BACKGROUND:Weight monitoring as part of heart failure (HF) self-care enables timely intervention to prevent hospitalizations. Apps with prompts may improve adherence to monitoring and earlier help-seeking behavior compared with paper logbooks. OBJECTIVE:This study aimed to evaluate the effectiveness of the Fluid Heart Tracker App compared with a paper logbook for weight monitoring in patients with HF, focusing on monitoring adherence, help-seeking behavior, and hospitalization. METHODS:A quasi-experimental, multicenter study was conducted in 2 consecutive 12-month phases, guided by the Situation-Specific Theory of HF Self-Care. A logbook was used initially (phase 1), followed by the Fluid Heart Tracker App (phase 2). Of 184 participants, 136 completed both phases. Analyses compared adherence, help-seeking behavior, and hospitalization outcomes between both phases. RESULTS:App adherence was higher (median: 346.5 days, interquartile range [IQR] = 299-360) than logbook use (median: 315 days, IQR = 36-365; P < .001). Help-seeking behavior increased from 43.4% in phase 1 to 73.5% in phase 2 ( P = .031), while the longest delay reduced from 14 to 2 days ( P < .001). Males were more likely to initiate app use ( P = .046); age was not a barrier ( P = .668). Hospitalization rates according to app use frequency did not differ ( P = .384). Declines were observed in the number of participants hospitalized ( P = .0066) and the number of episodes ( P = .0035). CONCLUSIONS:These results support integrating simple, alert-enabled apps such as the Fluid Heart Tracker into HF programs to strengthen self-care and reduce preventable admissions.

BACKGROUND:Cardiometabolic multimorbidity (CMM), the coexistence of two or more cardiometabolic diseases (CMDs), is increasingly recognized as a key risk factor for cognitive decline and dementia in older adults. Healthy lifestyle behaviors may mitigate these effects, but this remains poorly understood. Given the rising prevalence of CMM worldwide and the urgent need for effective dementia prevention strategies, a systematic review and meta-analysis are warranted to investigate whether and to what extent a healthier lifestyle can mitigate this risk. METHODS:A comprehensive search of Embase, Medline, PsycINFO, CINAHL, Web of Science, and Scopus will be conducted to identify longitudinal observational studies reporting incident adverse cognitive outcomes in older adults with CMM, while also exploring the influence of lifestyle factors on such outcomes. Grey literature will be included, and no language or date restrictions will be applied. Retrieved records will be managed in Covidence, with two independent reviewers conducting all review processes. Data will be extracted using a predesigned extraction form. The ROBINS-E tool will be used to assess the risk of bias, and the GRADE approach will evaluate the certainty of evidence. If sufficient homogeneous data are available, a meta-analysis will be conducted; otherwise, findings will be narratively synthesized. DISCUSSION:This systematic review and meta-analysis will provide comprehensive insights into the extent to which a healthier lifestyle may mitigate cognitive decline associated with CMM. The findings may inform future intervention designs to promote healthy aging and reduce the risk of cognitive impairment among individuals with CMM. PROSPERO REGISTRATION:Prospero registration ID: CRD420251000046. Registered on 26th February 2025.

To explore the effectiveness of heart failure-designated applications (‘apps’), with embedded alerts, on patient engagement with daily weight monitoring, help-seeking behaviour, and hospitalisation. A systematic search of nine databases identified three studies (two randomised controlled trials, one prospective study) evaluating three apps. As help-seeking and weight monitoring were not directly measured, patient-reported self-care behaviour was used as a proxy. A meta-analysis was not possible owing to study heterogeneity. The two randomised controlled trials reported high app engagement rates, supporting feasibility in heart failure populations. All studies reported significant improvements in self-care (P≤0.05). One randomised controlled trial also reported a significant reduction in hospital bed days (P<0.05), though not in admissions. The prospective study observed a low hospitalisation rate of 3%. Apps with embedded alerts to enhance heart failure self-care show promise. However, their impact on prompting help-seeking and weight-monitoring engagement requires direct evaluation.

Heart failure (HF) is frequently linked to hospitalisations due to fluid retention, and regular weight monitoring is essential for early detection and timely intervention. Delays in help-seeking often worsen outcomes. The Fluid Heart Tracker App provides a simple, automated tool for proactive, independent weight monitoring. It tracks weight over a 7-day period and alerts patients to significant weight gains, prompting medical consultation. If the weight is within acceptable values, no alert indicates that the weight is stable, and the patient should continue daily weight monitoring (fig 1). Aim and Objectives: We evaluated the effectiveness of this app in promoting help-seeking behaviour and its impact on hospitalisation compared to the standard paper logbook. This ethically approved quasi-experimental, multicentre study recruited 184 participants (NYHA II-III) across 12 sites. The paper logbook was initially used for weight monitoring, followed by the Fluid Heart Tracker App over two consecutive 12-month phases. The outcomes assessed were help-seeking behaviour and hospitalisation rates. Wilcoxon signed-rank and Kruskal-Wallis tests were employed in the data analysis. Complete data were available for 136 participants (mean age 66, SD 11.3 years; 72.8% male). Help-seeking behaviour improved significantly, with 73.5% of app users seeking timely intervention compared to 43.4% during the logbook phase (p = 0.031). Additionally, 28.6% of the participants sought care on the same day of weight gain during logbook phase, compared to 86.1% during the App phase. The delay in seeking help was reduced from 5 days (mean: 3.21 days, SD: 3.641 days) with the logbook to 2 days (mean: 0.12 days, SD: 0.42 days) with the app (p = 0.031). While hospitalisation rates did not show a significant difference, there was a non-significant reduction of 2.96 days in the mean length of stay following App use (p = 0.20). The Fluid Heart Tracker app substantially improves proactive, independent help-seeking behaviour among patients with HF. The results highlight the app’s potential to alleviate healthcare burdens and enhance patient outcomes.

OBJECTIVE:Assess the relationship of time to first expression after very preterm birth and mothers' own milk quantity. DESIGN:A cohort study (nested within a randomised trial). SETTING:Four neonatal units in the UK. PATIENTS:132 mothers of single or twin infants born at 23+0 to 31+6 weeks postmenstrual age. EXPOSURES:Time to the first attempt to express after birth. PRIMARY OUTCOMES:24-hour mother's own milk yield on days 4, 14 and 21 after birth. RESULTS:Median time to first expression attempt was 6 hours. 51.7% expressed within 6 hours of birth (62/120) and 48.3% expressed more than 6 hours after birth (58/120). Expressing within 6 hours of birth was associated with higher milk yield on day 4 (88.3 g, 95% CI 7.1 to 169.4) and day 14 (155.7 g, 95% CI 12.2 to 299.3) but not on day 21 (73.6 g, 95% CI -91.4 to 238.7). There was an interaction between expressing frequency and time to first expression (p<0.005), with increased expressing frequency being associated with higher yield only in those who expressed within 6 hours. Expressing within 2 hours of birth was not associated with further milk yield increase. CONCLUSIONS:Mothers who expressed within 6 hours of birth had higher milk yield, and a greater yield per expressing session, in the first 3 weeks after birth. This information will be highly motivating for families and the clinicians supporting them. There was no evidence of further benefit of extremely early expression (first 2 hours after birth). TRIAL REGISTRATION NUMBER:ISRCTN 16356650.

BACKGROUND:Arterial stiffness has been associated with an increased risk of cardiovascular disease (CVD) in some patient populations. OBJECTIVES:The aims of this study were to investigate (1) whether there is an association between arterial stiffness, as measured by the Mobil-O-Graph, and risk for CVD in a population of individuals with intellectual disability and (2) whether arterial stiffness can predict the risk for CVD. METHODS:This cross-sectional study included 58 individuals who participated in wave 4 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Aging (2019-2020). Statistical models were used to address the first aim, whereas machine learning models were used to improve the accuracy of risk predictions in the second aim. RESULTS:Sample characteristics were mean (SD) age of 60.69 (10.48) years, women (62.1%), mild/moderate level of intellectual disability (91.4%), living in community group homes (53.4%), overweight/obese (84.5%), high cholesterol (46.6%), alcohol consumption (48.3%), hypertension (25.9%), diabetes (17.24%), and smokers (3.4%). Mean (SD) pulse wave velocity (arterial stiffness measured by Mobil-O-Graph) was 8.776 (1.6) m/s. Cardiovascular disease risk categories, calculated using SCORE2, were low-to-moderate risk (44.8%), high risk (46.6%), and very high risk (8.6%). Using proportional odds logistic regression, significant associations were found between arterial stiffness, diabetes diagnosis, and CVD risk SCORE2 ( P < .001). We also found the Mobil-O-Graph can predict risk of CVD, with prediction accuracy of the proportional odds logistic regression model approximately 60.12% (SE, 3.2%). Machine learning models, k -nearest neighbor, and random forest improved model predictions over and above proportional odds logistic regression at 75.85% and 77.7%, respectively. CONCLUSIONS:Arterial stiffness, as measured by the noninvasive Mobil-O-Graph, can be used to predict risk of CVD in individuals with intellectual disabilities.

Importance Human milk feeding is a key public health goal to optimize infant and maternal/parental health, but global lactation outcomes do not meet recommended duration and exclusivity. There are connections between lactation and mental health. Objective To appraise all available evidence on whether the provision of relaxation interventions to lactating individuals improves lactation and well-being. Data Sources Embase, MEDLINE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and the Cochrane Library were searched on September 30, 2023, and topic experts were consulted. Study Selection Two independent reviewers screened for eligibility. Inclusion criteria were full-text, peer-reviewed publications with a randomized clinical trial design. Techniques that were entirely physical (eg, massage) were excluded. A total of 7% of initially identified studies met selection criteria. Data Extraction and Synthesis Two independent reviewers extracted data and assessed risk of bias with the Cochrane Risk of Bias 2 tool. Fixed-effects meta-analysis and Grading of Recommendations, Assessment, Development, and Evaluations guidelines were used to synthesize and present evidence. Main Outcomes and Measures Prespecified primary outcomes were human milk quantity, length and exclusivity of human milk feeding, milk macronutrients/cortisol, and infant growth and behavior. Results A total of 16 studies were included with 1871 participants (pooled mean [SD] age for 1656 participants, 29.6 [6.1] years). Interventions were music, guided relaxation, mindfulness, and breathing exercises/muscle relaxation. Provision of relaxation was not associated with a change in human milk protein (mean difference [MD], 0 g/100 mL; 95% CI, 0; 205 participants). Provision of relaxation was associated with an increase in human milk quantity (standardized mean difference [SMD], 0.73; 95% CI, 0.57-0.89; 464 participants), increased infant weight gain in breastfeeding infants (MD, z score change = 0.51; 95% CI, 0.30-0.72; 226 participants), and a slight reduction in stress and anxiety (SMD stress score, −0.49; 95% CI, −0.70 to −0.27; 355 participants; SMD anxiety score, −0.45; 95% CI, −0.67 to −0.22; 410 participants). Conclusions and Relevance Results of this systematic review and meta-analysis suggest that provision of relaxation was associated with an increase in human milk quantity and infant weight gain and a slight reduction in stress and anxiety. Relaxation interventions can be offered to lactating parents who would like to increase well-being and improve milk supply or, where directly breastfeeding, increase infant weight gain.

Aim: The aim of this study was to examine Newly Qualified General Nurses' (NQGNs’) experiences of and the value of the internship period. Background: Internship was introduced as the final part of the undergraduate nursing degree in Ireland in 2002. The aim was to provide students with clinical experience, whereby they work more independently and in doing so, seamlessly progress their transition to the role of registered nurse. Design: A cross-sectional, quantitative, descriptive study. Setting and Participants: Newly Qualified General Nurses who completed their undergraduate degree in general nursing and graduated from Higher Education Institutions (HEIs) in the Republic of Ireland between 2018 and 2020 were eligible for inclusion in the study. Methods: Participants were recruited using snowball sampling. Data were collected anonymously using the electronic Experience of Internship Questionnaire. Analysis was undertaken using the Statistical Package for Social Sciences (SPSS 27). Results: Pre-internship preparation experiences differed across hospitals. The NQGNs would have preferred more support with their caseloads and help with understanding the rationale for care delivery. However, internship provided good opportunities to link theory to practice and was considered valuable by most in preparing them for practicing as a registered nurse. Conclusion: Internship assists intern nursing students to link theory to practice. Further, support in internship is crucial when managing a caseload and to enhance understanding of the care provided. The value of internship was identified with suggestions on ways to strengthen the experience of internship.

Many babies cared for on a neonatal unit are at risk of adverse neurodevelopmental outcomes. The aim of early intervention (EI), therefore, is to support a child and their family to achieve the best outcome possible. Notably, EI is not one specific thing. The term encompasses a wide range of approaches and interventions that can vary in a number of ways, including who undertakes them, where they happen and when they start. There is debate as to the most effective approach, but the evidence supports the implementation of EI from soon after birth, continuing post-discharge. Furthermore, involving the parents in EI is critical, not only to ensure sustained effects throughout childhood, but also because of the beneficial impact on parental wellbeing. All in all, the evidence shows improved neurodevelopmental outcomes for children exposed to EI, particularly in the short-term. This review will explore what EI means in practice, considering the variations in application, as well as the evidence of benefit. It will also consider the limitations of current research.

AbstractWhen infants cannot directly breastfeed after birth, mothers are advised to initiate lactation through mechanical expression. Families are recommended to target an expression volume of at least 500–750 mL by Day 14 after birth, as this is considered a ‘critical window’ to establish milk supply. This is challenging for many mothers after a very preterm birth. This article explores the relationship of early milk quantity and later full breastmilk feeding as a ‘gold standard’ outcome, using statistical techniques designed for diagnostic tests. A cohort of 132 mothers of infants born at 23 + 0 to 31 + 6 weeks' gestational age submitted expressing logs on Day 4, 14 and 21 after birth and provided later feeding outcome. Using receiver operating characteristic (ROC) analysis, the following 24‐h milk quantities were identified as associated with high probability of full breastmilk at 36 weeks' post‐menstrual age (PMA): on Day 4, ≥250 g (specificity 88%; positive predictive value 88%) and on Day 21 ≥650 g (specificity 88%; positive predictive value 91%). The following values were identified as associated with low probability of full breastmilk at 36 weeks' PMA: on Day 4 <50 g (sensitivity 92%; negative predictive value 72%) and on Day 21 <250 g (sensitivity 90%; negative predictive value 70%). Participants exceeding the high thresholds had 3–4 times increased likelihood of full breastmilk, whereas those below the low thresholds had 3–5 times lower likelihood. These thresholds have potential as targets for families, to provide individualised prognostic information and to help clinicians target more intensive lactation support.

Background/Aims There have been calls to make rehabilitation programmes more accessible to patients with peripheral arterial disease. This study aimed to evaluate the effectiveness of a standalone peripheral arterial disease rehabilitation programme on walking outcomes, quality of life and cardiovascular risk factors as primary outcomes. Secondary outcomes relating to the characteristics that may have influenced change in walking outcomes and reasons for non-attendance or non-completion were also explored. Methods In this prospective, observational, one-site study, new patients were offered a 10-week programme, consisting of exercise, education and intervention for uncontrolled cardiovascular risk factors, in line with international peripheral arterial disease guidelines. Claudication times were measured using the Gardner-Skinner protocol and quality of life was measured using VascuQol. Pre- and post-intervention data were analysed using the SPSS version 23, with Pearson's Rho, Spearman's Rho and t tests being performed as appropriate. Statistical significance was set at P<0.05. Results Of the 160 referrals received, 114 patients were enrolled in the programme and 89 (78%) completed it. Reasons for non-completion were mainly either logistical (domestic commitments or return to work) or perceptions of insuitability relating to age, infirmity or severity of peripheral arterial disease. Of those who completed the programme, the median age was 66 years, 81% were men, 71% had a history of hypertension, 25% had diabetes and 37% smoked. There were significant pre–post improvements (P<0.05) in initial and maximum claudication time and distance, systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein and quality of life scores. Improvements in maximum claudication times were associated with lower baseline initial claudication times, lower body mass index, some quality of life scores and male gender. Conclusions The peripheral arterial disease rehabilitation programme was effective in improving functional capacity, quality of life and some cardiovascular risk factors. Factors found to influence improvements in claudication times could be discussed with patients before and during the programme to address misperceptions, provide encouragement and improve compliance and recruitment. The safe environment of supervised exercise may have contributed to these results, prompting efforts to make exercise accessible to all patients with peripheral arterial disease.

INTRODUCTION:Mothers of very premature infants often have difficulties expressing breastmilk, which can cause distress and potential negative impact on infant health. Clinical recommendations on breastmilk expression are extrapolated from term infants' breastfeeding patterns. This study's objective was to analyse the association of expressing pattern with lactation outcomes after very premature birth. METHODS:132 participants were recruited after birth between 23+0 and 31+6 weeks' gestation. Participants recorded the milk expressed in several 24-hour periods in the three weeks after birth. RESULTS:Expressing frequency was positively associated with 24-hour milk yield, with an adjusted 30.5g increase per expressing session on day four (95% CI 15.7 to 45.3) and 94.4g on day 21 (95% CI 62.7 to 126.2). Expressing ≥8 times per day was associated with higher adjusted milk yield than expressing <6 times (on day four, 146.8g, 95% CI 47.4 to 246.1), but not in comparison to expressing 6-7 times (on day four, 82.1g, 95% CI -25.9 to 190.1). Participants with six months or more prior breastmilk feeding experience had a higher adjusted milk yield than others (on day four, 204.3g, 95% CI 125.2 to 283.3). Night-time (2300-0700 hours) expressing sessions were not associated with increased milk yield after adjustment for time since the prior session. On average, participants who had a longest gap between expressions of less than six hours achieved the UK target of 750g breastmilk, whereas those with a longer gap did not. CONCLUSION:Expressing frequency was an important determinant of milk yield. Clinical recommendations to express ≥8 times per day were supported but for some, 6-7 times was sufficient. This was particularly likely for those with six months or more of prior breastmilk feeding experience. A need to express during the night-time hours appeared to be related to minimising the gap between expressions rather than an inherent value of night-time expression.

Importance Human milk feeding is a key public health goal to optimize infant and maternal/parental health, but global lactation outcomes do not meet recommended duration and exclusivity. There are connections between lactation and mental health. Objective To appraise all available evidence on whether the provision of relaxation interventions to lactating individuals improves lactation and well-being. Data Sources Embase, MEDLINE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and the Cochrane Library were searched on September 30, 2023, and topic experts were consulted. Study SelectionTwo independent reviewers screened for eligibility. Inclusion criteria were full-text, peer-reviewed publications with a randomized clinical trial design. Techniques that were entirely physical (eg, massage) were excluded. A total of 7% of initially identified studies met selection criteria. Data Extraction and SynthesisTwo independent reviewers extracted data and assessed risk of bias with the Cochrane Risk of Bias 2 tool. Fixed-effects meta-analysis and Grading of Recommendations, Assessment, Development, and Evaluations guidelines were used to synthesize and present evidence. Main Outcomes and MeasuresPrespecified primary outcomes were human milk quantity, length and exclusivity of human milk feeding, milk macronutrients/cortisol, and infant growth and behavior. Results A total of 16 studies were included with 1871 participants (pooled mean [SD] age for 1656 participants, 29.6 [6.1] years). Interventions were music, guided relaxation, mindfulness, and breathing exercises/muscle relaxation. Provision of relaxation was not associated with a change in human milk protein (mean difference [MD], 0 g/100 mL; 95% CI, 0; 205 participants). Provision of relaxation was associated with an increase in human milk quantity (standardized mean difference [SMD], 0.73; 95% CI, 0.57-0.89; 464 participants), increased infant weight gain in breastfeeding infants (MD, z score change = 0.51; 95% CI, 0.30-0.72; 226 participants), and a slight reduction in stress and anxiety (SMD stress score, -0.49; 95% CI, -0.70 to -0.27; 355 participants; SMD anxiety score, -0.45; 95% CI, -0.67 to -0.22; 410 participants). Conclusions and Relevance Results of this systematic review and meta-analysis suggest that provision of relaxation was associated with an increase in human milk quantity and infant weight gain and a slight reduction in stress and anxiety. Relaxation interventions can be offered to lactating parents who would like to increase well-being and improve milk supply or, where directly breastfeeding, increase infant weight gain.

BACKGROUND:Mothers of very premature newborns often have low milk supply. Systematic review has shown increased milk quantity with relaxation interventions. We hypothesised that a self-directed audio relaxation and lactation-specific visualisation would increase milk quantity after a very premature birth. METHODS:Unmasked, randomised, controlled trial, recruiting 132 participants in four United Kingdom neonatal units. Eligible women had given birth to one or two infants between 23+0 and 31+6 weeks of gestation. The intervention was a 12-min voice recording including breathing exercises, muscle relaxation and lactation-specific visualisation. Primary outcome was the highest 24-h breastmilk weight expressed on any of day 4, day 14 or day 21 after birth. RESULTS:Mean birth gestation was 27.8 weeks (SD 2.4), with 26% of participants giving birth under 26 weeks (34/132). Adjusted mean difference in primary outcome was 73.9 g (95% CI -61.7 to 209.5, p = 0.28). Spielberger State-Trait Anxiety Index adjusted mean difference was -1.9 (-8.2 to 4.3, p = 0.54). The majority of relaxation group participants felt the intervention was relaxing (32/42, 76%). CONCLUSIONS:There was no beneficial effect of this relaxation intervention on milk quantity. Mothers of very premature infants may value relaxation interventions but they are unlikely to have a large effect on milk quantity. IMPACT:This randomised trial did not show a beneficial effect of a self-directed audio relaxation and visualisation on mothers' own milk quantity expressed after very preterm birth. Mothers of very and extremely preterm infants may value relaxation interventions, but they are unlikely to have a large effect on milk quantity. Prior systematic review of mixed populations has shown an increase in mothers' own milk quantity with relaxation interventions. Combining this study with existing meta-analysis could result in a new hypothesis that the lower the gestation at birth, the smaller the impact of relaxation on milk quantity.

Objectives Most studies of neurodevelopmental follow-up (NFU) for children born preterm in the UK describe outcomes or compliance with services; few studies describe the spectrum of NFU practice. The aim of our study was to identify the range of NFU services in the UK so as to determine the potential for improving the care of children born preterm. Methods Two surveys were conducted across all neonatal units in the UK. In the first survey (April to August 2019), we asked neonatal leads to involve their units and specifically the staff who deliver NFU services. In the second survey (May to November 2021), we targeted neonatal consultants to validate and expand on the responses of the first survey. The consultants were accessed via a national database, the BAPM newsletter and phone calls. The surveys were run on Qualtrics and Survey Monkey. No ethical approval was required for a service improvement project. Results Table 1 is a summary of the survey items assessed. Conclusions Most of the neonatal units that participated in this study offer NFU to high-risk infants in keeping with the NICE guidelines. Key practices that could be replicated in other settings include: having an NFU protocol; extending NFU to other at-risk infants, including MPT and LPT children; multiple-stage follow-up; allocating funding for NFU, and good referral linkages for those identified with impaired neurodevelopment. However, there are gaps in implementing the NICE guidelines and attaining universal coverage for high-risk infants, often because of staffing and financial barriers. Therefore, we recommend task-shifting some NFU activities to less specialised (costly) staff. Harmonising the plurality of NFU tools to ensure comparability of neurodevelopmental outcomes and standardising NFU practices are important for scaling up sustainable NFU services. Further studies involving more neonatal units are required to understand the extent to which the NICE guidelines are being implemented in the UK. References https://www.nice.org.uk/guidance/ng72 https://www.paediatricsandchildhealthjournal.co.uk/article/S1751-7222(22)00102-0/fulltext

Premature birth is the leading cause of neonatal death and can cause major morbidity. Maximising the amount of maternal breastmilk given to very premature infants is important to improve outcomes, but this can be challenging for parents. Parents of infants receiving neonatal care also have high rates of anxiety and distress. There is growing evidence for the impact of maternal relaxation interventions on lactation, as well as mental health. The trial will assess whether a brief self-directed relaxation and visualisation intervention, recommended for use several times a day during expression of milk, improves lactation and mental health outcomes for mothers of very premature infants. Multi-centre, randomised, controlled, unmasked, parallel-group trial with planned 132 participants who have experienced premature birth between 23 weeks and 31 weeks and 6 days of gestation and plan to express milk for at least 14 days. The primary outcome is the highest 24-h expressed milk yield recorded on any of day 4, day 14 or day 21 after birth. Secondary outcomes include exclusive breastmilk feeding at 36 weeks post-menstrual age and at 4 months after the estimated date of delivery, Spielberger State Trait Anxiety Index at day 21 and Post-traumatic stress Check List (for DSM 5) at day 21. Breastmilk feeding for premature infants is an important research priority, but there are few randomised controlled trials assessing interventions to help parents reach lactation goals in this challenging context. This trial will assess whether a no cost, easily scalable relaxation tool has a role in this setting. Given the lack of harm and potential for immediate dissemination, even a small benefit could have an important global impact. ISRCTN16356650 . Date assigned: 19/04/2021.

Objective: The objective of this scoping review is to map the available evidence on the assessment of workplace integration of migrant nurses and midwives in international health care settings. Introduction: Internationally, migrant nurses and midwives are an increasingly important resource in government strategy for addressing the current and predicted workforce shortages in health care. Much has been documented about the orientation stages of their transition to foreign workplaces but few sources have considered the workplace integration of this population. Inclusion criteria: The review will include all studies involving migrant nurses and midwives who are working outside their country of initial nurse or midwife registration for at least one year. The context will be all hospital, community, and residential care home settings, including the mental health, intellectual disability, and maternity care sectors. Methods: The JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used to conduct this review. The databases to be searched will include CINAHL, MEDLINE, Embase, CENTRAL, and Google Scholar. Gray literature will also be searched and a hand search will be conducted of sources that fall outside these database searches. Two reviewers will independently screen titles, abstracts, and full-text articles. The extracted data will be presented in a tabulated chart accompanied by a narrative summary that aligns with the objectives and scope of this review.

The purpose of this study was to examine the role of persistent symptoms of depression and anxiety in a second acute coronary syndrome (ACS) event. Data presented in this study were from an RCT study. A follow-up for 24 months after baseline to detect a second ACS event among 1162 patients from five hospitals. Hierarchal Cox regression analyses were used. The results showed that persistent depression only (HR 2.27; 95% CI: 1.35–3.81; p = 0.002), and comorbid persistent depression and anxiety (HR 2.03; 95% CI: 1.03–3.98; p = 0.040) were the significant predictors of a second ACS event. Secondary education level compared to primary educational level (HR 0.63; 95% CI: 0.43–0.93; p = 0.020) and college or more education level compared to primary educational level (HR 0.47; 95% CI: 0.27–0.84; p = 0.011) were the only demographic variables that were significant predictors of a second event. The study reveals that attention must be paid by healthcare providers to assess and manage persistent depression; particularly when it is co-morbid with anxiety.

BACKGROUND:Patient and Public Involvement (PPI) is a rich and valuable part of the process of planning, designing, carrying out and disseminating research. It is important to communicate PPI findings in detail so that the contributions of those involved are fully utilised and disseminated. The extended and iterative PPI process used within a neonatal randomised controlled trial related to the expression of breastmilk after very preterm birth is reported here.METHODS:Seven iterative stages of PPI were used. Stage 1 was informal PPI using historical interaction with parents and publicly available resources. Stage 2 was an online questionnaire open to parents of premature babies and advertised via a charity collaborator. Stage 3 was partnership with a charity collaborator. Stage 4 was a set of online panels focusing on study design and documents. Stage 5 was an interactive exercise to modify the trial intervention. Stage 6 is the presence of PPI contributors on the trial steering committee. Stage 7 is a dissemination panel. At each stage attention was paid to the diversity of participants involved, with strategies to increase the involvement of parents from under-reached groups.RESULTS:Six hundred and seventy-five participants responded at Stage 2, six parents were involved at Stage 4 and 12 parents at Stage 5. PPI contributed to the choice of study question, outcomes and produced a set of questions for future research. PPI impacted on the study design, with specific emphasis on reducing participant distress related to lactation, and reducing the burden of being involved in research at a time of significant stress.CONCLUSIONS:PPI had a far-reaching influence on this neonatal randomised controlled trial during the planning and design phase, which reinforces the importance of PPI at the earliest stages of the research cycle. The online questionnaire format elicited an unexpectedly deep and broad pool of transferable insights, which will have an impact on future research focus and design in the area of lactation and prematurity. Approaches to increasing PPI involvement from under-reached populations are important and can be successful despite resource constraints.

Background Parental involvement is a critical pillar in the provision of quality care for preterms, especially given their increased risk of compromised neurodevelopment.1 However, parental opinions, experiences and preferences regarding neurodevelopmental follow-up of preterms have hardly been studied or considered in healthcare planning. Objectives To understand what parents know about neurodevelopmental outcomes for children born preterm. To describe parents’ experiences, satisfaction and recommendations for neurodevelopmental follow-up of preterms. Methods METHODS Purposive sampling: parents of 2- to 3-year-old children who were born preterm. ⇓ Virtual in-depth interviews ⇓ Thematic content analysis2 The South Central – Hampshire B Research Ethics Committee approved the study (REC reference: 19/SC/0474). Results Emerging themes are shown in table 1 from 17 interviews of parents whose children were born at <32 weeks (n=5), 32 to <34 weeks (n=5) and 34 to <37 weeks’ gestation (n=7). Limitation: Potential recall bias of past experiences by parents. Conclusions Parent interviews have emphasised the need for policymakers and the neonatal care team to consider parents’ knowledge, experiences, satisfaction and preferences for preterm neurodevelopmental follow-up. References doi: 10.1016/j.clp.2018.05.001. PMID: 30144844 https://www.bmj.com/content/320/7227/114