Case Discussion: ( ), RN, ScD, MPH : 24,,,,,,, ( ) ) ( ),
: ( ),,
randomized controlled trial (RCT). minimization program,,,, : : ; Apgar score > 7 ;, : ; ; ; ; (BT<36.3; HR>180/min;
2, 83,50 (60.2%)., 25 ( 30 ),, 60,,,. : Baseline measure:,, 60 Sure Temp (Welch Allyn Model 986) Biopack monitor (MP100) Anderson Behavioral State Scale:, 30,.
vs Baseline 37.0 (0.4) vs. 36.9 (0.4), p=0195 30 37.0 (0.5) vs. 36.9 (0.4), p=0.221 60 37.3 (0.4) vs. 37.0 (0.3), p=0.022 : vs Pretest 141.6 (11.9) vs. 134.9 (13.2), p=.07 15 137.3 (10.8) vs. 131.4 (10.0), p=.053 30 139.4 (14.8) vs. 132.9 (10.3), p=.079 45 137.6 (12.9) vs. 131.3 (12.3), p=.087 60 135.1 (13.4) vs. 128.5 (10.5), p=.061
vs Pretest 97.2 (2.2) vs. 98.2 (1.3), p=.06 15 97.5 (1.8) vs. 98.3 (1.2), p=.063 30 97.6 (1.4) vs. 97.8 (1.5), p=.671 45 96.8 (2.3) vs. 97.6 (2.0), p=.187 60 96.8 (1.8) vs. 97.6 (2.0), p=.125 : vs % 14.4 (12.6) vs. 0.6 (1.5), p=.001 26.6 (13.1) vs. 12.9 (5.5), p=.002 7.7 (6.6) vs. 14.8 (7.7), p=.019 1.9 (2.8) vs. 9.5 (6.2), p<.001 0.6 (1.6) vs. 7.7 (5.8), p<.001 27.6 (22.6) vs. 2.8 (4.7), p=.001
vs % 1.9 (2.2) vs. 4.6 (4.3), p=.056 0 (0) vs. 1.5 (2.6), p=.36 4.8 (3.4) vs. 11.7 (7.6), p=.003 4.5 (5) vs. 5.2 (3.0), p=.653 5.8 (5.2) vs. 21.5 (7.4), p<.001 :, 60,,,
:., Quality assessment Purpose of quality assessment Can I use this intervention in my patients? RCT design with limited sample size from one institution.
1. Were participants randomized to study groups? Yes 2. Allocation to treatment group was concealed from the allocator? Yes 3. Other than research intervention, were participants in each group treated the same? No 4. Were groups comparable at entry? Yes 5. Were the outcome measured in the same manner for all participants? Yes RCT Critical Appraisal Form 6. Those assessing outcome were blinded to treatment allocation? No 7. Outcomes were measured in a reliable manner? Not clear 8. The statistical analysis used was appropriate for the data presented? Yes 9. Was there adequate follow-up of participants? Yes
theoretical basis, ( )?? Quality assessment: Internal validity Adequate allocation concealment: Allocation to treatment was concealed from the allocator. Method of random assignment: Well described. Selection bias: Participation rate is moderate. Did not use successive admissions, who to ask to participate is a concern. Healthy preterm/ was
Performance bias: possible Infant feeding Move of infants Measurement bias Outcome assessors and care providers did not blind to the group status. Patient is not blinded. Indicated time point and duration of measurement. Quality assessment: Internal validity Attrition bias: none? Norm?.? moving time? Stabilization time? Potential confounding: environmental
60??? (or norm)?. Critical Appraisal, Size of the effect
Only from one institution Selection bias: high educational level?? Inclusion of only NBW, healthy, and NSD mothers Did not include foreign spouses Practice Implications Context The intervention Importance of the outcomes Further evidence is needed to justify use of this intervention.
, RCT Thank you for your attention