Publications by authors named "Jane Chudleigh"

35 Publications

The problem with 'My Five Moments for Hand Hygiene'.

BMJ Qual Saf 2021 Jul 14. Epub 2021 Jul 14.

The Health Systems Collaborative, Nuffield Department of Clinical Medicine, Oxford, UK

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http://dx.doi.org/10.1136/bmjqs-2020-011911DOI Listing
July 2021

Congenital heart disease: factors influencing parents' knowledge of their child's condition.

Nurs Child Young People 2021 Mar 15. Epub 2021 Mar 15.

child health, City, University of London, London, England.

The extent of parental knowledge is an important factor in the care of children with congenital heart disease (CHD), with research recommending that to achieve optimal care, parents should be appropriately educated in the condition. This literature review aimed to identify the factors that influence parents' knowledge of their child's CHD. Relevant databases were searched for literature using appropriate search terms. Thematic analysis identified four common themes in six articles: the educational technique used, the parents' educational background, effective communication and the source of information. The findings identified a need for improved delivery and communication of parental education.
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http://dx.doi.org/10.7748/ncyp.2021.e1312DOI Listing
March 2021

Survey with content analysis to explore nurses' satisfaction with opportunities to undertake continuing professional education in relation to aseptic technique.

Nurse Educ Today 2021 Mar 13;98:104749. Epub 2021 Jan 13.

City, University of London, London, UK. Electronic address:

Background: Aseptic technique is a key skill undertaken every day by large numbers of nurses. However, there is relatively little empirical evidence to underpin practice. Furthermore, it is not clear to what extent it should be considered a single task or a set of principles to be applied differentially depending upon the situation and how individual nurses make this decision.

Objective: This study explored nurses' experiences of continuing professional education (CPE) in relation to aseptic technique.

Design: A national survey was undertaken throughout the United Kingdom. Responses were subjected to inductive quantitative content analysis.

Participants: Participants were recruited via an electronic link placed on the website of a major nursing organisation.

Results: 941 nurses responded. 253 (26.9%) were satisfied with arrangements for continuing professional education. Satisfaction was associated with a perception of good support from employers, sound preparation before qualifying and practising aseptic technique regularly. 311 (33%) were dissatisfied. Reasons included witnessing unwarranted variations in practice (n = 55, 5.8%), witnessing suboptimal practice requiring correction (65, 6.9%), a perception that standards had fallen through a decline in pre-registration preparation (n = 109, 11.6%) and opportunities for updating (n = 124, 13.2%). Some employers had introduced training in conjunction with organisation-wide change in practice. In other cases participants reported receiving updates when required to perform a new procedure, when moving between clinical specialities or changing employer. Train-the-trainer (cascade) teaching was used in formal and informal arrangements for updating.

Conclusion: This study provides a springboard for exploring arrangements for updating and assessing nurses' competence to undertake aseptic technique. Health providers need to evaluate what is currently provided and address gaps in provision. There is clear evidence that the current system does not meet the needs of many nurses.
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http://dx.doi.org/10.1016/j.nedt.2021.104749DOI Listing
March 2021

Processing of positive newborn screening results: a qualitative exploration of current practice in England.

BMJ Open 2020 12 12;10(12):e044755. Epub 2020 Dec 12.

Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.

Objective: To explore current communication practices for positive newborn screening results from the newborn bloodspot screening (NBS) laboratory to clinicians to highlight differences, understand how the pathways are implemented in practice, identify barriers and facilitators and make recommendations for future practice and research.

Design: A qualitative exploratory design was employed using semi-structured interviews.

Setting: Thirteen NBS laboratories in England.

Participants: Seventy-one clinicians; 22 NBS laboratory staff across 13 laboratories and 49 members of relevant clinical teams were interviewed.

Results: Assurance of quality and consistency was a priority for all NBS laboratories. Findings indicated variation in approaches to communicating positive NBS results from laboratories to clinical teams. This was particularly evident for congenital hypothyroidism and was largely influenced by local arrangements, resources and the fact individual laboratories had detailed standard operating procedures for how they work. Obtaining feedback from clinical teams to the laboratory after the child had been seen could be challenging and time-consuming for those involved. Pathways for communicating carrier results for cystic fibrosis and sickle cell disease could be ambiguous and inconsistent which in turn could hamper the laboratories efforts to obtain timely feedback regarding whether or not the result had been communicated to the family. Communication pathways for positive NBS results between laboratories and clinical teams could therefore be time-consuming and resource-intensive.

Conclusion: The importance placed on ensuring positive NBS results were communicated effectively and in a timely fashion from the laboratory to the clinical team was evident from all participants. However, variation existed in terms of the processes used to report positive NBS results to clinical teams and the people involved. Variant practice identified may reflect local needs, but more often reflected local resources and a more consistent 'best practice' approach is required, not just in the UK but perhaps globally.

Trial Registration Number: ISRCTN15330120.
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http://dx.doi.org/10.1136/bmjopen-2020-044755DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735110PMC
December 2020

Practice nurses' perceptions of their immunization role and strategies used to promote measles, mumps, and rubella vaccine uptake in 2014 - 2018: A qualitative study.

J Adv Nurs 2021 Feb 22;77(2):948-956. Epub 2020 Nov 22.

School of Health Sciences, City, University of London, London, UK.

Aim: The aim of this study was to explore which aspects of their role practice nurses perceive to be most influential and the strategies they employ to promote the MMR vaccine.

Design: Qualitative study employing in depth interviews.

Method: Fifteen London based practice nurses, nine in 2014 and six in 2018, took part in semi-structured interviews that were audio recorded and transcribed verbatim. Qualitative content analysis was used to systematically manage, analyse, and identify themes.

Results: Analysis of data identified aspects of their role practice nurses perceived to be most influential (the themes) including: promoting vaccination, assisting parents' to make informed decisions, and provided insight into how they used specific strategies to achieve these in practice. These themes were consistent over both phases of the study.

Conclusion: The findings provide an understanding of: (i) the practice nurses perceptions of the most important aspects of their role when promoting the measles, mumps, and rubella vaccine; and (ii) the strategies they implemented in practice to achieve these. The latter included assisting parents in their immunization decisions and was facilitated by practice nurses engaging with parents to provide relevant evidence to address parent queries, dispel misconceptions and tailor strategies to promote the measles, mumps, and rubella vaccine.

Impact: This study addresses the paucity of literature available that specifically explores practice nurses' perceptions of their role concerning the measles, mumps, and rubella vaccine. The findings reveal how practice nurses promote the measles, mumps, and rubella vaccine by identifying strategies to enable parents to make informed decisions. At a time of an increasing incidence of measles, practice nurses have an important public health role in achieving herd immunity levels for measles, mumps, and rubella.
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http://dx.doi.org/10.1111/jan.14652DOI Listing
February 2021

Psychological Impact of NBS for CF.

Int J Neonatal Screen 2020 06 30;6(2):27. Epub 2020 Mar 30.

Faculty of Sports, Health and Applied Science, St Mary's University, London TW1 4SX, UK;

Newborn screening for cystic fibrosis has resulted in diagnosis often before symptoms are recognised, leading to benefits including reduced disease severity, decreased burden of care, and lower costs. The psychological impact of this often unsought diagnosis on the parents of seemingly well children is less well understood. The time during which the screening result is communicated to families but before the confirmatory test results are available is recognised as a period of uncertainty and it is this uncertainty that can impact most on parents. Evidence suggests this may be mitigated against by ensuring the time between communication and confirmatory testing is minimized and health professionals involved in communicating positive newborn screening results and diagnostic results for cystic fibrosis to families are knowledgeable and able to provide appropriate reassurance. This is particularly important in the case of false positive results or when the child is given a Cystic Fibrosis Screen Positive, Inconclusive Diagnosis designation. However, to date, there are no formal mechanisms in place to support health professionals undertaking this challenging role, which would enable them to meet the expectations set out in specific guidance.
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http://dx.doi.org/10.3390/ijns6020027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422999PMC
June 2020

Processing Newborn Bloodspot Screening Results for CF.

Int J Neonatal Screen 2020 06 25;6(2):25. Epub 2020 Mar 25.

School of Health Sciences, City, University of London, London EC1V 0HB, UK;

Every newborn bloodspot screening (NBS) result for cystic fibrosis (CF) consists of two parts: a screening part in the laboratory and a clinical part in a CF centre. When introducing an NBS programme, more attention is usually paid to the laboratory part, especially which algorithm is most suitable for the region or the country. However, the clinical part, how a positive screening result is processed, is often underestimated and can have great consequences for the affected child and their parents. A clear algorithm for the diagnostic part in CF centres is also important and influences the performance of a CF NBS programme. The processing of a positive screening result includes the initial information given to the parents, the invitation to the sweat test, what to do if a sweat test fails, information about the results of the sweat test, the inconclusive diagnosis and the carrier status, which is handled differently from country to country. The time until the definitive diagnosis and adequate information is given, is considered by the parents and the CF team as the most important factor. The communication of a positive NBS result is crucial. It is not a singular event but rather a process that includes ensuring the appropriate clinicians are aware of the result and that families are informed in the most efficient and effective manner to facilitate consistent and timely follow-up.
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http://dx.doi.org/10.3390/ijns6020025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422987PMC
June 2020

Qualitative exploration of health professionals' experiences of communicating positive newborn bloodspot screening results for nine conditions in England.

BMJ Open 2020 10 1;10(10):e037081. Epub 2020 Oct 1.

Paediatrics, Institute of Child Health, Merseyside, UK.

Objective: To explore health professionals' experiences of communicating positive newborn bloodspot screening (NBS) results, highlight differences, share good practice and make recommendations for future research.

Design: Qualitative exploratory design was employed using semi-structured interviews SETTING: Three National Health Service provider organisations in England PARTICIPANTS: Seventeen health professionals involved in communicating positive newborn bloodspot screening results to parents for all nine conditions currently included in the newborn bloodspot screening programme in England.

Results: Findings indicated variation in approaches to communicating positive newborn bloodspot screening results to parents, largely influenced by resources available and the lack of clear guidance. Health professionals emphasised the importance of communicating results to families in a way that is sensitive to their needs. However, many challenges hindered communication including logistical considerations; difficulty contacting the family and other health professionals; language barriers; parental reactions; resource considerations; lack of training; and insufficient time.

Conclusion: Health professionals invest a lot of time and energy trying to ensure communication of positive newborn bloodspot screening results to families is done well. However, there continues to be great variation in the way these results are communicated to parents and this is largely influenced by resources available but also the lack of concrete guidance. How best to support health professionals undertaking this challenging and emotive task requires further exploration. We recommend evaluation of a more cohesive approach that meets the needs of parents and staff while being sensitive to the subtleties of each condition.

Trial Registration Number: ISRCTN15330120.
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http://dx.doi.org/10.1136/bmjopen-2020-037081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534703PMC
October 2020

Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis.

BMJ Open 2020 02 18;10(2):e030371. Epub 2020 Feb 18.

School of Health Sciences, City, University of London, London, UK.

Objective: To systematically review the literature exploring the impact of isolation on hospitalised patients who are infectious: psychological and non-psychological outcomes.

Design: Systematic review with meta-analysis.

Data Sources: Embase, Medline and PsycINFO were searched from inception until December 2018. Reference lists and Google Scholar were also handsearched.

Results: Twenty-six papers published from database inception to December 2018 were reviewed. A wide range of psychological and non-psychological outcomes were reported. There was a marked trend for isolated patients to exhibit higher levels of depression, the pooled standardised mean difference being 1.28 (95% CI 0.47 to 2.09) and anxiety 1.45 (95% CI 0.56 to 2.34), although both had high levels of heterogeneity, and worse outcomes for a range of care-related factors but with significant variation.

Conclusion: The review indicates that isolation to contain the risk of infection has negative consequences for segregated patients. Although strength of the evidence is weak, comprising primarily single-centre convenience samples, consistency of the effects may strengthen this conclusion. More research needs to be undertaken to examine this relationship and develop and test interventions to reduce the negative effects of isolation.
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http://dx.doi.org/10.1136/bmjopen-2019-030371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044903PMC
February 2020

Applying thematic synthesis to interpretation and commentary in epidemiological studies: identifying what contributes to successful interventions to promote hand hygiene in patient care.

BMJ Qual Saf 2020 09 4;29(9):756-763. Epub 2020 Feb 4.

Infection Prevention and Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

Objectives: Hand hygiene is considered the most important preventive measure for healthcare-associated infections, but adherence is suboptimal. We previously undertook a Cochrane Review that demonstrated that interventions to improve adherence are moderately effective. Impact varied between organisations and sites with the same intervention and implementation approaches. This study seeks to explore these differences.

Methods: A thematic synthesis was applied to the original authors' interpretation and commentary that offered explanations of how hand hygiene interventions exerted their effects and suggested reasons why success varied. The synthesis used a published Cochrane Review followed by three-stage synthesis.

Results: Twenty-one papers were reviewed: 11 randomised, 1 non-randomised and 9 interrupted time series studies. Thirteen descriptive themes were identified. They reflected a range of factors perceived to influence effectiveness. Descriptive themes were synthesised into three analytical themes: (eg, Hawthorne effect) and two related themes that address issues with implementing hand hygiene interventions: (eg, visible managerial support) and (eg, embedding the intervention into wider patient safety initiatives).

Conclusions: The analytical themes help to explain the original authors' perceptions of the degree to which interventions were effective and suggested new directions for research: exploring ways to avoid the Hawthorne effect; exploring the impact of components of multimodal interventions; the use of theoretical frameworks for behaviour change; potential to embed interventions into wider patient safety initiatives; adaptations to demonstrate sustainability; and the development of systematic approaches to implementation. Our findings corroborate studies exploring the success or failure of other clinical interventions: context and leadership are important.
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http://dx.doi.org/10.1136/bmjqs-2019-009833DOI Listing
September 2020

Rethinking Strategies for Positive Newborn Screening Result (NBS+) Delivery (ReSPoND): a process evaluation of co-designing interventions to minimise impact on parental emotional well-being and stress.

Pilot Feasibility Stud 2019 4;5:108. Epub 2019 Sep 4.

9Women's and Children's Health, University of Liverpool, Liverpool, L69 3BX UK.

Background: Newborn blood spot (NBS) screening seeks to prevent ill health, disability and death through early diagnosis and effective intervention. Each year, around 10,000 parents of babies born in England are given a positive NBS result indicating their child may be affected or carriers of one of the nine conditions currently screened for. Despite guidance, these results are inconsistently delivered to parents across geographical regions. There is evidence that many parents are dissatisfied with how NBS results are communicated to them and that poor communication practices can lead to various negative sequelae. The purpose of this study is to co-design, implement and undertake a process evaluation of new, co-designed interventions to improve delivery of initial positive NBS results to parents.

Methods: This mixed-methods study will use four phases with defined outputs. Family Systems Theory will form the theoretical basis for the study. The principles and methods of experience-based co-design will underpin intervention development. Normalisation Process Theory will underpin the process evaluation of the interventions co-designed to improve the delivery of positive NBS results to parents. An economic analysis will determine resource use and costs of current practice and of implementing the new co-designed interventions. The nominal group technique will be used to inform the selection of suitable outcome measures for a future evaluation study.

Discussion: The main output of the proposed study will be co-designed interventions for initial communication of positive NBS results to parents ready to be evaluated in a definitive evaluation study.The interventions, co-designed with parents, will help to minimise potential negative sequelae associated with poor communication practices by considering parental and staff experiences as well as healthcare challenges such as finite resources. In addition, information about indicative costs associated with different communication strategies will be determined.It is anticipated it may also be possible to extrapolate principles of good communication practices from the present study for the delivery of bad news to parents for children newly diagnosed with other conditions including cancer and other chronic conditions such as diabetes or epilepsy.

Trial Registration: ISRCTN 15330120 date of registration 17/01/2018.
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http://dx.doi.org/10.1186/s40814-019-0487-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724281PMC
September 2019

Impact of Cystic Fibrosis on Unaffected Siblings: A Systematic Review.

J Pediatr 2019 07;210:112-117.e9

School of Health Sciences, City, University of London, London, England, United Kingdom.

Objective: To conduct a systematic review of the evidence to determine the impact of cystic fibrosis (CF) on unaffected siblings.

Study Design: We searched MEDLINE (Ovid interface, from 1946); EMBASE (Ovid interface, from 1946); CINAHL (EBSCO interface); Academic Search Complete (EBSCO interface); Psych Info (EBSCO interface); ProQuest Theses' and Dissertation's (ProQuest); British Index of Nursing (ProQuest); Web of Science (ISI, Web of Knowledge portal); PubMed (PubMed NCBI); BASE (Bielefeld Academic Research Engine); Scopus; EThOS (e-theses online service); Open Grey; and Cochrane Library. Contents pages of the Journal of Cystic Fibrosis, June 2002-April 2017 were hand searched to identify further eligible studies. Reference lists of eligible articles and relevant review papers were screened. Inclusion criteria were full studies published after 1989 in English focusing on the impact of cystic fibrosis on unaffected siblings.

Results: In total, 13 papers, 4 PhD theses and 1 MSc thesis were included in the review. Four themes were identified; family functioning, psychosocial impact, knowledge of CF, and condition-specific differences.

Conclusions: Most studies are old and may not accurately represent the impact of CF on unaffected siblings following changes to health care provision including newborn bloodspot screening and the advent of CF transmembrane regulator modulator therapies. Further work is needed directly with siblings rather than using mothers as proxies to determine effect of age, sex, and disease trajectory on unaffected siblings' experiences.
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http://dx.doi.org/10.1016/j.jpeds.2019.03.035DOI Listing
July 2019

The Australian National Hand Hygiene Initiative: framework for future research.

Lancet Infect Dis 2018 11 28;18(11):1171-1172. Epub 2018 Sep 28.

School of Health Sciences, CitXersity of London, London, UK.

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http://dx.doi.org/10.1016/S1473-3099(18)30598-XDOI Listing
November 2018

Isolating infectious patients: organizational, clinical, and ethical issues.

Am J Infect Control 2018 08 27;46(8):e65-e69. Epub 2018 Jun 27.

King's College, London, UK. Electronic address:

Background: Isolating infectious patients is essential to reduce infection risk. Effectiveness depends on identifying infectious patients, transferring them to suitable accommodations, and maintaining precautions.

Methods: Online study to address identification of infectious patients, transfer, and challenges of maintaining isolation in hospitals in the United Kingdom.

Results: Forty-nine responses were obtained. Decision to isolate is made by infection prevention teams, clinicians, and managers. Respondents reported situations where isolation was impossible because of the patient's physical condition or cognitive status. Very sick patients and those with dementia were not thought to tolerate isolation well. Patients were informed about the need for isolation by ward nurses, sometimes with explanations from infection prevention teams. Explanations were often poorly received and comprehended, resulting in complaints. Respondents were aware of ethical dilemmas associated with isolation that is undertaken in the interests of other health service users and society. Organizational failures could delay initaiting isolation. Records were kept of the demand for isolation and/or uptake, but quality was variable.

Conclusion: Isolation has received the most attention in countries with under-provision of accommodations. Our study characterizes reasons for delays in identifying patients and failures of isolation, which place others at risk and which apply to any organization regardless of availability. It also highlights the ethical dilemmas of enforcing isolation.
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http://dx.doi.org/10.1016/j.ajic.2018.05.024DOI Listing
August 2018

Interventions to improve hand hygiene compliance in patient care: Reflections on three systematic reviews for the Cochrane Collaboration 2007-2017.

J Infect Prev 2018 May 24;19(3):108-113. Epub 2018 Jan 24.

Ottawa Hospital Research Institute, Ottawa, ON, Canada.

This article presents highlights from a recently updated systematic Cochrane review evaluating the effectiveness of interventions to improve hand hygiene compliance in patient care. It is an advance on the two earlier reviews we undertook on the same topic as it has, for the first time, provided very rigorous synthesis of evidence that such interventions can improve practice. In this article, we provide highlights from a recently updated Cochrane systematic review. We identify omissions in the information reported and point out important aspects of hand hygiene intervention studies that were beyond the scope of the review. A full report of the review is available free of charge on the Cochrane website.
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http://dx.doi.org/10.1177/1757177417751285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956703PMC
May 2018

Survey to explore understanding of the principles of aseptic technique: Qualitative content analysis with descriptive analysis of confidence and training.

Am J Infect Control 2018 04 21;46(4):393-396. Epub 2017 Nov 21.

City University, London, United Kingdom.

Background: In many countries, aseptic procedures are undertaken by nurses in the general ward setting, but variation in practice has been reported, and evidence indicates that the principles underpinning aseptic technique are not well understood.

Methods: A survey was conducted, employing a brief, purpose-designed, self-reported questionnaire.

Results: The response rate was 72%. Of those responding, 65% of nurses described aseptic technique in terms of the procedure used to undertake it, and 46% understood the principles of asepsis. The related concepts of cleanliness and sterilization were frequently confused with one another. Additionally, 72% reported that they not had received training for at least 5 years; 92% were confident of their ability to apply aseptic technique; and 90% reported that they had not been reassessed since their initial training. Qualitative analysis confirmed a lack of clarity about the meaning of aseptic technique.

Conclusion: Nurses' understanding of aseptic technique and the concepts of sterility and cleanliness is inadequate, a finding in line with results of previous studies. This knowledge gap potentially places patients at risk. Nurses' understanding of the principles of asepsis could be improved. Further studies should establish the generalizability of the study findings. Possible improvements include renewed emphasis during initial nurse education, greater opportunity for updating knowledge and skills post-qualification, and audit of practice.
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http://dx.doi.org/10.1016/j.ajic.2017.10.008DOI Listing
April 2018

Pulmonary function deficits in newborn screened infants with cystic fibrosis managed with standard UK care are mild and transient.

Eur Respir J 2017 11 9;50(5). Epub 2017 Nov 9.

Clinical Epidemiology, Nutrition and Biostatistics, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK.

With the advent of novel designer molecules for cystic fibrosis (CF) treatment, there is huge need for early-life clinical trial outcomes, such as infant lung function (ILF). We investigated the degree and tracking of ILF abnormality during the first 2 years of life in CF newborn screened infants.Forced expiratory volume in 0.5 s (FEV), lung clearance index (LCI) and plethysmographic functional residual capacity were measured at ∼3 months, 1 year and 2 years in 62 infants with CF and 34 controls.By 2 years there was no significant difference in FEV z-score between CF and controls, whereas mean LCI z-score was 0.81 (95% CI 0.45-1.17) higher in CF. However, there was no significant association between LCI z-score at 2 years with either 3-month or 1-year results. Despite minimal average group changes in any ILF outcome during the second year of life, marked within-subject changes occurred. No child had abnormal LCI or FEV on all test occasions, precluding the ability to identify "high-risk" infants in early life.In conclusion, changes in lung function are mild and transient during the first 2 years of life in newborn screened infants with CF when managed according to a standardised UK treatment protocol. Their potential role in tracking disease to later childhood will be ascertained by ongoing follow-up.
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http://dx.doi.org/10.1183/13993003.00326-2017DOI Listing
November 2017

Interventions to improve hand hygiene compliance in patient care.

Cochrane Database Syst Rev 2017 09 1;9:CD005186. Epub 2017 Sep 1.

School of Healthcare Sciences, Cardiff University, Eastgate House, Cardiff, Wales, UK.

Background: Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review.

Objectives: To assess the short- and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection.

Search Methods: We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016.

Selection Criteria: We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol-based hand rub (ABHR), or both.

Data Collection And Analysis: Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta-analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table.

Main Results: This review includes 26 studies: 14 randomised trials, two non-randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long-term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention.Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes.Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low.Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence).Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence.Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence.Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence.Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence.

Authors' Conclusions: With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context.
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http://dx.doi.org/10.1002/14651858.CD005186.pub4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483670PMC
September 2017

Information provision reduces parental anxiety.

Authors:
Jane Chudleigh

Nurs Child Young People 2017 Feb;29(1):19

City, University of London.

Parents find the delivery of positive newborn screening results distressing, in large part due to information provision at time of screening and when the results are communicated to them ( Buchbinder and Timmermans 2012 , Salm et al 2012 , Chudleigh et al 2016 ).
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http://dx.doi.org/10.7748/ncyp.29.1.19.s21DOI Listing
February 2017

Interventions needed to help families with inherited conditions.

Authors:
Jane Chudleigh

Nurs Child Young People 2016 Jul;28(6):17

King's College London.

The authors comment that this is the first intervention for facilitating better communication for families affected by, or at risk of, inherited genetic conditions (IGCs). Therefore the study provides an important contribution to the literature.
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http://dx.doi.org/10.7748/ncyp.28.6.17.s22DOI Listing
July 2016

Parents' Experiences of Receiving the Initial Positive Newborn Screening (NBS) Result for Cystic Fibrosis and Sickle Cell Disease.

J Genet Couns 2016 12 20;25(6):1215-1226. Epub 2016 Apr 20.

Florence Nightingale Faculty of Nursing & Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.

The clinical advantages of the newborn screening programme (NBS) in the UK are well described in the literature. However, there has been little exploration of the psychosocial impact on the family. This study followed the principles of grounded theory to explore parents' experiences of receiving the initial positive NBS result for their child with cystic fibrosis (CF) or sickle cell disease (SCD). Semi-structured, qualitative interviews were conducted with 22 parents (12 mothers and 10 fathers) whose children had been diagnosed with CF or SCD via NBS and were under the age of 1 year at the time of interview. The main themes that arose from the data were; parents previous knowledge of the condition and the NBS programme, the method of delivery and parental reactions to the result, sharing the results with others, the impact on parental relationships and support strategies. Study conclusions indicate that most parents thought initial positive NBS results should be delivered by a health professional with condition specific knowledge, preferably with both parents present. Genetic counselling needs to include a focus on the impact of NBS results on parental relationships. Careful consideration needs to be given to strategies to support parents of babies who have positive NBS results both in terms of the psychological health and to assist them in sharing the diagnosis.
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http://dx.doi.org/10.1007/s10897-016-9959-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114338PMC
December 2016

Research essentials.

Nurs Child Young People 2016 Mar;28(2):12

King's College London.

TO MAXIMISE success, a research grant application should: ■ Have a clear purpose with demonstrable and measurable outcomes. ■ Be in line with government policies, healthcare agendas and health priorities. ■ Meet objectives of the funding body and application criteria.
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http://dx.doi.org/10.7748/ncyp.28.2.12.s14DOI Listing
March 2016

Funding sources and grant applications.

Nurs Child Young People 2016 Feb;28(1):14

University of Leeds.

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http://dx.doi.org/10.7748/ncyp.28.1.14.s20DOI Listing
February 2016

Research essentials.

Nurs Child Young People 2015 Apr;27(3):12

King's College London.

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http://dx.doi.org/10.7748/ncyp.27.3.12.s13DOI Listing
April 2015

Research essentials.

Nurs Child Young People 2015 Mar;27(2):14

Children's nursing, University of Huddersfield.

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http://dx.doi.org/10.7748/ncyp.27.2.14.s15DOI Listing
March 2015

Evidence suggests information is withheld for a number of reasons.

Authors:
Jane Chudleigh

Nurs Child Young People 2014 Sep;26(7):13

King's College London, on behalf of the RCN's Research in Child Health network's core community.

The advantages of the newborn screening (NBS) programme in the UK are well documented ( Farrell et al 2011 ), but screening identifies carriers of these conditions for whom there are minimal or no health concerns. However, there are implications for the future, when carriers reach reproductive age.
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http://dx.doi.org/10.7748/ncyp.26.7.13.s16DOI Listing
September 2014

Quality of newborn screening information needs to improve.

Authors:
Jane Chudleigh

Nurs Child Young People 2013 Oct;25(8):13

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http://dx.doi.org/10.7748/ncyp2013.10.25.8.13.s16DOI Listing
October 2013

Evolution of lung function during the first year of life in newborn screened cystic fibrosis infants.

Thorax 2014 Oct 26;69(10):910-7. Epub 2013 Sep 26.

Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK.

Rationale: Newborn screening (NBS) for cystic fibrosis (CF) allows early intervention. Design of randomised controlled trials (RCT) is currently impeded by uncertainty regarding evolution of lung function, an important trial end point in such infants.

Objective: To assess changes in pulmonary function during the first year of life in CF NBS infants.

Methods: Observational longitudinal study. CF NBS infants and healthy controls were recruited between 2009 and 2011. Lung Clearance Index (LCI), plethysmographic lung volume (plethysmographic functional residual capacity (FRCpleth)) and forced expired volume (FEV₀.₅) were measured at 3 months and 1 year of age.

Main Results: Paired measurements were obtained from 72 CF infants and 44 controls. At 3 months, CF infants had significantly worse lung function for all tests. FEV₀.₅ improved significantly (0.59 (95% CI 0.18 to 0.99) z-scores; p<0.01) in CF infants between 3 months and 1 year, and by 1 year, FEV₀.₅ was only 0.52 (0.89 to 0.15) z-scores less than in controls. LCI and FRCpleth remained stable throughout the first year of life, being on average 0.8 z-scores higher in infants with CF. Pulmonary function at 1 year was predicted by that at 3 months. Among the 45 CF infants with entirely normal LCI and FEV₀.₅ at 3 months, 80% remained so at 1 year, while 74% of those with early abnormalities remained abnormal at 1 year.

Conclusions: This is the first study reporting improvements in FEV₀.₅ over time in stable NBS CF infants treated with standard therapy. Milder changes in lung function occurred by 1 year than previously reported. Lung function at 3 months predicts a high-risk group, who should be considered for intensification of treatment and enrolment into RCTs.
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http://dx.doi.org/10.1136/thoraxjnl-2013-204023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174068PMC
October 2014
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