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Supervised contact centres, where a child may maintain contact with a parent (mother or father) in a safe and supervised environment, have been available in New Zealand since the early 1990s. This article explores the services provided by such centres, previous research on the topic and describes the experiences of 12 parents participating in supervised contact arrangements at centres. Parents' overall experiences of supervised contact centres are positive, with strengths being that the contact centre staff are viewed as supportive and understanding, and that the service fulfils an important role in improving relationships between child and parent. Limitations include the lack of resources, (in)flexibility regarding rules and the lack of feedback beyond the contact session. Supervised contact centres provide a means by which a group of parents are enabled to maintain and/or develop relationships with their children (and vice versa) that would not otherwise happen. [ABSTRACT FROM AUTHOR]

Objective: To identify the differences in radiation exposure per suspected stone episode between percutaneous nephrostomy tube (PCN), stent, and primary ureteroscopy (URS).The incidence of nephrolithiasis in pregnancy is low; however, repercussions for both mother and fetus can be significant. In cases of suspected obstructing nephrolithiasis, intervention may be required, including ureteral stent, PCN, or URS, with the potential for multiple subsequent procedures that often utilize fluoroscopy., Methods: Pregnant patients who required an intervention (stent, PCN, or URS) for suspected obstructing nephrolithiasis were retrospectively reviewed. The primary outcome was total fluoroscopy exposure per suspected stone episode. Secondary outcomes included fluoroscopic exposure per procedure and number of procedures required., Results: After excluding patients with renal anomalies and incomplete radiation data, 78 out of 100 patients were included in the analysis. Forty patients (51.3%) underwent initial stent placement, 22 (28.2%) underwent initial PCN placement, and 16 (20.5%) underwent primary URS. Total mean radiation exposure per stone episode was significantly higher in patients who underwent PCN, (286.9 mGy vs 3.7 mGy (stent) and 0.2 mGy (URS), P <.001). In addition, patients who underwent initial PCN placement had significantly more procedures (P <.001) and mean radiation exposure per procedure was higher (P <.001). More than 40% of PCNs experienced dysfunction, and mean duration between PCN exchanges was 16.5 days., Conclusion: In pregnant patients with suspected obstructing nephrolithiasis requiring intervention, initial PCN placement was associated with a significantly higher number of procedures, radiation exposure per procedure, and total radiation exposure per suspected stone episode compared to stent and URS., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: This study investigated cesarean delivery surgical site infection (SSI) rates before and after implementation of a SSI care bundle., Methods: A SSI bundle for cesareans was introduced in our hospital in April 2014 to reduce the SSI rate. The practices were divided into bundle elements that reflected preoperative, intraoperative, and postoperative care. We conducted a retrospective cohort study to evaluate implementation of the SSI care bundle. Women were included if they had a gestational age of at least 23 0/7 weeks and delivered a liveborn neonate(s) between 2012 and 2015. They were then divided into 2 study groups: pre-bundle and post-bundle. The primary study outcome was SSI rate. Secondary outcomes included comorbidities, perioperative factors, and SSI classification., Results: The overall incidence of cesarean SSIs during the study time period was 1.89 (76 SSIs in 4014 cesarean deliveries). The pre-bundle mean was 2.44 and decreased to 1.1 following implementation of the SSI bundle (P = .013). This represents a 221% reduction in the SSI rate. Patient demographics and pre-existing medical conditions were similar pre- and post-bundle. Compliance with bundle elements was high., Conclusions: A significant reduction in SSI rate in cesarean deliveries was seen following implementation of an infection prevention bundle., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Hypertension and cardiovascular disease are common in children undergoing dialysis. Studies suggest that hemodiafiltration (HDF) may reduce cardiovascular mortality in adults, but data for children are scarce., Methods: The HDF, Heart and Height study is a nonrandomized observational study comparing outcomes on conventional hemodialysis (HD) versus postdilution online HDF in children. Primary outcome measures were annualized changes in carotid intima-media thickness (cIMT) SD score and height SD score., Results: We enrolled 190 children from 28 centers; 78 on HD and 55 on HDF completed 1-year follow-up. The groups were comparable for age, dialysis vintage, access type, dialysis frequency, blood flow, and residual renal function. At 1 year, cIMT SD score increased significantly in children on HD but remained static in the HDF cohort. On propensity score analysis, HD was associated with a +0.47 higher annualized cIMT SD score compared with HDF. Height SD score increased in HDF but remained static in HD. Mean arterial pressure SD score increased with HD only. Factors associated with higher cIMT and mean arterial pressure SD-scores were HD group, higher ultrafiltration rate, and higher β 2-microglobulin. The HDF cohort had lower β 2-microglobulin, parathyroid hormone, and high-sensitivity C-reactive protein at 1 year; fewer headaches, dizziness, or cramps; and shorter postdialysis recovery time., Conclusions: HDF is associated with a lack of progression in vascular measures versus progression with HD, as well as an increase in height not seen in the HD cohort. Patient-related outcomes improved among children on HDF correlating with improved BP control and clearances. Confirmation through randomized trials is required., (Copyright © 2019 by the American Society of Nephrology.)

Background: Cardiovascular disease is prevalent in children on dialysis and accounts for almost 30% of all deaths. Randomised trials in adults suggest that haemodiafiltration (HDF) with high convection volumes is associated with reduced cardiovascular mortality compared to high-flux haemodialysis (HD); however paediatric data are scarce. We designed the haemodiafiltration, heart and height (3H) study to test the hypothesis that children on HDF have an improved cardiovascular risk profile, growth and nutritional status and quality of life, compared to those on conventional HD. We performed a non-randomised parallel-arm intervention study within the International Paediatric Haemodialysis Network Registry comparing children on HDF and conventional HD to determine annualised change in cardiovascular end-points and growth. Here we present the 3H study design and baseline characteristics of the study population., Methods: 190 children were screened and 177 (106 on HD and 71 on HDF) recruited from 28 centres in 10 countries. There was no difference in age, underlying diagnosis, comorbidities, previous dialysis therapy, dialysis vintage, residual renal function, type of vascular access or blood flow between HD and HDF groups. High flux dialysers were used in 63% of HD patients and ultra-pure water was available in 52%. HDF patients achieved a median convection volume of 13.3 L/m 2 ; this was associated with the blood flow rate only ((p = 0.0004, r = 0.42) and independent of access type (p = 0.38)., Discussion: This is the largest study on dialysis outcomes in children that involves deep phenotyping across a wide range of cardiovascular, anthropometric, nutritional and health-related quality of life measures, to test the hypothesis that HDF leads to improved cardiovascular and growth outcomes compared to conventional HD., Trial Registration: ClinicalTrials.gov: NCT02063776 . The trial was prospectively registered on the 14 Feb 2014.

Purpose: Activity pacing (AP) is widely used to manage chronic pain. However, recent developments in pain management do not necessarily include AP. Research has explored the experience of AP for physiotherapists who specialize in chronic pain. The innovation of this study is to build on previous research by exploring the experiences of patients and physiotherapists who do not specialize in chronic pain., Methods: We interviewed eight patients with chronic musculoskeletal pain who had used AP and eight physiotherapists working in an out-patient department who had not specialized in chronic pain. Interviews were recorded, and transcribed verbatim and Interpretative Phenomenological Analysis (IPA) were used for analysis., Results: We present the following themes: 1) I have tried everything and have no other place to go; 2) AP provides a tangible, physical structure that can be used flexibly; 3) working to retune the brain to a different way of life; 4) retuning the brain can pay off in the end as "less is more"; 5) working hard to connect with patients; 6) connecting with patients can be exhausting; and 7) the patient needs to be on board., Conclusion: AP can provide a useful vehicle for psychological change through experiential learning. It can support psychological flexibility and is not incompatible with other biopsychosocial approaches.

Purpose: Activity pacing is a strategy used by physiotherapists treating people with chronic pain. Questions as to the usefulness of activity pacing with people with chronic pain have been raised clinically and in research. This study explores physiotherapists' experiences of using activity pacing with people with chronic musculoskeletal pain., Method: We interviewed six physiotherapists and used the methods of Interpretative Phenomenological Analysis (IPA) to explore the meaning of pacing., Results: We identified three master themes. First, activity pacing was perceived as part of a process whereby patients came to realize that change is possible, and that life could be different. Second, in order to use activity pacing effectively the physiotherapist needs to shift from a "fix it" to a "sit with" approach to the treatment. Third physiotherapists described how they used many combined therapeutic approaches in managing chronic pain., Conclusions: This study increases our understanding of activity pacing and will help to make the best use of activity pacing in clinical practice, and optimize outcomes for the patients. These findings suggest that physiotherapists need to develop reflective listening skills, and use an experiential learning approach to facilitate activity pacing.

Background: As the Chilean population ages, anesthesiologists are regularly faced with elderly and even nonagenarian people undergoing surgical procedures., Aim: To determine the postoperative survival time in nonagenarians and its risk factors at a private clinic., Material and Methods: Review of medical records of the clinic, searching for patients aged 90 years or older, which were subjected to a surgical procedure between 2001 and 2012. Certification of survival or death was obtained from the clinical records or death certification at the National Identification Service. Survival analysis was made using Kaplan-Meier and Gompertz regression., Results: The medical records of 167 patients, aged 90 to 101 years (64% women), were reviewed. Sixty four percent had an underlying cardiovascular disease; in 37%, cognitive impairment. Hip fracture surgery was the most common procedure. One intraoperative death occurred. Five percent of patients died one month after surgery. The median survival time was two years and the longest, seven years. According to Gompertz probability regression, the predictors of death were the presence of cardiac disease (Hazard ratio (HR): 1.91, 95% confidence intervals (95% CI): 1.16; 3.16), cognitive impairment (HR: 2.10,95% CI: 1.32; 3,22), cancer (HR:2.10,95% CI: 1.32; 3.22), requirement of transfusion (HR: 1.79, 95% CI: 1.13; 2.83) and an American Society of Anesthesiologists (ASA) Class III classification (HR: 1.95, IC95%: 1.21; 3.15)., Conclusions: In nonagenarian patients undergoing surgery; 50% mortality was observed 2 years after surgery. The presence of cardiac disease, cognitive impairment, cancer, transfusion and a Class IIIASA classification were predictors of death.

Background: In individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)., Aims: To perform a systematic review of all such studies., Method: We conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability., Results: A total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was -0.14, 95% Cl -0.07 to -0.22). A similar significant advantage was found against SSRIs (20 studies) but not tricyclic antidepressants (7 studies)., Conclusions: Venlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.

A cross-sectional duplex study of blood flow in the fetal aorta, umbilical artery, and arcuate arteries of 111 normal subjects was performed once at between 20 and 42 weeks gestation. Peak systolic velocity, end-diastolic velocity, mean velocity, and volume flow were measured in the fetal aorta, and systolic to diastolic (S/D) ratios were measured in all three vessels. Velocities show an inverse exponential (Y = Exp [1/X x B + C]) increase with gestational age, reaching a plateau just before term, while S/D ratios in the aorta and umbilical arteries show a linear decrease. Such findings are at variance with some published data. Our results suggest a reduction in fetal placental resistance at term and provide useful data concerning normal fetal and placental circulations.