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Actuarial survival of a large Canadian cohort of preterm infants.

https://arctichealth.org/en/permalink/ahliterature172012
Source
BMC Pediatr. 2005;5:40
Publication Type
Article
Date
2005
Author
Huw P Jones
Stella Karuri
Catherine M G Cronin
Arne Ohlsson
Abraham Peliowski
Anne Synnes
Shoo K Lee
Author Affiliation
Department of Pediatrics, St Mary's Hospital, Portsmouth, UK. joneshuw@doctors.org.uk
Source
BMC Pediatr. 2005;5:40
Date
2005
Language
English
Publication Type
Article
Keywords
Actuarial Analysis
Age Factors
Birth weight
Canada - epidemiology
Female
Gestational Age
Humans
Infant mortality
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Intensive Care Units, Neonatal
Male
Multiple Birth Offspring - statistics & numerical data
Patient Discharge
Prospective Studies
Sex Factors
Survival Analysis
Abstract
The increased survival of preterm and very low birth weight infants in recent years has been well documented but continued surveillance is required in order to monitor the effects of new therapeutic interventions. Gestation and birth weight specific survival rates most accurately reflect the outcome of perinatal care. Our aims were to determine survival to discharge for a large Canadian cohort of preterm infants admitted to the neonatal intensive care unit (NICU), and to examine the effect of gender on survival and the effect of increasing postnatal age on predicted survival.
Outcomes for all 19,507 infants admitted to 17 NICUs throughout Canada between January 1996 and October 1997 were collected prospectively. Babies with congenital anomalies were excluded from the study population. Gestation and birth weight specific survival for all infants with birth weight
Notes
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PubMed ID
16280080 View in PubMed
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Determining behavioural and physiological responses to pain in infants at risk for neurological impairment.

https://arctichealth.org/en/permalink/ahliterature167357
Source
Pain. 2007 Jan;127(1-2):94-102
Publication Type
Article
Date
Jan-2007
Author
Bonnie Stevens
Patrick McGrath
Sharyn Gibbins
Joseph Beyene
Lynn Breau
Carol Camfield
Allen Finley
Linda Franck
Alexandra Howlett
Celeste Johnston
Patricia McKeever
Karel O'Brien
Arne Ohlsson
Janet Yamada
Author Affiliation
Faculty of Nursing, University of Toronto, Toronto, Ont., Canada. b.stevens@utoronto.ca
Source
Pain. 2007 Jan;127(1-2):94-102
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Canada
Child Behavior
Child, Preschool
Cohort Studies
Female
Humans
Infant, Newborn
Male
Nervous System Diseases - complications - diagnosis - physiopathology
Pain - complications - diagnosis - physiopathology
Pain Measurement - methods
Risk Assessment - methods
Risk factors
Abstract
Multiple researchers have validated indicators and measures of infant pain. However, infants at risk for neurologic impairment (NI) have been under studied. Therefore, whether their pain responses are similar to those of other infants is unknown. Pain responses to heel lance from 149 neonates (GA>25-40 weeks) from 3 Canadian Neonatal Intensive Care units at high (Cohort A, n=54), moderate (Cohort B, n=45) and low (Cohort C, n=50) risk for NI were compared in a prospective observational cohort study. A significant Cohort by Phase interaction for total facial action (F(6,409)=3.50, p=0.0022) and 4 individual facial actions existed; with Cohort C demonstrating the most facial action. A significant Phase effect existed for increased maximum Heart Rate (F(3,431)=58.1, p=0.001), minimum Heart Rate (F(3,431)=78.7, p=0.001), maximum Oxygen saturation (F(3,425)=47.6, p=0.001), and minimum oxygen saturation (F(3,425)=12.2, p=0.001) with no Cohort differences. Cohort B had significantly higher minimum (F(2,79)=3.71, p=0.029), and mean (F(2,79)=4.04, p=0.021) fundamental cry frequencies. A significant Phase effect for low/high frequency Heart Rate Variability (HRV) ratio (F(2,216)=4.97, p=0.008) was found with the greatest decrease in Cohort A. Significant Cohort by Phase interactions existed for low and high frequency HRV. All infants responded to the most painful phase of the heel lance; however, infants at moderate and highest risk for NI exhibited decreased responses in some indicators.
PubMed ID
16997468 View in PubMed
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Determining the structure of acute pain responses in vulnerable neonates.

https://arctichealth.org/en/permalink/ahliterature162057
Source
Can J Nurs Res. 2007 Jun;39(2):32-47
Publication Type
Article
Date
Jun-2007
Author
Bonnie Stevens
Linda Franck
Sharyn Gibbins
Patrick J McGrath
Annie Dupuis
Janet Yamada
Joseph Beyene
Carol Camfield
G Allen Finley
Celeste Johnston
Karel O'Brien
Arne Ohlsson
Author Affiliation
Lawrence Bloomberg Faculty of Nursing, University of Toronto, Canada.
Source
Can J Nurs Res. 2007 Jun;39(2):32-47
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Canada
Clinical Nursing Research
Cohort Studies
Crying
Facial Expression
Factor Analysis, Statistical
Gestational Age
Heart rate
Humans
Infant, Newborn
Infant, Newborn, Diseases - etiology
Monitoring, Physiologic
Neonatal Nursing
Neonatal Screening
Nursing Assessment
Pain - diagnosis - etiology - physiopathology - psychology
Pain Measurement - methods - nursing
Risk assessment
Risk factors
Abstract
The primary purpose was to determine the underlying structure of the vulnerable infant's response to an acute painful procedure. The secondary purpose was to explore the influence of context (e.g., risk for neurological impairment [NI] and gestational age [GA]). A descriptive cohort design determined contributions of selected indicators to the structure of infant pain. The magnitude of variance for 19 pain indicators was assessed using 3 exploratory factor analyses in 149 neonates. The basic exploratory factor structure included behavioural (e.g., facial actions) and physiological (e.g., oxygen saturation, heart rate) indicators. Facial actions accounted for the greatest variance across all factor solutions (29-39%). Physiological indicators explained 8 to 26% additional variance. There were no consistent differences in the factor structures when contextual factors were explored.
PubMed ID
17679584 View in PubMed
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Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature188524
Source
JAMA. 2002 Sep 18;288(11):1373-81
Publication Type
Article
Date
Sep-18-2002
Author
Ellen D Hodnett
Nancy K Lowe
Mary E Hannah
Andrew R Willan
Bonnie Stevens
Julie A Weston
Arne Ohlsson
Amiram Gafni
Holly A Muir
Terri L Myhr
Robyn Stremler
Author Affiliation
Faculty of Nursing and Maternal-Child Nursing Research Unit, Centre for Research in Women's Health, University of Toronto, 50 St George St, Toronto, Ontario, Canada M5S 3H4. ellen.hodnett@utoronto.ca
Source
JAMA. 2002 Sep 18;288(11):1373-81
Date
Sep-18-2002
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cesarean Section - utilization
Delivery Rooms - standards
Delivery, Obstetric - nursing - statistics & numerical data
Female
Humans
Infant, Newborn
Labor, Obstetric
Male
Nurse Midwives
Nurse's Role
Nursing Staff, Hospital
Obstetric Labor Complications - epidemiology
Obstetric Nursing - methods - standards
Parity
Pregnancy
Pregnancy outcome
Puerperal Disorders - epidemiology
United States - epidemiology
Abstract
North American cesarean delivery rates have risen dramatically since the 1960s, without concomitant improvements in perinatal or maternal health. A Cochrane Review concluded that continuous caregiver support during labor has many benefits, including reduced likelihood of cesarean delivery.
To evaluate the effectiveness of nurses as providers of labor support in North American hospitals.
Randomized controlled trial with prognostic stratification by center and parity. Women were enrolled during a 2-year period (May 1999 to May 2001) and followed up until 6 to 8 postpartum weeks.
Thirteen US and Canadian hospitals with annual cesarean delivery rates of at least 15%.
A total of 6915 women who had a live singleton fetus or twins, were 34 weeks' gestation or more, and were in established labor at randomization.
Patients were randomly assigned to receive usual care (n = 3461) or continuous labor support by a specially trained nurse (n = 3454) during labor.
The primary outcome measure was cesarean delivery rate. Other outcomes included intrapartum events and indicators of maternal and neonatal morbidity, both immediately after birth and in the first 6 to 8 postpartum weeks.
Data were received for all 6915 women and their infants (n = 6949). The rates of cesarean delivery were almost identical in the 2 groups (12.5% in the continuous labor support group and 12.6% in the usual care group; P =.44). There were no significant differences in other maternal or neonatal events during labor, delivery, or the hospital stay. There were no significant differences in women's perceived control during childbirth or in depression, measured at 6 to 8 postpartum weeks. All comparisons of women's likes and dislikes, and their future preference for amount of nursing support, favored the continuous labor support group.
In hospitals characterized by high rates of routine intrapartum interventions, continuous labor support by nurses does not affect the likelihood of cesarean delivery or other medical or psychosocial outcomes of labor and birth.
Notes
Comment In: JAMA. 2003 Jan 8;289(2):175-6; author reply 17612517223
PubMed ID
12234231 View in PubMed
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Healthcare professionals' perceptions of pain in infants at risk for neurological impairment.

https://arctichealth.org/en/permalink/ahliterature177424
Source
BMC Pediatr. 2004 Nov 12;4(1):23
Publication Type
Article
Date
Nov-12-2004
Author
Lynn M Breau
Patrick J McGrath
Bonnie Stevens
Joseph Beyene
Carol S Camfield
G Allen Finley
Linda Franck
Alexandra Howlett
Karel O'Brien
Arne Ohlsson
Author Affiliation
Pediatric Pain Service, IWK Health Centre, 5850 University Ave,, P,O, Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada. lbreau@ns.sympatico.ca
Source
BMC Pediatr. 2004 Nov 12;4(1):23
Date
Nov-12-2004
Language
English
Publication Type
Article
Keywords
Adult
Analysis of Variance
Attitude of Health Personnel
Canada
Empathy
Female
Health Knowledge, Attitudes, Practice
Humans
Infant Care - methods
Infant, Newborn
Intensive Care Units, Neonatal - manpower
Judgment
Male
Middle Aged
Nervous System Diseases - complications
Pain - etiology - rehabilitation
Pain Measurement
Personnel, Hospital
Risk assessment
Abstract
To determine whether healthcare professionals perceive the pain of infants differently due to their understanding of that infant's level of risk for neurological impairment.
Neonatal Intensive Care Units (NICU's) at two tertiary pediatric centers. Ninety-five healthcare professionals who practice in the NICU (50 nurses, 19 physicians, 17 respiratory therapists, 9 other) participated. They rated the pain (0-10 scale and 0-6 Faces Pain Scale), distress (0-10), effectiveness of cuddling to relieve pain (0-10) and time to calm without intervention (seconds) for nine video clips of neonates receiving a heel stick. Prior to each rating, they were provided with descriptions that suggested the infant had mild, moderate or severe risk for neurological impairment. Ratings were examined as a function of the level of risk described.
Professionals' ratings of pain, distress, and time to calm did not vary significantly with level of risk, but ratings of the effectiveness of cuddling were significantly lower as risk increased [F (2,93) = 4.4, p = .02]. No differences in ratings were found due to participants' age, gender or site of study. Physicians' ratings were significantly lower than nurses' across ratings.
Professionals provided with visual information regarding an infants' pain during a procedure did not display the belief that infants' level of risk for neurological impairment affected their pain experience. Professionals' estimates of the effectiveness of a nonpharmacological intervention did differ due to level of risk.
Notes
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PubMed ID
15541179 View in PubMed
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Improved outcomes of outborn preterm infants if admitted to perinatal centers versus freestanding pediatric hospitals.

https://arctichealth.org/en/permalink/ahliterature174968
Source
J Pediatr. 2005 May;146(5):626-31
Publication Type
Article
Date
May-2005
Author
Prakesh S Shah
Vibhuti Shah
Zhenguo Qiu
Arne Ohlsson
Shoo K Lee
Author Affiliation
Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Source
J Pediatr. 2005 May;146(5):626-31
Date
May-2005
Language
English
Publication Type
Article
Keywords
Apgar score
Canada - epidemiology
Cross Infection - epidemiology
Databases, Factual
Female
Gestational Age
Hospitals, Pediatric
Humans
Infant, Newborn
Infant, Newborn, Diseases - epidemiology - mortality
Infant, Premature
Intensive Care Units, Neonatal
Male
Severity of Illness Index
Treatment Outcome
Abstract
To examine whether admission hospital type (13 perinatal centers vs 4 freestanding pediatric hospitals) was associated with differences in risk and illness severity adjusted mortality and morbidity among outborn preterm infants.
Records of singleton outborn infants
PubMed ID
15870665 View in PubMed
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Improving the quality of care for infants: a cluster randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature149217
Source
CMAJ. 2009 Oct 13;181(8):469-76
Publication Type
Article
Date
Oct-13-2009
Author
Shoo K Lee
Khalid Aziz
Nalini Singhal
Catherine M Cronin
Andrew James
David S C Lee
Derek Matthew
Arne Ohlsson
Koravangattu Sankaran
Mary Seshia
Anne Synnes
Robin Walker
Robin Whyte
Joanne Langley
Ying C MacNab
Bonnie Stevens
Peter von Dadelszen
Author Affiliation
Departments of Paediatrics, University of Toronto, Toronto, Ontario, Canada. sklee@mtsinai.on.ca
Source
CMAJ. 2009 Oct 13;181(8):469-76
Date
Oct-13-2009
Language
English
Publication Type
Article
Keywords
Bronchopulmonary Dysplasia - epidemiology - prevention & control
Canada
Cluster analysis
Cross Infection - epidemiology - therapy
Evidence-Based Medicine - methods - standards
Female
Follow-Up Studies
Humans
Incidence
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Male
Prospective Studies
Quality Assurance, Health Care - statistics & numerical data
Abstract
We developed and tested a new method, called the Evidence-based Practice for Improving Quality method, for continuous quality improvement.
We used cluster randomization to assign 6 neonatal intensive care units (ICUs) to reduce nosocomial infection (infection group) and 6 ICUs to reduce bronchopulmonary dysplasia (pulmonary group). We included all infants born at 32 or fewer weeks gestation. We collected baseline data for 1 year. Practice change interventions were implemented using rapid-change cycles for 2 years.
The difference in incidence trends (slopes of trend lines) between the ICUs in the infection and pulmonary groups was - 0.0020 (95% confidence interval [CI] - 0.0007 to 0.0004) for nosocomial infection and - 0.0006 (95% CI - 0.0011 to - 0.0001) for bronchopulmonary dysplasia.
The results suggest that the Evidence-based Practice for Improving Quality method reduced bronchopulmonary dysplasia in the neonatal ICU and that it may reduce nosocomial infection.
Notes
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Comment In: CMAJ. 2009 Oct 13;181(8):457-819667032
Comment In: CMAJ. 2009 Sep 15;181(6-7):39919752146
PubMed ID
19667033 View in PubMed
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Indicators of pain in neonates at risk for neurological impairment.

https://arctichealth.org/en/permalink/ahliterature153989
Source
J Adv Nurs. 2009 Feb;65(2):285-96
Publication Type
Article
Date
Feb-2009
Author
Bonnie Stevens
Patrick McGrath
Annie Dupuis
Sharyn Gibbins
Joseph Beyene
Lynn Breau
Carol Camfield
Gordon Allen Finley
Linda S Franck
Alexandra Howlett
Celeste Johnston
Patricia McKeever
Karel O'Brien
Arne Ohlsson
Janet Yamada
Author Affiliation
The Hospital for Sick Children, Toronto, Ontario, Canada. b.stevens@utoronto.ca
Source
J Adv Nurs. 2009 Feb;65(2):285-96
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Canada
Facial Expression
Humans
Infant Behavior - physiology
Infant, Newborn
Infant, Premature - physiology
Intensive Care, Neonatal
Nervous System Diseases - diagnosis
Pain - diagnosis - etiology
Pain Measurement - methods - standards
Risk factors
Abstract
This paper is a report of a study to compare the importance and usefulness ratings of physiological and behavioural indicators of pain in neonates at risk for neurological impairment by nurse clinicians and pain researchers.
Neonates at risk for neurological impairment have not been systematically included in neonatal pain measure development and how clinicians and researchers view pain indicators in these infants is unknown.
Data triangulation was undertaken in three Canadian Neonatal Intensive Care Units using data from: (a) 149 neonates at high, moderate and low risk for neurological impairment, (b) 95 nurse clinicians from the three units where infant data were collected and (c) 14 international pain researchers. Thirteen indicators were assessed following heel lance in neonates and 39 indicators generated from nurse clinicians and pain researchers were assessed for importance and accuracy. Data were collected between 2004 and 2005.
Across risk groups, indicators with the highest accuracy for discriminating 'pain' among neonates were: brow bulge (77-83%), eye squeeze (75-84%), nasolabial furrow (79-81%), and total facial expression (78-83%). Correlations between nurse ratings and neonatal accuracy scores ranged from moderate to none (mild risk r = 0.52, P = 0.07; moderate r = 0.43, P = 0.15; high r = -0.12, P = 0.69). Researchers demonstrated a better understanding of the importance of pain indicators (mild risk, r = 0.91, P
PubMed ID
19040693 View in PubMed
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Influence of risk of neurological impairment and procedure invasiveness on health professionals' management of procedural pain in neonates.

https://arctichealth.org/en/permalink/ahliterature146315
Source
Eur J Pain. 2010 Aug;14(7):735-41
Publication Type
Article
Date
Aug-2010
Author
Bonnie Stevens
Patrick McGrath
Marilyn Ballantyne
Janet Yamada
Annie Dupuis
Sharyn Gibbins
Linda Franck
G. Allen Finley
Alexandra Howlett
Celeste Johnston
Karel O'Brien
Arne Ohlsson
Author Affiliation
The Hospital for Sick Children, Toronto, Canada. b.stevens@utoronto.ca
Source
Eur J Pain. 2010 Aug;14(7):735-41
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Adult
Analgesia - methods
Canada
Humans
Infant
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Pain - etiology
Pain Management
Pain Measurement - methods
Physician's Practice Patterns
Prospective Studies
Risk assessment
Abstract
To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals' assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU).
Prospective observational study.
Three tertiary level NICUs in Canada.
114 neonates, 25-40 weeks gestational age (GA) undergoing painful procedures.
Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions.
114 neonates at high (Cohort A, n=35), moderate (Cohort B, n=25) and low (Cohort C, n=54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C (pA, B>C, p
PubMed ID
20047845 View in PubMed
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Neonatal intensive care unit characteristics affect the incidence of severe intraventricular hemorrhage.

https://arctichealth.org/en/permalink/ahliterature168218
Source
Med Care. 2006 Aug;44(8):754-9
Publication Type
Article
Date
Aug-2006
Author
Anne R Synnes
Ying C Macnab
Zhenguo Qiu
Arne Ohlsson
Paul Gustafson
Charmaine B Dean
Shoo K Lee
Author Affiliation
Department of Pediatrics, University of British Columbia, Canada.
Source
Med Care. 2006 Aug;44(8):754-9
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Acute Disease
Bayes Theorem
Canada - epidemiology
Cerebral Hemorrhage - epidemiology - etiology - pathology
Cerebral Ventricles - blood supply
Humans
Infant, Newborn
Intensive Care, Neonatal - organization & administration
Male
Premature Birth - pathology
Abstract
The incidence of intraventricular hemorrhage (IVH), adjusted for known risk factors, varies across neonatal intensive care units (NICU)s. The effect of NICU characteristics on this variation is unknown. The objective was to assess IVH attributable risks at both patient and NICU levels.
Subjects were
PubMed ID
16862037 View in PubMed
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15 records – page 1 of 2.