20-week follow-ups. Visual feedback of intensity was integrated with auditory cues from a microcomputer that was then worn outside the clinic. The results indicated that the subject did transfer a substantial portion of clinic improvement to the outside environment while wearing the feedback device and suggest the utility of a microcomputer-based wearable device for assessing treatment effects as well as for improving transfer.

Relationship between dimensions of cognitive style: field-articulation control and stimulus-intensity control

There has been only one study with normals which examines relationships among Silverman's three dimensions of attention (cf. Silverman & King, 1970). The present study examined the relationship between scores of normal females on tasks that correlate with factors interpreted as field-articulation control and stimulus-intensity control. No significant linear or curvilinear relationships were obtained from Ss' scores on the rod-and-frame test and the kinesthetic figural aftereffects' test. These results support the belief that field-articulation control and stimulus-intensity control are independent cognitive controls in normals.

Stimulable and spontaneous bioluminescence in the marine dinoflagellates, Pyrodinium bahamense, Gonyaulax polyedra, and Pyrocystis lunula

P. bahamense, G. polyedra, and P. lunula exhibit interspecies differences in stimulable and spontaneous bioluminescence. For each species the total number of photons that can be emitted upon mechanical stimulation is a constant, regardless of the time during scotophase at which stimulation occurs. Ratios of stimulable bioluminescence per organism during scotophase and photophase are as high as 950:1 for laboratory cultures and have been observed as high as 4000: 1 for natural populations of P. bahamense. Spontaneous emission in darkness shows flashing as well as low-level continuous emission. Natural populations of P. bahamense, placed in darkness during natural photophase, exhibit a dual character to their stimulable bioluminescence. Mechanical stimulation techniques are described for rapid and reproducible stimulation of bioluminescence.

BIOLUMINESCENCE AND CHLOROPLAST MOVEMENT IN THE DINOFLAGELLATE PYROCYSTIS LUNULA(1)

The lunate cysts of Pyrocystis lunula have a bioluminescent emission spectrum with a peak intensity of 477.5 ± 1 mμ. The light originates from the protoplasm in the center of the cysts. Six to eight hr after the cysts were placed in the dark, they produced 300 to 800 times more luminescence than controls maintained under constant, illumination. Plastids contract distally when the cysts are placed in the dark. If kept in the dark, the plastids contract distally and expand with a circadian rhythm persisting several days. At intensities of 2200 μm cm-'or less, the plastids are expanded. The plastids are contracted into the central area of the cysts at light intensities of 4000 μw cm-(2) and above. The Gymnodinium stage of the life cycle is not bioluminescent.

THE EFFECT OF pH ON THE DIVISION RATE OF THE COCCOLITHOPHORID CRICOSPHAERA ELONGATA(1)

The division rate of Cricosphaera elongata was measured as a function of pH in a medium buffered with the CO2 -bicarbonate-carbonate system. The optimum pH for cell division of the coccolithophorid was 7.8. A change of the partial pressure of CO2 in the medium from 0.03 to 5% did not affect the division rate. Between pH 6.4 and 7.8 changes in the bicarbonate concentration from 0.1 to 6.0 mm and carbonate concentration from 0.007 to 0.1 mm did not affect the rate of division. At loiv experimental pH, C. elongata was nonmotile and grew in clumps; at higher pH values, it was motile and solitary. Coccoliths were not found covering C. elongata if calcite was soluble in the medium.