Family centred care? Facilities, information and support for parents in UK neonatal units.

OBJECTIVE: To assess how UK neonatal units address parent communication, support and information needs during neonatal care and the early months after discharge. DESIGN: All units were invited to participate in a survey of practice and policy relating to the needs of parents with babies admitted for neonatal care. SETTING: Neonatal care, UK. MAIN OUTCOME MEASURES: Proportions of units by unit level providing specific facilities, information, policies and support mechanisms. RESULTS: Facilities, information and support for parents vary and can be quite limited: units may have as many as 10 babies receiving intensive or high dependency care in one room; 24% have no rooms in which to accommodate one or two babies only; 96% have at least one room for parents to stay overnight, 27% of rooms have ensuite amenities; 72% have written information about the equipment used, 64 % on ventilation and 91% on breastfeeding; parents have free access to notes in 20% of units and in 14% parents are excluded from ward rounds; 27% have a policy on keeping in contact with parents, 47% did not have the services of a social worker, psychologist, counsellor or psychiatrist and only 15% have a unit-based family care nurse. CONCLUSIONS: Elements of unit policy and practice that support family-centred care are variably in place currently and units need to address the gaps.

Developmental care in the UK: a developing initiative.

AIM: To review developmental care over time in the UK. METHODS: Longitudinal study comprising two prospective observational studies of unit organization and developmental care activity collected in 2005 and 2008 in all UK neonatal units. Indices related to developmental care and an aggregated score are reported corresponding to year and level of care. RESULTS: In 2008, over 90% units had open visiting for parents and modified lighting and 80% modified noise, showing no change since 2005. Incubator cover usage increased from 75% to 95%. Rates of parental tube feeding dropped from 76% to 64% and kangaroo care increased from 50% to 80%. Proportions of units with developmental care personnel and staff trained in developmental care have almost doubled to 64% and 57%. Aggregated scores, reflecting eight basic indices of developmental care, were unchanged: the 2005 mean was 5.7 (SD = 1.5) and 6.2 (SD = 1.5) in 2008. Scores were significantly higher in larger units and in those with developmental care personnel or developmentally trained staff. CONCLUSION: Despite a significant increase in developmental care skills and infrastructure, variable approaches persist, with limited improvements over time. These findings reflect a UK culture that is ambivalent towards developmental care, and enable comparison with other countries where developmental care is more fully supported.

A survey of the use of portable ultrasound for central vein cannulation on critical care units in the UK.

A questionnaire was sent to 288 critical care units in the UK to assess the use of portable ultrasound machines to assist central vein cannulation. There was a 58% response rate. Ultrasound guidance was used by 36 (21.6%) units for central vein cannulation. Of these, only four (11.1%) used it routinely and 25 (69.4%) used it when faced with a difficult vein cannulation. Half of the units with ultrasound facilities may be using it suboptimally. Of those units not using ultrasound for central vein cannulation, 70 (53%) said it was because of lack of equipment and 51 (38.9%) did not think that it was necessary. Overall, over half of the units did not audit complications of central vein cannulation.

Analysis of sensitivity and specificity of a new digital subtraction system: an in vitro study.

OBJECTIVE: The purpose of this study was to compare a new digital subtraction system with conventional radiograph images for the detection of periapical and periodontal bone lesions. STUDY DESIGN: Periapical and periodontal bone lesions were simulated with cortical bone chips of varying sizes placed on a human dry mandible. Radiographic film images were acquired from varying projections and were subsequently digitized, registered, and subtracted. Four clinicians evaluated the subtracted images, and sensitivity and specificity were calculated. RESULTS: The mean sensitivity and specificity of the Diagnostic Subtraction Radiography system for detecting bone lesions of all sizes with varying projection geometry were 87.90% and 85.23%, respectively. The corresponding results for conventional radiograph images were 47.54% and 97.38%. The difference in sensitivity was statistically significant, whereas the difference in specificity was not. CONCLUSIONS: These results indicate that, even when radiographs are taken from disparate projection geometries, the Diagnostic Subtraction Radiography system is capable of excellent discrimination between healthy and disease states in this in vitro model.