Lullaby Trust

Abstract: Background Conflict is a recognised component of healthcare. Disagreements about treatment protocols, treatment aims and poor communication are recognised warning signs. Conflict management strategies can be used to prevent escalation, but are not a routine component of clinical training. Objective To report the findings from a novel training intervention, aimed at enabling paediatric staff to identify and understand the warning signs of conflict, and to implement conflict resolution strategies. Design and setting Self-report measures were taken at baseline, immediately after the training and at 6 months. Questionnaires recorded quantitative and qualitative feedback on the experience of training, and the ability to recognise and de-escalate conflict. The training was provided in a tertiary teaching paediatric hospital in England over 18 months, commencing in June 2013. Intervention A 4-h training course on identifying, understanding and managing conflict was provided to staff. Results Baseline data were collected from all 711 staff trained, and 6-month follow-up data were collected for 313 of those staff (44%). The training was successful in equipping staff to recognise and de-escalate conflict. Six months after the training, 57% of respondents had experienced conflict, of whom 91% reported that the training had enabled them to de-escalate the conflict. Learning was retained at 6 months with staff more able than at baseline recognising conflict triggers (Fischer9s exact test, p=0.001) and managing conflict situations (Pearson9s χ 2 test, p=0.001). Conclusions This training has the potential to reduce substantially the human and economic costs of conflicts for healthcare providers, healthcare staff, patients and relatives.

Abstract: Background Consent rates for postmortem (PM) examination in the perinatal and paediatric setting have dropped significantly in the United Kingdom, the United States, and the Western Europe. We explored the factors that act as facilitators or barriers to consent and identified processes and practices that support parental decision-making. Methods A qualitative study conducted with bereaved parents, parent advocates, and health care professionals in the United Kingdom. Analysis was conducted on 439 free-tect comments within a cross-sectional survey, interviews with a subset of 20 survey respondents and 25 health professionals, and a focus group with five parent advocates. Results Three broad parental decision-making groups were identified: 1, "Not open to postmortem examination"; 2, "Consent regardless of concerns"; and 3, "Initially undecided." Decisional drivers that were particularly important for this "undecided" group were "the initial approach," "adjustment and deliberation," "detailed discussion about the procedure," and "formal consent." The way in which these were managed by health care staff significantly impacted whether those parents' consented to PM, particularly for those who are ambivalent about the procedure. Conclusions We propose a set of recommendations to improve the way PM counselling and consent is managed. Adopting such measures is likely to lead to improved family experience and more consistent and high-quality discussion regarding PM.

Abstract: The impact on sudden infant death rates of the “Back to Sleep” or “Reduce the Risk” campaigns introduced across many countries in the late 1980s and early 1990s has been hailed as one of the great public health success stories of the 20th century (1, 2). Many countries around the world saw substantial reductions in their sudden infant death syndrome (SIDS) rates around the time of introduction of the campaigns (Figure 12.1), with falls of between 42% and 92% (Figure 12.2). The rate of SIDS was halved in the United Kingdom (UK) in just one year, and in New Zealand in two years (1, 3). Instituting a “Back to Sleep” campaign has been estimated to have saved 3,000 lives in New Zealand, 17,000 lives in the UK, and 40,000 lives in the United States (3).Since the initial drop-off immediately after the “Back to Sleep” campaigns, the rate of SIDS has continued to decline in line with overall post-neonatal mortality (4). For example, in England and Wales, SIDS rates fell from an average of 2.27 per 1,000 live births in 1986-88 to 0.66 per 1,000 live births in 1993-95 and 0.32 per 1,000 live births in 2012-14 (5). These reductions have been accompanied by a shift in the demographics of SIDS cases, such that most cases now occur in high-risk families with multiple recognized risk factors (6). As a result, SIDS rates are much higher in families from deprived socioeconomic backgrounds and particular population groups, such as the Māori population in New Zealand (7) or the Indigenous and black populations in the United States (8). While these campaigns appear to have effectively reached some segments of our population and resulted in behavioral change, this is not universal.In order to better understand how we can reach those higher-risk groups and achieve further reductions in SIDS rates, we need a better understanding of the nature and impact of preventive strategies. In this chapter we will outline the principles of public health approaches to prevention and the evidence base for different strategies; in light of this, we will consider the evidence for current approaches to further reduce the risk of SIDS.

Abstract: The successful reduction in cot deaths (sudden infant death syndrome or SIDS) in England and Wales from nearly 1600 deaths in 1988 to less than 200 in 2015 stems from evidence based research.1 Results from case-control studies internationally form the basis for infant sleep recommendations. We are, therefore, concerned that cardboard boxes are being promoted for infant sleep, as a safe alternative to the more traditional cots, bassinets, or Moses baskets, without any observational evidence in place.23 The cardboard baby box is based on a Finnish tradition of giving pregnant women a box full of free infant care items—including a mattress that fits into the bottom of the box as a makeshift infant sleeping environment—as an incentive to enter prenatal care early. It was one component of a drive towards reducing health inequalities, recognising the privations of the Finnish population after the second world war. Any government or charity that is willing to provide a box full of free unbranded infant care items should be applauded, but we have three concerns: the scarcity of observational evidence that the cardboard baby box can be used safely (and no evidence that it reduces SIDS), the lack of safety standard regulations in place, …