The BaSICS (Baby Skin Integrity Comparison Survey) study: A prospective experimental study using maternal observations to report the effect of baby wipes on the incidence of irritant diaper dermatitis in infants, from birth to eight weeks of age.

BACKGROUND: Baby wipes have been shown to be safe and effective in maintaining skin integrity when compared to the use of water alone. However, no previous study has compared different formulations of wipe. The aim of the BaSICS study was to identify any differences in incidence of irritant diaper dermatitis (IDD) in infants assigned to three different brands of wipe, all marketed as suitable for neonates, but which contained varying numbers of ingredients. METHODS: Women were recruited during the prenatal period. Participants were randomly assigned to receive one of three brands of wipe for use during the first eight weeks following childbirth. All participants received the same nappies. Participants reported their infant's skin integrity on a scale of 1-5 daily using a bespoke smartphone application. Analysis of effect of brand on clinically significant IDD (score 3 or more) incidence was conducted using a negative binomial generalised linear model, controlling for possible confounders at baseline. Analysts were blind to brand of wipe. RESULTS: Of 737 women enrolled, 15 were excluded (admitted to neonatal intensive care, premature or other infant health issues). Of the 722 eligible babies, 698 (97%) remained in the study for the full 8-week duration, 24.6% of whom had IDD at some point during the study. Mothers using the brand with the fewest ingredients reported fewer days of clinically significant nappy rash (score≥3) than participants using the two other brands (p = 0.002 and p < 0.001). Severe IDD (grades 4 and 5) was rare (2.4%). CONCLUSIONS: Rarity of severe IDD suggested that sensitive formula baby wipes are safe when used in cleansing babies from birth to eight weeks during nappy changes. The brand with fewest ingredients had significantly fewer days of clinically significant IDD. Daily observations recorded on a smartphone application proved to be a highly acceptable method of obtaining real-time data on IDD. CLINICAL TRIAL REGISTRATION: This study was not designed or registered as a clinical trial as no intervention in normal patterns of infant care took place. Mothers who had already decided to use disposable nappies and a baby wipe product agreed to observe and report on their infants' skin condition; in return they received a 9-week supply of free nappies and wipes.

Implementation of a Blood Conservation Initiative to Effectively Reduce Blood Transfusions in Cardiac Surgery Patients.

Perioperative and postoperative blood transfusions in cardiac surgery patients are associated with as much as a 16% increased risk of mortality and a significantly increased risk in morbid outcomes. At the project site, red blood cell transfusions in cardiac surgery patients undergoing isolated coronary artery bypass graft were above national benchmarks. The aim of the project was to reduce blood transfusions in cardiac surgery patients by 10% over 8 weeks. Primary interventions included engagement for the team and use of a shared decision-making tool for patients. Use of the Any RBC Transfusion online risk calculator was implemented with initiation of anemia protocol orders, chart identification, and blood conservation coordinator referral. There was no decrease in the blood transfusion rate during project implementation. However, this project heightened blood conservation awareness among team members and clinical leaders, brought attention to the need for evidence-based practice, and stimulated conversation about change.

Use of acupuncture during labour.

Acupuncture is becoming widely recognised as an effective method of pain relief and is being increasingly integrated within the NHS, particularly for the treatment of tension-type headache, migraine and low back pain. Acupuncture during labour has been shown by a Cochrane review to reduce labour pain intensity, increase patient satisfaction and limit the use of pharmacological analgesia (Smith et al 2011) and epidural anaesthesia (Nesheim and Kinge 2006). It may therefore be particularly suited to labouring women who wish to avoid more invasive forms of pain relief. Furthermore, women receiving acupuncture in labour appear to experience additional benefits including shorter labours and reduced rates of instrumental vaginal birth (Smith et al 2011). In the UK, intrapartum acupuncture is usually provided by professional acupuncturists, but in countries such as Germany and Scandinavia it is widely given by midwives. A midwife-delivered acupuncture service appears to be a similarly feasible and cost-effective option in the UK and is currently being piloted at University College London Hospitals NHS Trust.

Getting needled!

Anxiety and stress in pregnancy can become severe and disabling, negatively impacting on both the short and long term outcomes for mother and baby. Women often seek alternative treatments for such problems, acupuncture being a popular choice. It has been shown to have an effect on the limbic system and on serotonin production, leading to increased feelings of wellbeing. Women having acupuncture in pregnancy have reported increased self esteem and control of symptoms, leading to improved wellbeing. With appropriate training, midwives may be in a good position to offer acupuncture to support women suffering with anxiety, improving outcomes for women and babies.

Application of the team objective structured clinical encounter (TOSCE) for continuing professional development amongst postgraduate health professionals.

Educators in healthcare face significant challenges trying to improve interprofessional teamworking skills, with a lack of clarity on how to teach and evaluate such skills. Previously, the team objective structured clinical encounter (TOSCE) has been reported as a teaching and assessment tool, but it has been used primarily in homogenous groups of undergraduates. An interprofessional team of educators set out to evaluate the TOSCE as a teaching intervention amongst a large interprofessional group of postgraduate nurses and midwives. After the TOSCE, 83% of participants reported that they were more aware of potential weaknesses in teamworking and 60% felt more able to work in a team. Mean Likert scale ratings were 4/5 for usefulness, enjoyment and relevance. The TOSCE is a feasible tool for teamwork skill assessment in the demanding postgraduate interprofessional setting and requires further investigation to ascertain its potential for formative and summative assessment of skills.

How complimentary can midwives be about acupuncture?

As midwives we strive to provide woman centred holist care and acupuncture fits this paradigm well. It creates an opportunity for a woman to gain control, an alternative to the medical solutions. Studies on neurophysiology may explain why acupuncture has a calming effect. Midwives and obstetricians are well placed to offer pregnant women acupuncture and although more research is needed, there is enough evidence to consider its development within maternity services as an option. This article provides evidence that acupuncture can be an effective treatment and should be a part of informed choice discussions for conditions related to pregnancy.

All change! Supervision in action.

Making it Better' (MiB) is a programme of reorganisation of future women and children's services in Greater Manchester (Children and Young People's Network (CYPN) 2011). The challenge for midwifery supervision is to maintain the safety and quality of services whilst managing the emotional needs of those involved. A consultation with midwives revealed they wanted an opportunity away from the clinical area to create a positive way forward. A study day was developed entitled 'Midwives building a future within reconfiguration'. Midwives shared their experiences and plans for the future, strengthening their resolve to continue being the advocates for women and the profession.

The 'breathe' model of smoking cessation.

I challenge you to look beyond this abstract. Read the main text to discover how the use of a framework or tool to explore a study reveals so much more. The 'Breathe' study findings at first glance support the use of the 'Breathe' model of smoking cessation, yet on critiquing, using appropriate evaluation tools, this conclusion is questionable. The purpose was to measure the effectiveness of identifying pregnant smokers at booking using carbon monoxide testing and self reporting, to see if this increased the numbers engaging with specialist services and quitting for a month. The study raises many issues in relation to the identification of smokers and its impact on both engagement and cessation. It is limited by a lack of clear outcomes and dependence on an established data system. Inclusion of qualitative elements regarding women and staff views would have added depth, making it more applicable to wider service development.