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Showing content with the highest reputation since 02/23/2017 in all areas

  1. 3 points
    This is very true. Also, keep in mind that rude criticism by senior MDs to junior staff during rounds has pretty much the same effect in impairing team performance.
  2. 2 points
    I have written about respectful communication before in Kill them with kindness. The importance of collaborating in a respectful manner cannot be overemphasized, as a calm and well prepared team can handle just about anything thrown their way. This past week I finally had the opportunity to take the 7th ed NRP instructor course. What struck me most about the new version of the course was not the approach to the actual resuscitation but the preparation that was emphasized before you even start! It only takes 30 seconds to establish who is doing what in a resuscitation and while it would seem logical to divide up the roles each will take on it is something that has not been consistently done (at least in our institution). When a baby is born and responds to PPV quickly, this may not seem that important but in a situation where a team is performing chest compressions, placing an emergency UVC and moving on to epinephrine administration it certainly is nice to know in advance who is doing what. The Golden Hour We and many other centres have adopted this approach to resuscitation and at least here developed a checklist to ensure that everyone is prepared for a high risk delivery. While teams may think they have all the bases covered, when heart rates are racing it may surprise you to see how many times crucial bits of information or planning is missed. As I told you in another post I will be releasing a series of videos that I hope others will find useful. The video in this case is of a team readying itself for the delivery of a preterm infant that they anticipate will have respiratory distress. Ask yourself as you watch the film whether your team is preparing to this degree or not. Preparing in such a fashion certainly reduces the risk of errors caused by assumptions about who is doing what or what risk factors are present. As you can tell I am a big fan of simulation in helping to create high functioning teams! More of these videos can be accessed on my Youtube channel at All Things Neonatal YouTube To receive regular updates as new videos are added feel free to subscribe! Lastly a big thank you to NS, RH and GS without whom none of this would have been possible!
  3. 2 points
    Work becomes more difficult.. https://www.nytimes.com/2017/02/27/well/family/what-happens-when-parents-are-rude-in-the-hospital.html
  4. 2 points
    Can you please post a typical milk analysis report ? And the fortification technique? Pl share the brand names if possible thanks dr.r.selvan
  5. 1 point
    What we do here is open the cord as well, but we tied it with no 1 or 2 silk (which is kind of rough, so it would not move). Without any stitches, just tied it firmly it.. We made flags to stick and stitch the silks, without bridge.. Just a small tape to fix it at abdominal wall.. It works all along.. [emoji4]
  6. 1 point
    I agree that rudness will affect our mood and expectations but this should not affect our performance . We are human beings but we are dealing with death and life .Maintaing professional behaviour at any circumstances is difficult but possoble
  7. 1 point
    Thanks a lot for the very valuable effort and every day practice problems. I think how much is the bicarbonate and how much is the bicarbonate deficit will give a clue for the prognosis and outcome more than the pH . What is ur opinion regarding this
  8. 1 point
    Dear Stefan, Wonderful study. Did you also measure lactate levels? Khalid
  9. 1 point
  10. 1 point
    We would like to share the following survey about what you think is preferred probiotics for preterm infants. The survey is part of a Master Project for two students at the Copenhagen Business School. We are two Master students from Copenhagen Business School about to finalize our Master Project. Together with the non-profit organization Neobiomics, we are investigating what would be an optimal probiotics product for preterm infants. Why do we need your help? We desire to develop a probiotic product for preterm infants that are customized with preferred features of your input. Your expertise is therefore very essential to our project. This project is only usable if it includes a large number of responders. We want to accommodate your preferences and therefore we ask you to complete an online questionnaire. The questionnaire can only be answer by pediatric or neonatal doctors. Please click on the following link to get access to the survey: http://www.questionpro.com/t/AMzdSZYVzk
  11. 1 point
    @livesynapse I could not agree more about "within-team rudeness" - it is very contra-productive. Maybe you were thinking of this publication (?): http://pediatrics.aappublications.org/content/136/3/487 (I cut and paste from the abstract below)
  12. 1 point
    @Andrej Vitushka Actually, we firsts included also elective CS in the "normal reference group" to get more statistical power in the analyses. However, the reviewers thought differentely and we skipped those. I don't have exact data in my head but elective CS had sign higher pH than normal vag delivery, but it was really on the 2nd decimal.
  13. 1 point
    Rather excited this week as Biomed Central picked up a blog post that I wrote on social media. The post is found here. It is based though on a larger version that I have included below and really delves into the impact of social media and how one uses it. A big thank you to Kristy Wittmeier for all of her help in writing the post. Original Piece I read with great interest the article by Campbell et al entitled Social media use by physicians: a qualitative study of the new frontier of medicine. The study interviewed 17 physician users of social media of which only one writer of a blog responded, but then declined to participate. The four themes that emerged of Rugged Individualism, Uncertainty, Social Media as Media and Time Constraints certainly resonate with me as a blogger who also happens to be a Pediatrician but more specifically a Neonatologist. The first theme truly resonates with me as I think back over the journey that has taken me to where I am now. We in the medical social media world are certainly learning as we go. Without clear paths drawn for us we explore and contemplate how we will make a positive difference far beyond the reach of the typical physician in a clinic, hospital or local community. The commentary that follows explores the journey that I have taken with social media; engaging in largely unpaid work to bring information to others using these forums. My own story as a Neonatal Blogger began in 2015 when my Minecraft-obsessed son asked me to help him start a blog about Minecraft. Two very poorly read posts started my foray into blogging using WordPress as my blogging forum. Around the same time, our family acquired a puppy and despite our best efforts over the next 18 months this new addition woke me between 4 – 5 AM daily. After being awoken one morning at 4 AM I read an article on NICU size as it relates to outcomes and had a marked reaction to the conclusions of the paper. On a whim on this early February morning, I chose to set up my own blog site, and All Things Neonatal was born. I would like to say that there was a master plan at the inception but it was due to a visceral reaction to a paper perhaps enhanced by irritability and fatigue that led to me choosing to put my thoughts out there. And I was hooked. A year and a half later, I have produced a total of 139 publications on the site. Knowing the benefit that I have received, and hopefully also imparted by engaging in social media as a healthcare professional has sparked my interest in encouraging others to consider doing the same. And for those interested in going beyond considering to doing, I would like to share some key learnings from my journey to inform yours. To establish yourself in the realm of social media you need to utilize more than one platform, obtain your content in a time efficient manner and do not let your voice stay silent for too long. Harnessing the combined power of multiple social media sites When you begin blogging you come to realize that the method has its limitations in terms of reach. As the paper suggests, the polling of social media users identifies multiple potential websites for both collecting and disseminating information (Facebook, Twitter, Tumblr, Linkedin, Google+ as examples). Using them in combination can far enhance your reach. At the time of this writing the number of people who “follow” me on each site is quite disparate with Facebook by far leading the way in distribution power. Table 1 – Variance in impact of commonly used social media websites Site Number of Followers Facebook 11859 Twitter 921 WordPress (my primary blogging platform) 393 Also in the article, concern is raised over the lack of feedback for social media users as it pertains to to data on interaction with their postings. With Facebook one cannot determine what was done with your post but on twitterthere is some further delineation as one receives a tally of impressions, engagements and link clicks. When it comes to real metrics though, this is where the actual blogging site provides more useful data. I recommend embracing metrics, not only to understand your reach but perhaps just as importantly to give you the drive to continue your writings. My most popular post, has received 5117 reads, meaning that this many took the time to open my blog post to hear what I had to say on the subject. If you were to share your thoughts on an article with colleagues via email, post a new guideline in an office or clinic or publish an article in a journal, how many people would actually see it? The same information, if cited in a blog post and shared through Facebook can see a dramatic rise in exposure, along with your interpretation of the work. The aforementioned post for example has had a reach on Facebook of 50934 people to date and was shared 58 times multiplying the distribution many fold. If you published a journal article and were notified of such circulation I suspect you would be jubilant. How to obtain content? One of the greatest benefits to my own practice has been the necessity of using a wide net to capture potentially interesting content for my readers. This habit facilitates the necessary practice of continuous learning through collecting articles from such sources as weekly automated pubmed searches, and various Child Health news websites. With time as your audience builds, postings on your own sites, tags on Facebook or mentions on Twitter draw your attention to content which your followers believe may be of interest to you. Remember in most circumstances you are not being paid for these efforts and in between managing the rest of your workday and balancing the demands of a personal life this aspect of your life needs to be done in a very time efficient manner. Do Not Let Your Voice Stay Silent For Too Long If you want people to pay attention to what you are adding to the pool of knowledge, deposits must occur frequently. Your followers are far more likely to mention you on various social media sites if they know you are likely to see and occasionally respond to their posts. Without such a presence, the mentions, likes and shares slow, as will your growth and relevance in the social media world. Future research should determine what the optimal frequency of posts to maximize reach would be. I have long suspected that excessive posting may have the effect of diluting the important messages while posting too infrequently means you may be quickly forgotten. Individuals must find the balance that works for them to keep their audience engaged while maintaining their motivation to continue the practice. What Really Motivates Those Who Participate in Social Media? I believe the motivation lies in the three qualities described by Malcolm Gladwell in his book The Tipping Point. He described three types of people that are needed for something to go from an idea to widespread adoption; connectors, mavens and salesmen. The doctors out there on social media likely have a little bit of all these characteristics. Gladwell said this about connectors; “They are people who “link us up with the world…people with a special gift for bringing the world together”. With respect to mavens he characterized them as having the ability to “start “word-of-mouth epidemics” due to their knowledge, social skills, and ability to communicate”. Lastly, salesmen in his view are “persuaders”. These three traits aptly describe those that have waded into this field. They must have the confidence to put their message out there with content that captures people’s attention and certainly have the goal of persuading people that it is worth considering what they have to say. The fundamental drive though comes from a place of harnessing these traits to help people. Whether writing original content or sharing what others have produced, the social media physician’s goal is generally pure and that is to share knowledge and generate discussion. For example, if you have a new strategy for reducing infection, the active social media physician would ask “why not share this with the world” rather than limit it to your institution or city. This frontier like field though does come with some caveats before you dip your feet into the collective pool of the various media sites. As opposed to the more traditional medium of peer reviewed publications there is no one to assess your content prior to its release. You are your own editor and therefore may miss the mark from time to time by missing a relevant publication that might influence your conclusions. You must be prepared for the good and the bad. One can easily appreciate the positive comments that often come but not all posts will be “home runs” and on some occasions the feedback (which will be public) may not be what you had hoped for. You must constantly reflect on your own potential biases yet strive to improve base of knowledge; adding more ‘signal’ than ‘noise’. Respect for patient confidentiality is paramount and within Canada and elsewhere. Organizations such as the Canadian Medical Association have set guidelines for conduct in this space that should be adhered to. [Ref 3] This new frontier for the Rugged Individualist is therefore not for the faint of heart. It does however bring the world closer together and provide one with a post-publication form of peer review. Once you enter into the fray it may surprise you how much information is in fact out there, that now flows to you through global connections. It is an evolving form of communication and one that I am happy to part of. In fact, I am a better neonatologist for it. Is it right for you?
  14. 1 point
    Not me personally but I know hospitals in SA that do neonatal surgery has used it to maintain temp in theatre.
  15. 1 point
    We also use plastic bag for babies in the incubator.. Not routinely, only when it temperature becomes unstable, it happens particularly in a single walled incubator.. Sent from my iPhone using Tapatalk
  16. 1 point
    Evidence-based protocols and reviews by the Cochrane Collaboration
  17. 1 point
    The infant car seat challenge(ICSC) is a test which most definitely fits the definition of a battleground issue in Neonatology. After publishing the Canadian Pediatric Practice point on the same topic I received interesting feedback through the various social media forums that I frequent. While some were celebrating the consensus of the statement as verification that a centres’ non practice of the test was acceptable, others seriously questioned the validity of the position. The naysayers would point out that extremely infrequent events unless intentionally tracked may be difficult to pick up. In the case of the ICSC, if a few patients were to suffer a hypoxic event leading to an ALTE or worse after discharge, could the ICSC have picked out these babies and prevented the outcome? The evidence for adverse events associated with the use of car seats as discussed in the position statement is poor when using autopsy records over decades but when many clinicians can point to a failed ICSC picking up events, the thought goes that they “caught one”. Does catching one make a difference though? The Well Appearing Infant Shah et al in their recent paper Clinical Outcomes Associated with a Failed Infant Car Seat Challenge attempt to address this very point. They performed a retrospective study of 148 patients who were either <37 weeks GA or < 2500g at birth. The study was made possible by the fact that all such infants in their hospital admitted to a well newborn area meeting these criteria by policy must have an ICSC prior to discharge. Keep in mind that these were all infants who were on the well newborn service since they were asymptomatic. The definition of an event in this group was one or more of pulse oximeter saturation ≤ 85% for > 10 seconds, apnea > 20 seconds, bradycardia < 80 bpm for > 10 seconds, or an apnea or bradycardia event requiring stimulation. The failure rate was 4.5% which is very similar to other reported studies. Why did they “fail”? Failure of the ICSC was owing to desaturation 59% Bradycardia 37% Tachypnea 4% Combination of 2 in 11% What is interesting about these results is what happened to these infants after admission to the NICU in that 39% were identified with apnea (48% in preterm vs 17% in term infants). These events were in the supine position which is a curious finding since the ICSC was designed to find risk of cardiorespiratory stability in a semi-recumbent position. This has been shown previously though. What does it all mean? The infants in this study ultimately had more NG feeding, prolonged length of stay and septic workups after failing the ICSC that comparable infants who passed. At first blush one would read this article and immediately question the validity of the CPS position but then the real question is what has this added to the “pool of knowledge”. That infants may fail an ICSC at a rate of 4.5% is already known. That such infants may demonstrate apneic events has also been shown before and a study like this may help to support those clinicians who feel it is still imperative to find these infants in order to achieve a safe discharge. I think it is important to put these findings in the context of what would have happened if such a unit did not routinely test these types of babies. As all were seemingly well and I presume feeding with their families, they would have been discharged after 24-48 hours to home. We have no evidence (since they have not compared this sample to a group who did not have such testing) that if these babies were discharged they would have faired poorly. The supporters of the ICSC would point to all the support these babies received by admitting them for 6-8 days, providing NG feeding and ruling out sepsis that they were unsafe for discharge. The other possible way to look at it was that the infants were subjected to interventions that we have no evidence helped them. Whether any of these infants had a positive blood culture justifying antibiotics or needed methylxanthine support is not mentioned. Judging however by the short length of stay I suspect that none or few of these infants needed such medication as I would expect they would have stayed much longer had they needed medical treatment for apnea. Conclusion I do commend the authors for completing the study and while it does raise some eyebrows, I don’t see it changing at least my position on the ICSC. While they have described a cohort of patients who failed the ICSC nicely, the fundamental question has been left unanswered. Does any of this matter? If you look well, are feeding well and free of any clinically recognizable events but are late preterm or IUGR can the ICSC prevent harm? This has not been answered here and perhaps the next step would be for a centre that has abandoned the ICSC to follow their patients after discharge prospectively and see whether any adverse outcomes do indeed occur. Any takers?
  18. 1 point
    To reduce the incidence of neonatal mortality and morbidity, Noninvasix is developing a patient monitor to directly, accurately, and noninvasively measure brain oxygenation in preterm and low birth weight babies in the NICU. Using optoacoustics, Noninvasix’s system pulses laser light into the brain to directly measure the amount of oxygen the baby is receiving in real time. Noninvasix Technology Video Noninvasix Pitch 16x9 20161027.pdf
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