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BackgroundWe tested the hypothesis that routine MRI would improve the care and well-being of preterm infants and their families.DesignParallel-group randomised trial (1.1 allocation; intention-to-treat) with nested diagnostic and cost evaluations (EudraCT 2009-011602-42).SettingParticipants from 14 London hospitals, imaged at a single centre.Patients511 infants born before 33 weeks gestation underwent both MRI and ultrasound around term. 255 were randomly allocated (siblings together) to receive only MRI results and 255 only ultrasound from a paediatrician unaware of unallocated results; one withdrew before allocation.Main outcome measuresMaternal anxiety, measured by the State-Trait Anxiety inventory (STAI) assessed in 206/214 mothers receiving MRI and 217/220 receiving ultrasound. Secondary outcomes included: prediction of neurodevelopment, health-related costs and quality of life.ResultsAfter MRI, STAI fell from 36.81 (95% CI 35.18 to 38.44) to 32.77 (95% CI 31.54 to 34.01), 31.87 (95% CI 30.63 to 33.12) and 31.82 (95% CI 30.65 to 33.00) at 14 days, 12 and 20 months, respectively. STAI fell less after ultrasound: from 37.59 (95% CI 36.00 to 39.18) to 33.97 (95% CI 32.78 to 35.17), 33.43 (95% CI 32.22 to 34.63) and 33.63 (95% CI 32.49 to 34.77), p=0.02. There were no differences in health-related quality of life. MRI predicted moderate or severe functional motor impairment at 20 months slightly better than ultrasound (area under the receiver operator characteristic curve (CI) 0.74; 0.66 to 0.83 vs 0.64; 0.56 to 0.72, p=0.01) but cost £315 (CI £295–£336) more per infant.ConclusionsMRI increased costs and provided only modest benefits.Trial registrationClinicalTrials.gov NCT01049594 https://clinicaltrials.gov/ct2/show/NCT01049594.EudraCT: EudraCT: 2009-011602-42 (https://www.clinicaltrialsregister.eu/).

Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.

Legislative changes relating to professional nursing practice and a reduction in junior doctors’ working hours have led to an increase in the number of nurse practitioners in the UK. While the educational preparation for these new roles is varied, the challenges faced by nurse practitioners are similar in nature and have implications for the nursing profession as a whole. The measures that can facilitate the development of individual nurse practitioners include: effective communication and negotiation regarding the introduction of their role; clearly defined and documented role descriptions; clarification regarding areas of risk and liability; and organizational and professional support. The stance of the nursing profession in relation to the development of the nurse practitioner role is also explored and questions are raised about crossboundary working, future role development, and the impact of nurse practitioners on the delivery of patient care.

Buckley, Key W. (1989). Mechanical man: John Broadeus Watson and the beginnings of Behaviorism.New York: Guilford Press. Pp. 293. ISBN 0-89862-744-3. $32.45/£18.00.Colgan, P. (1989), Animal Motivation.New York and London: Chapman and Hall. Pp. 168. ISBN 0412-31850. £25.00 (hardback). ISBN 0412-31860, £10.95 (paperback).Antinucci, F (Ed.) (1989). Cognitive structure and development in nonhuman prinates. Hillsdale,Nj: Laweence Erlbaum Associates, Inc. Pp. 266. ISBN 0-8058-0544. £16.50 (Hardback).Parker, S.T. & Gibson, K.R. (Eds.) (1990). “Language” and intelligence in monkeys and apes.Cambridge: Cambridge University Press. Pp. 590. ISBN 0-521-38028-6. £40.00 (hardback).Ley, Ronald (1990). A whisper of espionnage: Wolfgang Koehler and the apes of Tenerife.Garden City Park, NY: Avery Publoshing Corporation. Pp.264. ISBN 0-89529-432-x. $19.95.

The article focuses on a study conducted by the researchers from the Policy Research Unit for Maternal Health and Care at the University of Oxford's National Perinatal Epidemiology Unit in Oxford, England which shows that fathers loved their partner's pregnancy and engaged in pregnancy test, ultrasound examinations and labor. It further mentions that Paternal engagement was highest in partners of white women living in less deprived areas and in those whose pregnancy was planned.

OBJECTIVE:s To estimate the cost effectiveness of alternative planned places of birth. Design Economic evaluation with individual level data from the Birthplace national prospective cohort study. Setting 142 of 147 trusts providing home birth services, 53 of 56 freestanding midwifery units, 43 of 51 alongside midwifery units, and a random sample of 36 of 180 obstetric units, stratified by unit size and geographical region, in England, over varying periods of time within the study period 1 April 2008 to 30 April 2010. Participants 64 538 women at low risk of complications before the onset of labour. Interventions Planned birth in four alternative settings: at home, in freestanding midwifery units, in alongside midwifery units, and in obstetric units. MAIN OUTCOME MEASURES: Incremental cost per adverse perinatal outcome avoided, adverse maternal morbidity avoided, and additional normal birth. The non-parametric bootstrap method was used to generate net monetary benefits and construct cost effectiveness acceptability curves at alternative thresholds for cost effectiveness. RESULTS: The total unadjusted mean costs were £1066, £1435, £1461, and £1631 for births planned at home, in freestanding midwifery units, in alongside midwifery units, and in obstetric units, respectively (equivalent to about €1274, $1701; €1715, $2290; €1747, $2332; and €1950, $2603). Overall, and for multiparous women, planned birth at home generated the greatest mean net benefit with a 100% probability of being the optimal setting across all thresholds of cost effectiveness when perinatal outcomes were considered. There was, however, an increased incidence of adverse perinatal outcome associated with planned birth at home in nulliparous low risk women, resulting in the probability of it being the most cost effective option at a cost effectiveness threshold of £20 000 declining to 0.63. With regards to maternal outcomes in nulliparous and multiparous women, planned birth at home generated the greatest mean net benefit with a 100% probability of being the optimal setting across all thresholds of cost effectiveness. CONCLUSIONS: For multiparous women at low risk of complications, planned birth at home was the most cost effective option. For nulliparous low risk women, planned birth at home is still likely to be the most cost effective option but is associated with an increase in adverse perinatal outcomes.