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Browsing Over 834 Presentations
Be hip- early prevention of late congenital dysplasia of the hip
Is there a case for universal newborn pulse oximetry screening?
Routine pulse oximetry screening (POS) has been consistently shown to be a highly specific, moderately sensitive test for detecting critical congenital heart defects (CCHD) in asymptomatic newborn babies. POS meets the criteria for universal screening and an increasing number of countries across the world now recommend routine POS and it has been shown to reduce early mortality from CCHD by 33% when compared to existing screening methods such as antenatal ultrasound and postnatal examination.
POS has also been shown to identify asymptomatic babies with other important clinical conditions such as congenital pneumonia, pulmonary hypertension and early-onset sepsis. Although technically false positives for the screening test, identification of these potentially life-threatening conditions is an important additional clinical benefit of POS.
POS is acceptable to parents and clinical staff and does not increase parental anxiety even in the parents of false positives and has been shown to be cost-effective in a number of health care systems.
There are a number of possible algorithm options for cut-off levels for screening but most agree that testing both pre and post-ductal saturations is superior to a single post-ductal measurement. Earlier screening (within 24 hours of birth) has slightly more false positives than later screening but will identify more at-risk babies. Routine testing of homebirths is feasible and acceptable.
This talk with describe the current evidence supporting these statements, the pros and cons of different algoritms and how practice is changing across the UK and the rest of the world.
Quality improvement and implementing change in the PICU
Abstract BodyQuality Improvement (QI) is traditionally driven by a combination of governance, financial and patient experience metrics. It is carried out within a variety of frameworks often borrowed from other industries such as Lean and Six Sigma. QI training to acquire the knowledge and skills associated with designing a project plan and identifying measurable outcomes is increasingly credible and available but this really is only the start.
The real power and potential of QI lies in its ability to engage staff and families in meaningful, community driven change for the better. Safety-II, Learning from Excellence and Implementation Science all contribute to this vision and will be discussed in the session. It is only when we embrace the complexity of our working environments – designing for ease of use by talking to those doing the work, and reframe problems as aspirations – by asking ‘what does good look like?’ and ‘how can we have more of that?’ that we can free ourselves of an exclusively problem focused narrative and hope to generate lasting and meaningful improvement.
QI without an understanding of complexity, positivity and agency is not sustainable. The real question is how we inspire best, evidence based practice to provide the kind of high quality care that fosters job satisfaction and engagement in work which in turn is known to improve patient safety and outcomes.
Barriers and facilitators of changing practice in the NICU
Insight in congenital diaphragmatic hernia physiology (incl. delay cord management)
Current guideline on congenital diaphragmatic hernia: still best practice?
Utility of biomarkers in neonatal acute kidney injury
Acute kidney injury (AKI) is a very common condition in the neonates. The prevalence of AKI in this population of children is around 30% and the mortality is up to 80%. The golden standard for defining AKI is following the changes of the serum creatinine (sCr) and the diuresis. The most of the neonates have a nonoliguric AKI, and the interpretation of sCr is very complicated in the neonates so it makes it more difficult to achieve a consensus regarding the AKI definition. Hence, the research has focused on identifying new biomarkers that would help diagnose AKI only a couple of hours or even days before the reduction of the diuresis or the increase of SCr. The studies examining AKI biomarkers in the neonates are scarce and are usually referring to a specific subpopulation of the neonates (neonates that are undergoing cardiac surgery with cardiopulmonary bypass, very low and extremely low birth weight neonates, neonates with perinatal asphyxia and those with sepsis). Additional difficulties in finding the ideal biomarker for AKI detection is the fact that the concentration of some of the biomarkers depends on the gestational and postnatal age and birth weight. In recent studies, the most promising early noninvasive neonatal AKI biomarkers were serum cystatin C, urinary interleukin 18, serum and urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, osteopontin, angiotensinogen and beta-2 microglobulin.
The previous studies are promising and focused on finding and using a panel of validated novel urinary biomarkers for the early diagnose of neonatal AKI.
Management of acute liver failure without liver transplant - fact or fiction?
Vaccines in Europe – concepts and controversies when tackling preventable infections
Overcoming vaccine hesitancy
Childhood vaccine hesitancy (VH) is a challenge for healthcare professionals (HCPs) worldwide. The WHO defined VH as 'a delay in acceptance or refusal of vaccines despite the availability of vaccine services’ which often involves a range of factors and processes linked to both parental and health professional’s knowledge and beliefs. Our recent meta-synthesis identified the nature of the parental factors involved in VH as a set of linked themes: risk conceptualization, mistrust, alternative health beliefs, philosophical views and responsibility and information. However, HCPs appear to have a role in VH, maybe by failing to establish a positive professional relationship with the parents. This seems linked to how HCP’s exchange information and negotiate with patients within a spirit of cooperation and mutual respect. According to our recent Grounded Theory study, discordant interplays among HCPs and receivers (parents for the matter of this presentation) are the results of a neglected relationship. While parents desire to do what they feel right for their child, the HCPs' approach to this challenging situation may fail to acknowledge parents' fears. In this complex context, we propose several organizational actions and educative paths/pedagogy that minimise the risks of both VH and discordance. This involves effective communication between HCPs and parents in an atmosphere of mutual respect. As for pedagogy, for HCPs, training courses in qualitative health research (QHR) methodology provide innovative strategies for improving relational skills. Indeed, QHR can inform HCPs on how to interact with parents, enhancing the level of humanization of care and communication-related strategies.
Renal failure in the ICU
Fluid kills: what can the nurse do for a better fluid management?
Fluid therapy and maintaining an accurate fluid balance is essential in the critically ill child. This lecture will cover the reasons for fluid overload and fluid shifts in critically ill children and discuss the rationale for fluid restriction in the critically ill. It will also discuss different types of fluids used in the critically ill child and the physiological impact of these different fluid boluses. It will discuss enteral versus intravenous fluids and focus on nursing strategies to reduce fluid overload in the critically ill child, whilst trying to provide adequate energy intake in the form of enteral nutrition.