Capacity building of nurses providing neonatal care in Rio de Janeiro, Brazil: methods for the POINTS of care project to enhance nursing education and reduce adverse neonatal outcomes

Background

Increased survival of preterm infants in developing countries has often been accompanied by increased morbidity. A previous study found rates of severe retinopathy of prematurity varied widely between different neonatal units in Rio de Janeiro. Nurses have a key role in the care of high-risk infants but often do not have access to ongoing education programmes. We set out to design a quality improvement project that would provide nurses with the training and tools to decrease neonatal mortality and morbidity. The purpose of this report is to describe the methods and make the teaching package (POINTS of care--six modules addressing Pain control; optimal Oxygenation; Infection control; Nutrition interventions; Temperature control; Supportive care) available to others.

Methods/Design

Six neonatal units, caring for 40% of preterm infants in Rio de Janeiro were invited to participate. In Phase 1 of the study multidisciplinary workshops were held in each neonatal unit to identify the neonatal morbidities of interest and to plan for data collection. In Phase 2 the teaching package was developed and tested. Phase 3 consisted of 12 months data collection utilizing a simple tick-sheet for recording. In Phase 4 (the Intervention) all nurses were asked to complete all six modules of the POINTS of care package, which was supplemented by practical demonstrations. Phase 5 consisted of a further 12 months data collection. In Phase 1 it was agreed to include inborn infants with birthweight ?? 1500 g or gestational age of ?? 34 weeks. The primary outcome was death before discharge and secondary outcomes included retinopathy of prematurity and bronchopulmonary dysplasia. Assuming 400-450 infants in both pre- and post-intervention periods the study had 80% power at p = < 0.05 to detect an increase in survival from 68% to 80%; a reduction in need for supplementary oxygen at 36 weeks post menstrual age from 11% to 5.5% and a reduction in retinopathy of prematurity requiring treatment from 7% to 2.5%.

Discussion

The results of the POINTS of Care intervention will be presented in a separate publication.

Trial registration

Current Controlled Trials: ISRCTN83110114     

Nursing students motivation toward their studies – a survey study

Background

Antenatal education (AE) started more than 30 years ago with the purpose of decreasing pain during childbirth. Epidural anaesthesia has achieved this objective, and the value of AE is therefore currently questioned. This article describes the protocol and process of a study designed to assess AE results today.

Methods/Design

A prospective study was designed in which a cohort of 616 nulliparous pregnant women attending midwife offices of the Basque Health Service were followed for 13 months. Three exposure groups were considered based on the number of AE sessions attended: (a) women attending no session, (b) women attending 1 to 4, and (c) women attending 5 or more sessions. Sociodemographic, personality, and outcome variables related to childbirth and breastfeeding were measured. It was expected 40% of pregnant women not to have participated in any AE session. However, 93% had attended at least one session. This low exposure variability decreased statistical power of the study as compared to the initially planned power. Despite this, there was a greater than 80% power for detecting as significant differences between exposure groups of, for instance, 10% in continuation of breastfeeding at one and a half months and in visits for false labour. Women attending more sessions were seen to have a mean higher age and educational level, and to belong to a higher socioeconomic group (p < 0.01). Follow-up was completed in 99% of participants.

Discussion

Adequate prior estimation of variability in the exposure under study is essential for designing cohort studies. Sociodemographic characteristics may play a confounding role in studies assessing AE and should be controlled in design and analyses. Quality control during the study process and continued collaboration from both public system midwives and eligible pregnant women resulted in a negligible loss rate.     

Modified catheter for percutaneous gastrojejunostomy

A catheter for gastrojejunostomy was modified to include a Cope-loop retention device in the proximal part of the catheter and multiple side holes in the distal part. The modification was made to prevent catheter dislodgment, which can lead to infusion of feeding solution into the peritoneum. The catheter has been used successfully in 71 patients, and only minor complications have been reported.     

Unusual finding of bronchopulmonary carcinoma through a pterygoid muscle metastasis. About a case

Bronchopulmonary cancer muscle metastases are uncommon, especially when they are visible. They can impact any muscle in the body, but the psoas, diaphragmatic, and paravertebral muscles have a clear advantage. We present a case of lateral pterygoid muscle metastasis of squamous cell carcinoma of the lung in a 70-year-old habitual smoker (40 packs per year) presents headaches more marked on the right and progressively worsening. A complementary brain MRI revealed a well-limited oval formation with irregular contours in hypo signal T1 hyper signal T2 heterogeneous, with area of central necrosis of the right pterygoid muscle, which was revealed to be a secondary location of bronchopulmonary malignancy after further examination (CT scan of the cervico-thoraco-abdomino-pelvic region, TEP scan, and biopsy). Moreover, muscle metastases are rarely revealing of primary cancer.     

Post-traumatic biloma intrahepatic a rare complication of closed abdominal trauma: A case report

Post-traumatic hepatic biloma is a rare complication of closed trauma of the abdomen. Generally, biloma occurs spontaneously or secondary to traumatic or iatrogenic injury to the biliary system. It can lead to significant morbidity and mortality if not diagnosed promptly and properly managed. A 4-year-old child was admitted to the emergency room with abdominal pain following a traffic accident. Clinical examinations suspected closed abdominal trauma without biological signs of icteric cholestasis. Abdominal CT scan performed within 24 hours showed a focus of hepatic laceration, and follow-up imaging at 5 days showed post-traumatic intrahepatic cystic formations. This case report aims to emphasize the importance of imaging including ultrasound, CT, MRI, MRI cholangiopancreatography (MRCP), or hepatobiliary cholescintigraphy to establish the diagnosis and guide the therapeutic gestures.     

Mediastinal bronchial artery aneurysm presenting as an incidental mediastinal mass: A rare finding

Mediastinal bronchial artery aneurysm is very rare and only few cases have been reported in the literature. The clinical presentations are varied, ranging from an incidental radiological finding to a cataclysmic rupture leading to hemorrhagic shock. Thus, a quick treatment is indicated upon diagnosis. Therapeutic options are various including surgical resection, stent grafting with percutaneous embolization of feeding vessel or transtarterial embolization. Herein we describe a case of an incidental mediastinal bronchial artery aneurysm in a 63-year-old man, managed by transtarterial embolization.