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ImportanceVariation in attitudes between health care professionals involved in the counseling of parents facing extremely preterm birth (ObjectiveTo explore the attitudes of health care professionals involved in the counseling of parents facing preterm birth on the treatment of extremely preterm infants.Design, Setting, and ParticipantsThis qualitative study used Q methods to explore the attitudes of neonatal nurses, neonatologists, midwives, and obstetricians involved in the care of extremely preterm infants in 4 UK National Health Service perinatal centers between February 10, 2020, and April 30, 2021. Each participating center had a tertiary level neonatal unit and maternity center. Individuals volunteered participation through choosing to complete the study following a presentation by researchers at each center. A link to the online Q study was emailed to all potential participants by local principal investigators. Participants ranked 53 statements about the treatment of extremely preterm infants in an online quasi-normal distribution grid from strongly agree (6) to strongly disagree (−6).Main Outcomes and MeasuresDistinguishing factors per professional group (representing different attitudes) identified through by-person factor analysis of Q sort-data were the primary outcome. Areas of shared agreement (consensus) between professional groups were also explored. Q sorts achieving a factor loading of greater than 0.46 (P ResultsIn total, 155 health care professionals volunteered participation (128 [82.6%] women; mean [SD] age, 41.6 [10.2] years, mean [SD] experience, 14.1 [9.6] years). Four distinguishing factors were identified between neonatal nurses, 3 for midwives, 5 for neonatologists, and 4 for obstetricians. Analysis of factors within and between professional groups highlighted significant variation in attitudes of professionals toward parental engagement in decision-making, the perceived importance of potential disability in decision-making, and the use of medical technology. Areas of consensus highlighted that most professionals disagreed with statements suggesting disability equates to reduced quality of life. The statement suggesting the parents’ decision was considered the most important when considering neonatal resuscitation was placed in the neutral (middistribution) position by all professionals.Conclusions and RelevanceThe findings of this qualitative study suggest that parental counseling at extremely low gestations is a complex scenario further complicated by the differences in attitudes within and between professional disciplines toward treatment approaches. The development of multidisciplinary training encompassing all professional groups may facilitate a more consistent and individualized approach toward parental engagement in decision-making.

Objective Genomics is increasingly used for diagnostic testing in children. This study describes the expectations of parents whose child received genomic testing and whether or not they were met. Methods A diverse stratified, purposive sample of parents of 22 children in New York City was interviewed using a semi-structured guide. Genomic test results were positive, negative, or uncertain. Results Parents expressed their expectations in narrative and numeric fashion. Parents expected that their child’s test would have a direct effect on their child’s diagnosis. Some believed that results would be definitive, while others recognized testing limitations. Expectations reflected parents’ hope to find a diagnosis and led to disappointment when results were uninformative or did not impact clinical management. Conclusion Results suggest pre-test genetic counseling emphasize the low likelihood of actionable results; however, parents’ expectations of genomics’ diagnostic capabilities are strongly rooted in their need to end the diagnostic odyssey and may be difficult to manage. Practice Implications Parents’ hope for a resolution and effective treatment for their child is a powerful context in which genetic counseling is heard. Clinicians who provide genomic testing should continue to acknowledge parents’ preconceptions. Additional research in other settings will help understand how to best address and manage parent expectations of genomic medicine.

OBJECTIVE To explore the concepts and strategies parents employ when considering maternal-fetal surgery (MFS) as an option for the management of spina bifida (SB) in their fetus, and how this determines the acceptability of the intervention. METHODS A two-centre interview study enrolling parents whose fetuses with SB were eligible for MFS. To assess differences in acceptability, parents opting for MFS (n = 24) were interviewed at three different moments in time: prior to the intervention, directly after the intervention and 3-6 months after birth. Parents opting for termination of pregnancy (n = 5) were interviewed only once. Themes were identified and organised in line with the framework of acceptability. RESULTS To parents opting for MFS, the intervention was perceived as an opportunity that needed to be taken. Feelings of parental responsibility drove them to do anything in their power to improve their future child's situation. Expectations seemed to be realistic yet were driven by hope for the best outcome. None expressed decisional regret at any stage, despite substantial impact and, at times, disappointing outcomes. For the small group of participants, who decided to opt for termination of pregnancy (TOP), MFS was not perceived as an intervention that substantially could improve the quality of their future child's life. CONCLUSION Prospective parents opting for MFS were driven by their feelings of parental responsibility. They recognise the fetus as their future child and value information and care focusing on optimising the child's future health. In the small group of parents opting for TOP, MFS was felt to offer insufficient certainty of substantial improvement in quality of life and the perceived severe impact of SB drove their decision to end the pregnancy.

PurposeUse of genomic sequencing is increasing at a pace that requires technological solutions to effectively meet the needs of a growing patient population. We developed GUÍA, a web-based application, to enhance the delivery of genomic results and related clinical information to patients and families.MethodsGUÍA development occurred in 5 phases: formative research, content development, user interface design, stakeholder/community member input, and web application development. Development was informed by qualitative research involving parents (N=22) whose children underwent genomic testing. Participants enrolled in the NYCKidSeq pilot study (N=18) completed structured feedback interviews post-result disclosure using GUÍA. Genetic specialists, researchers, patients, and community stakeholders provided their perspectives on GUÍA’s design to ensure technical, cultural, and literacy appropriateness.ResultsNYCKidSeq participants responded positively to the use of GUÍA to deliver their children’s results. All participants (N=10) with previous experience with genetic testing felt GUÍA improved result disclosure, and 17 (94%) participants said the content was clear.ConclusionsGUÍA communicates complex genomic information in an understandable and personalized manner. Initial piloting demonstrated GUÍA’s utility for families enrolled NYCKidSeq pilot study. Findings from the NYCKidSeq clinical trial will provide insight into GUÍA’s effectiveness in communicating results among diverse, multilingual populations.

ObjectiveTo understand the dynamics of conversations between neonatologists and parents concerning limitation of life-sustaining treatments.DesignFormal conversations were recorded, transcribed and analysed according to the conventions and methods of conversation analysis.SettingTwo tertiary neonatal intensive care units.ParticipantsConsultant neonatal specialists and families.Main outcome measuresWe used conversation analysis and developed an inductive coding scheme for conversations based on the introduction of limiting life-sustaining treatments and on the parental responses.ResultsFrom recordings with 51 families, we identified 27 conversations about limiting life support with 20 families and 14 doctors. Neonatologists adopted three broad strategies: (1) ‘recommendations’, in which one course of action is presented and explicitly endorsed as the best course of action, (2) a ‘single-option choice’ format (conditional: referring to a choice that should be made, but without specifying or listing options), and (3) options (where the doctor explicitly refers to or lists options). Our conversation analysis-informed coding scheme was based on the opportunities available for parents to ask questions and assert their preference with minimal interactional constraint or pressure for a certain type of response. Response scores for parents presented with conditional formats (n=15, median 5.0) and options (n=10, median 5.0) were significantly higher than for those parents presented with ‘recommendations’ (n=16, median 3.75; p=0.002) and parents were more likely to express preferences (p=0.005).ConclusionEncouraging different approaches to conversations about limitation of life-supporting treatment may lead to better parent engagement and less misalignment between the conversational partners.

Background Open spina bifida (OSB) is one of the most common congenital central nervous system defects and leads to long-term physical and cognitive disabilities. Open fetal surgery for OSB improves neurological outcomes and reduces the need for ventriculoperitoneal shunting, compared to postnatal surgery, but is associated with a significant risk of prematurity and maternal morbidity. Fetoscopic surgery comes with less maternal morbidity, yet the question remains whether the procedure is neuroprotective and reduces prematurity. Comparison of outcomes between different treatment options is challenging due to inconsistent outcome reporting. We aim to develop and disseminate a core outcome set (COS) for fetal OSB, to ensure that outcomes relevant to all stakeholders are collected and reported in a standardised fashion in future studies. Methods The COS will be developed using a validated Delphi methodology. A systematic literature review will be performed to identify outcomes previously reported for prenatally diagnosed OSB. We will assess maternal (primary and subsequent pregnancies), fetal, neonatal and childhood outcomes until adolescence. In a second phase, we will conduct semi-structured interviews with stakeholders, to ensure representation of additional relevant outcomes that may not have been reported in the literature. We will include patients and parents, as well as health professionals involved in the care of these pregnancies and children (fetal medicine specialists, fetal surgeons, neonatologists/paediatricians and allied health). Subsequently, an international group of key stakeholders will rate the importance of the identified outcomes using three sequential online rounds of a modified Delphi Survey. Final agreement on outcomes to be included in the COS, their definition and measurement will be achieved through a face-to-face consensus meeting with all stakeholder groups. Dissemination of the final COS will be ensured through different media and relevant societies. Discussion Development and implementation of a COS for fetal OSB will ensure consistent outcome reporting in future clinical trials, systematic reviews and clinical practice guidelines. This will lead to higher quality research, better evidence-based clinical practice and ultimately improved maternal, fetal and long-term childhood outcomes. Trial registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42018104880. Registered on December 5, 2018. Core Outcome Measures in Effectiveness Trials (COMET): 1187

Objective Suicide is a leading cause of death among adolescents, and suicidal thoughts represent key predictors to suicidal behavior. Yet, suicidal thoughts can be challenging to accurately assess. Symptoms that commonly co-occur with suicidal thoughts, such as depressive symptoms, may provide valuable information for predicting these thoughts. Although clinicians commonly collect multi-informant reports about adolescent depressive symptoms, these reports often yield discrepant findings as individual predictors of adolescents' suicidal thoughts. Method We tested the ability of specific patterns of multi-informant reports to predict adolescents' suicidal thoughts. Ninety adolescent inpatients and their parents (i.e., "dyads") reported on adolescent depressive symptoms, and adolescents completed self-report assessments of suicidal thoughts at baseline and three-month follow-up. Results Dyads displayed variability in reporting patterns, and these patterns uniquely predicted suicidal thoughts. Adolescents reporting elevated depressive symptoms displayed increased concurrent suicidal thoughts relative to adolescents reporting subthreshold depressive symptoms, regardless of parent report. Yet, only adolescents who reported elevated depressive symptoms and whose parents reported subthreshold adolescent depressive symptoms displayed increased future suicidal thoughts. Conclusions Identifying patterns of multiple informants' reports about adolescent depressive symptoms may improve the prediction of suicidal thoughts. These findings have important implications for assessing adolescents at risk for suicide.

Objective To investigate whether parent-initiated or doctor-initiated decisions about limiting life-sustaining treatment (LST) in neonatal care has consequences for how possible courses of action are presented. Method Formal conversations (n = 27) between doctors and parents of critically ill babies from two level 3 neonatal intensive care units were audio or video recorded. Sequences of talk where decisions about limiting LST were presented were analysed using Conversation Analysis and coded using a Conversation Analytic informed coding framework. Relationships between codes were analysed using Fisher’s exact test. Results When parents initiated the decision point, doctors subsequently tended to refer to or list available options. When doctors initiated, they tended to use ‘recommendations’ or ‘single-option’ choice (conditional) formats (p=0.017) that did not include multiple treatment options. Parent initiations overwhelmingly concerned withdrawal, as opposed to withholding of LST (p=0.030). Conclusion Aligning parents to the trajectory of the news about their baby’s poor condition may influence how the doctor subsequently presents the decision to limit LST, and thereby the extent to which parents are invited to participate in shared decision-making. Practice implications Explicitly proposing treatment options may provide parents with opportunities to be involved in decisions for their critically ill babies, thereby fostering shared decision-making.

The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: ‘making recommendations’ and ‘providing options’. Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. ‘Making recommendations’ led to misalignment and reduced opportunities for questions and collaboration; ‘providing options’ led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance. A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/watch?v=MyuymxDNupk&feature=youtu.be

To examine the use of implicit and explicit measures to predict adolescent nonsuicidal self-injury (NSSI) before, during, and after inpatient hospitalization.Participants were 123 adolescent psychiatric inpatients who completed measures at hospital admission and discharge. The implicit measure (Self-Injury Implicit Association Test [SI-IAT]) and one of the explicit measures pertained to the NSSI method of cutting. Patients were interviewed at multiple time points at which they reported whether they had engaged in NSSI before their hospital stay, during their hospital stay, and within 3 months after discharge.At baseline, SI-IAT scores differentiated past-year self-injurers and noninjurers (t121 = 4.02, p.001, d = 0.73). These SI-IAT effects were stronger among patients who engaged in cutting (versus noncutting NSSI methods). Controlling for NSSI history and prospective risk factors, SI-IAT scores predicted patients' subsequent cutting behavior during their hospital stay (odds ratio (OR) = 8.19, CI = 1.56-42.98, p.05). Patients' explicit self-report uniquely predicted hospital-based and postdischarge cutting, even after controlling for SI-IAT scores (ORs = 1.82-2.34, CIs = 1.25-3.87, p values.01). Exploratory analyses revealed that in specific cases in which patients explicitly reported low likelihood of NSSI, SI-IAT scores still predicted hospital-based cutting.The SI-IAT is an implicit measure that is outcome-specific, a short-term predictor above and beyond NSSI history, and potentially helpful in cases in which patients at risk for NSSI explicitly report that they would not do so in the future. Ultimately, both implicit and explicit measures can help to predict future incidents of cutting among adolescent inpatients.

The aim of this study was to explore how often the participation of parents in their infants' care and professionals' support for parents was documented in the clinical records and to determine how such participation and support were documented.Comprehensive documentation can facilitate collaboration between parents and healthcare professionals, supporting family-centred care, yet little is known about how this is reflected in practice.A prospective, mixed methods approach was used to analyse the clinical records of newborns.The study was carried out in a large tertiary Neonatal Unit in the United Kingdom, from 2013 - 2014. We analysed the clinical records of 24 critically ill newborns using content analysis and thematic analysis, enabling us to determine the frequency of documented support and participation and how support and participation were documented.We identified four categories of support in the clinical records: "emotional", "spiritual", "social" and "practical support". We also identified instances where parents were encouraged to participate in their infant's care. Frequency differences in the documentation of support between infants facing a redirection of care decision and infants receiving active treatment were found. Two organisational themes were identified: "task focused documentation" and "minimal documentation of parental role". These were grouped together under the global theme "professional accountability". The perspectives and experiences of parents were minimally documented throughout.Documentation of support towards parents and parents' participation in their infants' care was limited in terms of frequency and content. Encouraging regular, detailed documentation of these aspects of care may facilitate family-centred care.

Using self-harm Implicit Association Tests (IATs), we sought to test whether (1) suicidal adolescents show implicit identification with self-harm and whether (2) IATs are reliable and sensitive to psychiatric change and (3) predict future suicide attempts. We administered 6 self-harm IATs to 71 adolescents from a psychiatric inpatient unit and assessed suicidal behaviors at admission, discharge and 3 months after discharge. Results were in the expected direction for each IAT but not statistically significant. After aggregating trials across IATs, suicide attempters showed increased implicit identification with self-harm, compared with non-suicidal controls. IATs showed good reliability and sensitivity to psychiatric change but did not prospectively predict suicide attempts. Adolescent suicide attempters may have stronger implicit associations with self-harm than non-suicidal controls.

Background Neonatal mortality accounts for nearly three quarters of all infant deaths in Vietnam. The nursing team are the largest professional group working with newborns, however do not routinely receive neonatal training and there is a lack of research into the impact of educational provision. This study explored changes in nursing perceptions towards their role following a neonatal educational intervention. Parents perceptions of nursing care were explored to determine any changes as nurses gained more experience. Method Semi-Structured qualitative interviews were conducted every 6 months over an 18 month period with 16 nurses. At each time point, parents whose infant was resident on the neonatal unit were invited to participate in an interview to explore their experiences of nursing care. A total of 67 parents participated over 18 months. Interviews were conducted and transcribed in Vietnamese before translation into English for manifest content analysis facilitated by NVivo V14. Results Analysis of nursing transcripts identified 14 basic categories which could be grouped (23) into 3 themes: (1) perceptions of the role of the neonatal nurse, (2) perception of the parental role and (3) professional recollections. Analysis of parent transcripts identified 14 basic categories which could be grouped into 3 themes: (1) information sharing, (2) participation in care, and (3) personal experience. Conclusions Qualitative interviews highlighted the short term effect that the introduction of an educational intervention can have on both nursing attitudes towards and parental experience of care in one neonatal unit in central Vietnam. Nurses shared a growing awareness of their role along with its ethical issues and challenges, whilst parents discussed their overall desire for more participation in their infants care. Further research is required to determine the long term impact of the intervention, the ability of nurses to translate knowledge into clinical practice through assessment of nursing knowledge and competence, and the impact and needs of parents. A greater understanding will allow us to continue to improve the experiences of nurses and parents, and highlight how these areas may contribute towards the reduction of infant mortality and morbidity in Vietnam. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0909-6) contains supplementary material, which is available to authorized users.

Background Preterm birth is a major global public health issue due to its prevalence, impact upon morbidity and mortality, and subsequent cost implications. Yet, policy analysis has not been undertaken to understand the different approaches across Europe to treatment decisions, and parental involvement in these decisions. Methods A European survey and national guidance documentation analysis was undertaken with national neonatal or paediatric societies in Europe, exploring treatment decisions and parental involvement in decision-making for babies born at 22 to 25 completed weeks of gestation. Results Responses were obtained from 19 European countries of 28 contacted. At 25 weeks of gestation there was universal initiation of active care at birth. At 24 weeks policy varied from initiating interventions (9), interventions dependent upon infant condition (8) and resuscitation restrictions (2). At 23 weeks and below, policy varied from no active intervention (7), individualised decision-making (8), parental permission required (3) and universal initiation of interventions (1). There were significant variations in the involvement of parents in the development of policy and in 16 countries the final decision regarding interventions rested with the attending doctor. Implications There was little consensus as to how active intervention after birth at 22 to 25 weeks of gestation is managed, nor were parents included in the development of policy in many countries. At extremely low gestational ages, the criteria for or against active intervention at birth vary widely between different health systems in Europe

ObjectiveTo explore the experiences of parents of infants admitted to the neonatal intensive care unit towards interaction with healthcare professionals during their infants critical care.DesignSemi-structured interviews were conducted with parents of critically ill infants admitted to neonatal intensive care and prospectively enrolled in a study of communication in critical care decision making. Interviews were transcribed verbatim and uploaded into NVivo V.10 to manage and facilitate data analysis. Thematic analysis identified themes representing the data.ResultsNineteen interviews conducted with 14 families identified 4 themes: (1) initial impact of admission affecting transition into the neonatal unit; (2) impact of consistency of care, care givers and information giving; (3) impact of communication in facilitating or hindering parental autonomy, trust, parental expectations and interactions; (4) parental perception of respect and humane touches on the neonatal unit.ConclusionFactors including the context of infant admission, interprofessional consistency, humane touches of staff and the transition into the culture of the neonatal unit are important issues for parents. These issues warrant further investigation to facilitate individualised family needs, attachment between parents and their baby and the professional team.

This paper describes how psychology faculty positions in academic health centers (AHCs) have evolved to meet the changing needs in healthcare. In that context, the roles of psychologists have expanded significantly to include a wide array of clinical responsibilities, teaching and supervisory roles, administrative functions, research initiatives, and academic scholarship. Traditionally, faculty compensation plans have been calculated through the use of Relative Value Units which are primarily based on clinical service delivery, hence, incomplete when attempting to account for these growing academic responsibilities. This paper reviews the need to expand the ways in which the work provided by psychologists is appropriately identified and compensated for in AHCs. Drawing upon six models utilized in other areas of medical education, this paper describes the potential utility of incorporating Educational Value Units as a metric for capturing this expanding set of academic responsibilities and systematically incorporating them into a psychologist’s job design. Recommendations for future considerations are provided.

Background: Although much has been published in the literature on how to perform a Q methodological study, the use of interviews within this process has received little attention. Approach: The purpose of this review is to explore the use of interviews in a Q methodological study. Results: An introduction to Q methodology is provided. The aims of an interview within a Q methodological study are described, and how these aims lend themselves to a particular method of analysis is explored. How to perform this analysis is outlined. Discussion: The use of interviews can increase the validity of a Q methodological study by providing the participant's rationale for analysis of the factor arrays. When to perform the interviews is still under debate, and further study is required to determine whether the timing affects the results.

This paper describes the process for and safety/feasibility of adapting the Beardslee Preventive Intervention Program for Depression for use with predominantly low income, Latino families. Utilizing a Stage I model for protocol development, the adaptation involved literature review, focus groups, pilot testing of the adapted manual, and open trial of the adapted intervention with 9 families experiencing maternal depression. Adaptations included conducting the intervention in either Spanish or English, expanding the intervention to include the contextual experience of Latino families in the United States with special attention to cultural metaphors, and using a strength-based, family-centered approach. The families completed preintervention measures for maternal depression, child behavioral difficulties, global functioning, life stresses, and an interview that included questions about acculturative stressors, resiliency, and family awareness of parental depression. The postintervention interview focused on satisfaction, distress, benefits of the adapted intervention, and therapeutic alliance. The results revealed that the adaptation was nonstressful, perceived as helpful by family members, had effects that seem to be similar to the original intervention, and the preventionists could maintain fidelity to the revised manual. The therapeutic alliance with the preventionists was experienced as quite positive by the mothers. A case example illustrates how the intervention was adapted.

Communication between medical teams and parents is a critical aspect of day-to-day neonatal care and helps to include parents in decisions made for their child. Nonetheless, parents report that current involvement is less than optimal.1 Communication skills are part of the Royal College of Paediatrics and Child Health (RCPCH) curriculum,2 assessed briefly during professional examinations, and signed off at the end of training. However, most training is delivered locally without formal evaluation. This study aimed to explore the experience of and need for communication training among trainee neonatologists. Using a short open-ended questionnaire, we explored the involvement of trainee neonatologists (ST3-8) in communications skills training. Data were collected during a British Association of Perinatal Medicine national training day during September 2014. Forty nine of 58 trainees attending completed the questionnaire. Of the 49, 51% (n=25) had …

Background Quality of health care services can be improved by promoting patient- and family-centered care informed by patient and family satisfaction with services delivered. Few studies have been conducted looking at satisfaction with psychiatric consultation services within an inpatient pediatric hospital setting. Objective The objective of the quality improvement pilot project was to identify ways to enhance services delivered and to guide the development of more comprehensive quality improvement projects. Method Forty-eight parents of forty-eight patients and 10 adult patients were administered the Pediatric Psychiatry Consultation Satisfaction Survey, which surveyed satisfaction with the psychiatric consultation services received during their stay in a freestanding tertiary pediatric academic hospital. Results Sixty-nine percent of participants reported overall high satisfaction (i.e., reports of excellent or very good) with the psychiatric consultation service along with 88% reporting that they would recommend this service to a friend. Overall high satisfaction with the service was associated with positive ratings with three core components of a consultation: provisions of impressions and recommendations (P = 0.018), consultant–participant communication and working relationship (P Conclusions This quality improvement project underscores the importance of having psychiatry consultants convey their clinical impressions and recommendations, communicate effectively, and provide helpful interventions to parents and young adults in the pediatric hospital. It serves as an initial step responding to national consumers' demand for higher levels of quality and service and will provide guidance in future design and implementation of more comprehensive quality improvement projects.

Introduction: Despite clinical advances in neonatal and paediatric palliative care, there is limited educational provision to underpin practice. To develop appropriate educational content, the needs of staff working in this area must be identified. Aim: To explore the educational needs of staff working with families with palliative or end-of-life care requirements. Methods: A training needs analysis (TNA) explored the perceived knowledge, confidence, and support of neonatal and paediatric health professionals in a tertiary children's hospital in London. Results: An online Likert scale TNA was completed by 111 participants. The results indicated that the staff did not feel educationally prepared in their working areas, despite having regular contact with families with palliative or end-of-life care issues. Discussion: Understanding the educational needs of staff can underpin the development of appropriate educational interventions. These modules require evaluation to determine their impact on health professionals' knowledge and confidence.

The paper is a report of a study of the attitudes of neonatal nurses towards extremely preterm infants.Alongside advancing survival at extremely preterm gestational ages, ethical debates concerning the provision of invasive care have proliferated in light of the high morbidity. Despite nurses being the healthcare professionals who work closest with the infant and their family, their potential influence is usually ignored when determining how parents come to decisions about future care for their extremely premature infant.A Q methodology was employed to explore the attitudes of neonatal nurses towards caring for extremely preterm infants. Data were collected between 2007 and 2008 and analysed using PQMethod and Card Content Analysis.Thirty-six nurses from six neonatal units in the United Kingdom participated. Although there was consensus around the professional role of the nurse, when faced with the complexities of neonatal nursing three distinguishing factors emerged: the importance of parental choice in decision-making, the belief that technology should be used to assess response to treatment, and the belief that healthcare professionals should undertake difficult decisions.Neonatal nurses report unexpected difficulties in upholding their professionally defined role through highly complex and ever varied decision-making processes. Recognition of individual attitudes to the care of extremely preterm infants and the role of the family in the face of difficult decisions should facilitate more open communication between the nurse and the parents and improve the experience of both the nurse and the family during these emotional situations.

gallagher k., porock d. & edgley a. (2010) The concept of ‘nursing’ in the abortion services. Journal of Advanced Nursing66(4), 849–857. Abstract Title. The concept of ‘nursing’ in the abortion services. Aim. This paper is a report of a study of the perceptions of nurses who work in abortion services. Background. International debate surrounds abortion. In England and Wales the Abortion Act which was introduced in 1967 recently came under public review in relation to its legal limit of 24 weeks gestation. The review did not extend to those working within abortion services, and these nurses’ views remained unknown. Investigating the perceptions of nurses who work in abortion services adds a dimension to the debate from a professional perspective which has hitherto been absent. Methods. Qualitative semi-structured interviews were conducted in 2007 with nine nurses working in three different abortion clinics in the United Kingdom. NVivo was used to manage the interview data and thematic analysis identified patterns of nursing concepts and attitudes. Findings. Two global themes of ‘Attitudes Towards’ and ‘Coping With’ abortion were identified. Six organizational themes detailed these: ‘society’, ‘nurses’ and ‘reasoning’ in ‘Attitudes Towards’ and ‘role’, ‘clients’ and ‘late gestation abortion’ in ‘Coping With’. Eleven basic themes further described the organizational themes. Kim’s theory of Human Living was used to clarify and provide a rationale for the nursing approach to care in this setting. Conclusion. The ability of participants to care for their clients as individuals illustrates the nature of empowerment of the nurses to attain the goals of the client. Making this support explicit through defined roles for nurses would potentially enable nurses in abortion services to perform their role more effectively at all gestation times.

Background: Peptide YY (PYY) is an intestinally derived anorexigen that acts via the Y2 receptor, and Y2 receptor deletion in rodents increases bone formation. Anorexia nervosa (AN) is associated with a deliberate reduction in food intake and low bone density, but endocrine modulators of food intake in AN are not known. In addition, known regulators of bone turnover, such as GH, cortisol, and estrogen, explain only a fraction of the variability in bone turnover marker levels.Hypotheses: We hypothesized that PYY may be elevated in AN compared with controls and may contribute to decreased food intake and bone formation.Methods: Fasting PYY was examined in 23 AN girls and 21 healthy adolescents 12–18 yr old. We also examined GH, cortisol, ghrelin, and leptin (overnight frequent sampling) and fasting IGF-I, estradiol, total T3, and bone markers. Macronutrient intake and resting energy expenditure (REE) were measured.Results: AN girls had higher PYY levels compared with controls (17.8 ± 10.2 vs. 4.8 ± 4.3 pg/ml; P < 0.0001). Predictors of log PYY were nutritional markers, including body mass index (r = −0.62; P < 0.0001), fat mass (r = −0.55; P = 0.0003), and REE (r = −0.51; P = 0.0006), and hormones, including GH (r = 0.38; P = 0.004) and T3 (r = −0.59; P = 0.0001). Body mass index, fat mass, REE, GH, and T3 explained 68% of the variability of log PYY. Log PYY predicted percentage of calories from fat (r = −0.56; P = 0.0002) and independently predicted osteocalcin (r = −0.45; P = 0.003), bone-specific alkaline phosphatase (r = −0.46; P = 0.003), N-telopeptide/creatinine (r = −0.55; P = 0.0003), and deoxypyridinoline/creatinine (r = −0.52; P = 0.001) on regression modeling.Conclusion: Elevated PYY may contribute to reduced intake and decreased bone turnover in AN.