Evaluation Of A Pilot Randomized Controlled Trial

Neonatal RDS is a condition of increasing respiratory distress commencing at or shortly after birth (BAPM-2006). It’s the single most important cause of morbidity and mortality in preterm infants (Greenough, et al 2004). Typically RDS affects preterm infants with the incidence being inversely proportional to the gestational age (Stewart 2005) Approximately 60% of those born before 28 weeks gestation are affected (Fraser, et al 2004) Incidence also increases in infants of diabetic mothers those born via elective caesarean section (Fraser, et al 2004) and perinatal asphyxia (Rodriguez, 2003).

Why would delayed cord clamping even be a topic of discussion or in practice if it was not beneficial to some degree for the neonate or mother? Early cord clamping takes place almost immediately after delivery and delayed cord clamping is preformed anywhere for 30-180 seconds after birth. The validity of the above question has been on the rise for some time. Why some doctors have made it protocol during a delivery or simply do it only if requested is still not yet understood. Some would say there are little benefits to waiting to clamp the umbilical cord after delivery, and some say there are many benefits, and then there are those that say there is no difference whether you clamp early or delayed. Throughout my research I have learned that yet some physicians will not wait to clamp the umbilical cord, there are minimal risk, if any, and although at first I thought delayed clamping was without a doubt more beneficial than immediate clamping, they really are not profound in the grand scheme of the neonates’ health. However, I have learned that in the preterm neonate waiting to clamp the umbilical cord can be more beneficial for various reasons than in a full term neonate. Because of the medical background I have, I believe the benefits for both mother and child are important postpartum, however, those that choose to not participate in delayed clamping are not putting their newborn at any risk

According to the World Health Organisation [WHO] (2014) pre-term babies are at increased risk of illness, disability and death. It also states that globally 15 million babies are born pre-term and the figures are rising. In England and Wales during 2012 7.3% of live births were pre-term under 37 weeks nearly 85% of all babies born prematurely will have a very low birth weight (Office for National Statistics, 2012). Pre-term birth is associated with respiratory complications and lung disease, long-tern neurological damage and problems with bowel function (Henderson & Macdonald, 2011). Neonatal services provide care to babies who are born prematurely or are ill and require specialist care. It is seen that sixty per cent of infant deaths occur in the neonatal period (DH,

The title of the work reviewed is, Late vs early clamping of the umbilical cord in full-term neonates: Systematic review and meta-analysis of controlled trials; this indicates per PRISMA criteria that the title identifies the report as both a systematic review and meta-analysis.

In this article Munro, Watson, and McFadyen, (2006) conduct a controlled trial in which assesses the significance of the training personnel who work directly with people who possess mental health and substance e abuse problems receive. The sample was administered in a NHS mental health service and incorporated a sample size of 49 (27.8%) mental health nurses, either in adult generic mental health or addictions services, out of 176 nurses who were initially invited to take the survey. 24 of the nurses were assigned to the experimental group (receiving training) and the rest (25) of the nurses were sent to the control group (receiving no training). Data was retrieved at three different times using surveys. The first survey was taken before training , training would last for 4 days, and then the latter two surveys were allotted following right after and then again 6 months later.

For the past two decades, the limit of gestational viability has been 22-24 weeks (Bhat, Weinberger, & Hanna, 2012). Around 50 years ago, a premature infant born between 22-24 weeks was not considered viable and resuscitation was only considered at 27-28 weeks (Kushchel & Kent, 2011). Medicine and technology advances have improved neonatology drastically and infants are surviving at lower gestational ages. However, many studies show very low survival rates of 22-week neonates and some physician refuse to resuscitate and provide only comfort care. In the NICHD Neonatal Network between 2003 and 2007, infants that were incubated and resuscitated had a 6% survival rate at 22 weeks and a 55% survival rate at 24 weeks (Bhat et al, 2012). Another study followed a hospital for many years were they delivered 85 infants at 22-week

Now, medical advances make it possible for even the most severe premature babies to survive. Preterm babies as young as 22 to 23 weeks gestation can survive, but the costs associated with them is high (Kornhauser & Schneiderman, 2010). The higher cost is attributed to the extended hospital stay of micro preemies in Level 3 NICU (Bird, 2014). Level 3 NICU offers a wide range of neonatal services that include special imaging techniques, advanced ventilation

In a study done by Emadedin et al. in 2012, they injected MSC from each respective patients bone marrow, into six female volunteers with evidence of knee OA that was severe enough to require joint replacement surgery. The authors described a detailed, meticulous procedure in how they obtained the MSC from the patient’s bone marrow, and made it into the cells they needed for the procedure. They injected the patient’s affected knee joints with the stem cells and followed up with them in one year. At the one year mark, Emadedin et al. (2012) found that overall, the study was successful in decreasing pain and increasing the patients walking distance for the first 6 months. However, they discovered that 3 of the

Prematurity is the primary cause of increasing infants’ serious illnesses and deaths in the United States (CDC, December 2014).Preterm infants are more likely to have developmental delays, impaired cognitive growth, and behavioral problems as compared to their normal counterparts. Also, the expenditure for the care of premature babies is constantly increasing due to their extended stay in Neonatal Intensive Care Unit (NICU). Previous studies have estimated that the Average daily expense of NICU stay is over $ 3000 for each preterm infant (Muraskas& Parsi 2008). The longer the stay, more will be the cost. The length of NICU stay depends upon the gestational age and complications associated with prematurity. The

The research topic I have chosen is techniques that help reduce the chances of Sudden Infant Death Syndrome (SIDS). My area of expertise in nursing is pediatrics. I chose this topic because of the high number of children I have witnessed in my career die from SIDS. One of the most important duties as a nurse is to provide education to my patients and parents I work with. I feel it is extremely important to know and understand risk factors for SIDS to teach parents before taking their new baby home. This paper will be a literature critique of the articles I will be using to support my findings.

The research designed used in this study is a descriptive pilot study. A descriptive pilot study is a standard scientific tool which allows scientists to conduct a preliminary analysis before committing to a full-blown study or experiment that also seeks a relationship between variables such as quality of life, burn out and the impact of an event has on compassion fatigue in oncology nurses.

The hospital that I work at does not have a labor and delivery unit, so my facility does not deliver infants. In the article Beliefs and Practices of Obstetric Care Providers Regarding Umbilical Cord Clamping, it is an interesting discussion to the timing of cutting the umbilical cord in full-term and preterm infants. Hill and Fontenot (2014) state, “If the umbilical cord remains unclamped for a small amount of time (approximately 30 to 120 seconds), rather than clamping immediately (15 to 20 seconds), placental transfusion occurs, increasing blood volume to the newborn and improving blood flow to vital organs” (Hill & Fontenot, p. 413). The article describes that waiting one minute or longer to clamp the umbilical cord can benefit the newborn

The primary disadvantage of randomised controlled trials would be ethics. There must be sufficient belief that the intervention will be safe. Moreover, clinical equipoise is very important. Clinical equipoise is the assumption that there is not one intervention better than the other during the design of a randomised controlled trial. (Cook and Sheets, 2011). Participants must be aware that they are taking part in a study and they should be informed of the risks and benefits of the trial - this is informed consent. It is also imperative that a data monitoring and safety committee review results and a closed and confidential data monitoring and ethics committee reviewed results for this trial. Ethics approval was granted by the northwest multicentre research ethics committee and each centre had to achieve local approval.

A total of 1736 articles were initially identified. Of these, 1687 were excluded according to the exclusion criteria listed above. The 49 remaining articles with full texts that met the inclusion criteria were assessed.11, 14, 17-19, 25 A total of 4 studies were included in this review. One study compared aflibercept with bevacizumab and ranibizumab for centre-involved DMO using a standardized follow-up and retreatment regimen.17, 18 Due to there being only one study comparing aflibercept with other anti-VEGF agents, it was not included in the meta-analysis.

Randomized control trials (RCTs) are considered the golden standard when assessing the effect of a variable of interest which refers to a specific treatment. Observational studies are another way to estimate treatment effects and in specific, they allow casual relationships to be explored between a given intervention and an outcome variable, the main problem in such studies however, is that bias might be introduced in the estimates. Instrumental variables (IV), provide a useful tool to overcome this problem by adjusting for all confounders, observed or not (Martens et al., 2006). The rationale behind the construction of instrumental variables is explicitly described in a study by Ludwig et al. published in 2009, who aim to provide an estimate on the casual relationship between suicide mortality and a specific category of antidepressant drugs, the SSRIs (selective serotonin reuptake inhibitors) by using data from 26 countries for up to 25 years. Researchers in past studies attempted to link suicide mortality and anti-depressant therapies, the main concerns raised however, were around endogeneity issues and the bias generated with regards to SSRI utilization rates and suicide mortality. Ludwig et al. provide a solution to overcome the above limitations. In specific, they assume that institutional differences across countries have no relation with trends in mental disease treatments and suggest that the variation in SSRIs sales can be predicted by changes in the rate