Effectiveness of preventive parental education delivered from pregnancy to 1 month postpartum on improving infant sleep and parental sleep and depression: a systematic review protocol.

OBJECTIVE: This review aims to evaluate the effectiveness of preventive parental education on infant sleep problems, delivered from pregnancy to 1 month postpartum, on infant sleep, postpartum parental sleep, and depression. INTRODUCTION: Infant sleep problems are likely to persist into childhood if not treated and are　associated with difficulties in later development. Parents of children with sleep problems had lower sleep quality and emotional regulation than those without sleep problems. Chronic sleep deprivation and fragmentation increases the risk of maternal depression. Therefore, preventive parental education regarding infant sleep problems can improve the long-term well-being of both children and their parents. INCLUSION CRITERIA: Experimental and quasi-experimental study designs, including preventive parental education about infant sleep problems delivered from pregnancy to 1 month postpartum, will be considered. The outcomes will be infants' sleep, postpartum parental sleep, and parental depression. METHODS: MEDLINE (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (Japan Medical Abstracts Society) will be searched without restrictions regarding language or date of publication. Eligible studies will be critically appraised, and data will be extracted by 2 independent reviewers using the JBI methodology. The studies will be pooled for statistical meta-analysis. Where statistical pooling is not possible, the findings will be presented in narrative format. We will use the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty in the quality of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER: The review title for this protocol is registered in PROSPERO (CRD42023430562).

Pregnant nurses' experiences of working shifts: a qualitative systematic review.

OBJECTIVE: The objective of this systematic review was to synthesize the experiences of nurses who work shifts during pregnancy. INCLUSION CRITERIA: This review included studies that focused on the experiences of pregnant registered nurses, regardless of their level of qualification, working shifts in any workplace, including hospitals, nursing home facilities, or clinics, in any country. Nurses not involved in direct care (eg, advanced practice nurses, administrators, educators) were excluded. METHODS: The review followed the JBI methodology for qualitative systematic reviews. Published and gray literature were searched for via CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycINFO (EBSCOhost), Igaku Chuo Zasshi (Japan Medical Abstracts Society), and JBI Evidence Synthesis. No language restrictions were imposed, and the date limit was set for 2013 to 2021. Two independent reviewers performed data collection, extraction, critical appraisal, and analysis. Unequivocal and credible findings were used to develop categories, which were then synthesized to provide a set of comprehensive findings, which were graded according to ConQual. RESULTS: Five qualitative studies were included (2 from the USA, 2 from Japan, and 1 from Korea), from which 23 findings with narrative illustrations were extracted. Of these findings, 22 were assessed as unequivocal, 1 as credible, and 3 not supported. The studies were low-to-moderate quality based on the JBI critical appraisal checklist for qualitative research. All studies used qualitative methodologies, including phenomenology, qualitative description, and the grounded theory approach. Results were integrated into 7 categories and 3 synthesized findings. The first synthesized finding was that nurses struggle with the physical burden of pregnancy and work environments that threaten continued pregnancy. The second was that nurses achieve work-pregnancy compatibility by disclosing their pregnancy and obtaining support. The third was that development as a nurse results from continuing to work during pregnancy. CONCLUSIONS: Pregnant nurses face a harsh work environment; the support they receive after disclosing their pregnancy allows them to balance work and pregnancy; and they feel that they grow as professionals by continuing to work even if they are pregnant. More research is needed to inform support systems for them. REVIEW REGISTRATION: PROSPERO CRD42022309674. SUPPLEMENTAL DIGITAL CONTENT: A Japanese-language version of the abstract of this review is available [http://links.lww.com/SRX/A31].

Pregnant nurses' experiences of working shifts: a qualitative systematic review protocol.

OBJECTIVE: The proposed systematic review will synthesize the experiences of nurses working in any shifts during pregnancy. INTRODUCTION: Nurses are among the most burdened health care workers and are at risk of diseases of the circulatory system due to prolonged standing. For pregnant nurses, this could reduce blood circulation and blood flow to the uterus and placenta. Contributing factors include long working hours and frequent heavy lifting, which may induce uterine contractions and premature birth; irregular shifts, which exacerbate fatigue; and high levels of psychosocial stress. There is no qualitative evidence as to what nurses are experiencing while working shifts when pregnant. This review will evaluate and integrate the current available findings related to the experience of shift-working nurses who are pregnant. INCLUSION CRITERIA: This review will include qualitative studies focusing on the experience of shift work among pregnant nurses. No language or date limits will be applied. All types of pregnancy among nurses will be included. METHODS: The databases to be searched will include CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycINFO (EBSCOhost), and Igaku Chuo Zasshi (the Japan Medical Abstracts Society). Sources of gray literature will include MedNar and DANS, as well as the websites of the American Nurses Association and the Japanese Nursing Association. Study selection, critical appraisal, data extraction, and data synthesis will be performed independently by 2 reviewers. The synthesized findings will be graded according to the ConQual approach for establishing confidence in findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022309674.

Differences in specific concerns perceived by parents of children with cleft lip and/or palate based on the types of cleft.

BACKGROUND: Parents of children with cleft lip and/or palate (CL/P) have concerns including guilt and worry. Differences in concerns by cleft type is, however, under-researched. AIM: To compare differences in perceived concerns among parents of children with CL/P by cleft type, adjusting for children's gender and age. DESIGN: Cross-sectional study conducted in an outpatient centre, assessing psychological status of 171 parents of children aged <12 with CL/P using 12 items. RESULTS: Across cleft types, 'I am worried about whether the child's teeth will be straight' was the most strongly perceived concern (70.8%). After adjusting for gender and age, logistic regression showed significant differences in type of CL/P for (eg) 'I am worried that the child's appearance will not be beautiful', associated with CL over CP (OR = 0.07, 95% CI: 0.02-0.26) and CLP over CP (8.52, 3.23-22.50);' 'I am concerned about my child being able to speak well', associated with CP (3.12, 1.07-9.11) and CLP (5.69, 2.43-13.33) over CL, and 'I am worried that the child could suffer due to his/her appearance', associated with CL over CP (0.08, 0.02-0.29) and CLP over CP (10.07, 13.78-27.36). CONCLUSIONS: Parents' concerns were influenced by cleft type.

The effectiveness of vibratory stimulation in reducing pain in children receiving vaccine injection: A randomized controlled trial.

BACKGROUND: Although vaccine injections are important, children experience pain and discomfort upon their administration. BUZZY®, a vibratory stimulation tool with an ice pack, was reported to be an effective tool for reducing the pain caused to children during injection administration; its mechanisms were explained by gate control theory. However, the evidence is inadequate because of insufficient methodology in previous reports. Therefore, we aimed to assess whether the application of vibration would significantly reduce children's pain during vaccine injections. METHODS: A single-blind randomized controlled trial recruiting children aged ≤6 years who were receiving vaccine injections was conducted between August and December 2019. If the children's parents consented to their participation, BUZZY® was attached to the child's arm prior to vaccination. BUZZY® was switched on before injection in the intervention group but not in the control group. The vaccination procedure was recorded, and researchers and parents assessed each child's pain using validated pain scales. Researchers conducted their assessment using video data to ensure blinding. Parents were administered a questionnaire after the children's vaccination. Data were analyzed using the t-test or chi-square test. RESULTS: We analyzed 118 children (intervention group = 62, control = 56). No between-group difference was observed according to the researchers' assessment (mean score = 6.98 and 7.63, respectively; p = 0.25); however, a significant difference was found based on the parents' assessment (mean score = 7.39 versus 8.46; p = 0.02). Most responses received to open-ended questions were positive comments for this study. CONCLUSIONS: We revealed that the effect of vibration is not significant in reducing vaccine injection pain among children. Further studies are needed to examine the other components of BUZZY®, which include its cooling effect, and the effect of BUZZY® itself in terms of whether children will undergo vaccination without resistance and have reduced trauma related to vaccination.

Decision-making process to undergo surgery among adolescent patients with cleft lip and/or palate.

AIM: As patients with cleft lip and/or palate grow older, the main decision-making process for treatment is likely to shift from a parent-centered to a patient-centered process. However, many adolescent patients have difficulty in treatment decision-making. This study aimed to clarify the decision-making process regarding undergoing surgery among adolescent patients with cleft lip and/or palate. METHODS: Participants were adolescent patients with cleft lip and/or palate aged 14-18 years who were admitted to a hospital in Japan for surgery. Fourteen patients (six boys, eight girls) and their parents agreed to participate in this study. Data were collected in face-to-face semi-structured interviews. Data were analyzed qualitatively with inductive content analysis. RESULTS: Fifteen categories were classified into three themes for adolescent patients' decision-making processes regarding undergoing surgery. The three themes were: (a) a doctor's recommendation for surgery, (b) psychological conflict about surgery, and (c) a final decision about surgery. CONCLUSION: This study's findings suggest that adolescent patients with cleft lip and/or palate were not adequately involved in the decision-making process before undergoing surgery. Medical staff need to explain other treatment options, the risks and benefits of surgery with materials and methods that adolescent patients can understand as part of "a doctor's recommendation for surgery." Medical staff and parents need to encourage adolescent patients to communicate their preferences and values to reduce patients' "psychological conflict about surgery" and adolescent patients' intentions should be considered in "a final decision about surgery."

Impact of breastfeeding and/or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: A systematic review.

BACKGROUND: Immediately after cleft lip repair, breastfeeding and bottle-feeding are generally restricted to avoid placing tension on the surgical incision. However, no consensus about feeding methods after cleft lip repair has been reached. The objective of this systematic review was to examine the impact of breastfeeding and/or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants. MATERIAL AND METHODS: We searched PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Mednar from October to November 2017. Two reviewers independently assessed eligibility for inclusion and checked critical appraisal of the study quality. RESULTS: Three randomized controlled trials and two cohort studies involving 342 infants were included in this review. Two cases of surgical wound dehiscence occurred in the control group of alternative feeding. In three of five studies, surgical wound dehiscence did not occur in either the intervention or control group within the first week postoperatively. CONCLUSIONS: This review showed no increased risk of surgical wound dehiscence in infants with breastfeeding and/or bottle-feeding after cleft lip repair compared with infants with alternative feeding methods. It may not be necessary to restrict breastfeeding and/or bottle-feeding immediately after cleft lip repair.

Resilience and difficulties of parents of children with a cleft lip and palate.

AIM: The present study explored the differences in emotional difficulties and resilience between fathers and mothers of a child with a cleft lip and palate. METHODS: Married couples were recruited who were accompanying their child with a cleft lip and palate (<12 years old) on regular visits to an outpatient clinic in a Japanese hospital. The participants were distributed an anonymous questionnaire that included items regarding emotional difficulties with the cleft lip and palate and a scale to measure resilience when caring for the children. In the data analysis, the paired t-test was used to compare the individuals within the couples. RESULTS: By analyzing the data of 64 couples who provided valid responses, two items with the highest mean score for the difficulties that were faced by both the father and mother of a child with a cleft lip and palate were: "I am worried about whether the child's teeth will be straightened" and "I am worried that the children could suffer due to their appearance." The mothers felt significantly more worry about their child's future and more guilt than did the fathers. In contrast, the fathers had greater resilience, in terms of problem-solving skills and recognition and acceptance than did the mothers. CONCLUSION: It is important that healthcare providers understand the difference between the fathers' and mothers' worries about their child with a cleft lip and palate. Specific support services should be offered to fathers with a high level of resilience, in terms of the acceptance of reality and problem-solving, which could increase their parenting ability.

Impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to examine the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants. BACKGROUND: Immediately after cleft lip repair in infants, breastfeeding and bottle-feeding are generally restricted. Alternative feeding methods such as spoon-feeding are recommended to avoid placing tension on the surgical wound. However, some studies have reported that alternative feeding methods are a source of stress to the infant and cause them to cry incessantly, resulting in postoperative weight loss. This suggests that these alternative feeding methods may have an unfavorable impact on surgical wound healing. However, a consensus on this topic has not been reached. The objective of this systematic review is to examine the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants.Cleft lip and/or palate is a craniofacial anomaly and one of the most common birth defects. The incidence of cleft lip and/or palate differs among races, ethnic groups and geographical areas. The prevalence of cleft lip and/or palate is highest in South American countries (Bolivia: 22.94 per 10,000 live births; Paraguay: 14.90 per 10,000 live births), followed by Asian countries (China: 13.60 per 10,000 live births; Japan: 16.04 per 10,000 live births). The prevalence is lowest in African countries (3.54 per 10,000 live births). The overall worldwide prevalence is 7.9 per 10,000 births.A cleft lip and/or a cleft palate can occur separately, although they are more likely to occur together early in pregnancy. These anomalies can be surgically repaired. Without proper treatment, patients have aesthetic and functional problems, such as feeding disorders, otitis media and speech difficulties.Patients with cleft lip and/or palate usually undergo a combination of surgical procedures, speech therapy and orthodontic treatment from infancy to young adulthood. Comprehensive treatment is provided with thoughtful consideration of the balance between intervention and growth. Cleft lip repair is carried out first in comprehensive treatment regimens. The aim of cleft lip repair is to create contrast between the lip and external nose and provide good muscular continuity across the cleft without any scarring. It is usually performed from three to six months of age. Surgery is delayed until this age to allow for growth of the lip structure and assessment of the patient for the presence of comorbidities. The ability of newborn patients with cleft lip and/or palate to drink milk is important for proper growth and development.For cleft lip and/or palate patients in the newborn developmental stage, feeding can be an area of great concern and anxiety for their parents. One study found that 32% of newborn patients with cleft lip and/or palate had poor feeding skills. Feeding difficulties lead to poor growth and development in early infancy and increase the burden of care. Therefore, it is important for new parents to learn appropriate feeding techniques. Infants with cleft lip can generally drink milk from the breast through various ways of feeding. In contrast, infants with both cleft lip and palate have difficulty sucking the nipple because of weak intraoral negative pressure, and specially designed nipples are generally used. Although such infants suckle with weakened pressure, these nipples enable them to drink milk by lightly pushing them through their lip. However, after cleft lip repair, infants with cleft lip and/or palate are forced to change their feeding methods (even infants who have managed to drink milk before the repair).Breastfeeding and bottle-feeding are generally restricted immediately after cleft lip repair. Alternative feeding methods such as the use of a spoon, cup or syringe are recommended to avoid placing tension on the surgical incision. The use of a very soft nipple of sufficient size is recommended to provide a dripping milk flow, thus avoiding tension on the operative site. Some authors have recommended that patients with cleft lip and/or palate be spoon-fed for a certain period of time after cleft lip repair to avoid tension on the surgical site. However, management of the surgical site after surgical repair of cleft lip and/or palate varies among countries and healthcare centers. Little evidence-based research is available to guide healthcare staff members through the many treatment protocols for cleft lip and/or palate. No consensus about feeding methods after cleft lip repair has been reached.The above mentioned alternative feeding methods might influence the process of surgical wound healing. Minimizing crying has been considered to be the most important factor in avoiding tension on the surgical wound. In one study, however, 21.7% of infants who were given milk by a spoon on the first day after cleft lip repair resisted feeding by crying and/or moving the head laterally, while all infants fed by the nipple that had been used preoperatively accepted feeding without a major observable response. In another study, infants who were breastfed or bottle-fed after the repair were reportedly more relaxed than spoon-fed or syringe-fed infants. Changes in feeding methods seem to stress the infants and cause them to cry, which places tension on the wound.These alternative feeding methods may also have other impacts on surgical wound healing. One study reported that infants took longer to drink milk using alternative feeding methods than when using traditional feeding methods after the surgery. A systematic review suggested that alternative feeding methods were associated with less postoperative weight gain in patients than traditional feeding methods. Postoperative nutritional intake also influences wound healing. A long duration of feeding milk coupled with weight loss after the surgery suggests unnecessary energy consumption associated with the alternative feeding methods. Wound healing may consequently be inhibited or delayed.Wound healing complications after surgery include wound infection, dehiscence and proliferative scarring. Surgical wound dehiscence has been regarded as a typical complication after cleft lip and/or palate repair, followed by pyrexia. In one case series, post-surgical complications were found in 11 of 2100 infants who underwent surgical cleft lip and/or palate repair during a seven-year period. Wound dehiscence results from tissue failure rather than improper suturing technique. Therefore, alternative feeding methods are recommended to avoid placing tension on the surgical wound. However, no strong evidence has been presented to show that breastfeeding or bottle-feeding after cleft lip repair may cause surgical wound dehiscence among infants with cleft lip.Our initial search failed to find any systematic review examining the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair using the Cochrane Library, the JBI Database of Systematic Reviews and Implementation Reports, and other bibliographic databases, including MEDLINE and CINAHL. The proposed systematic review will contribute to the understanding of this topic and identify areas for further research. If breastfeeding or bottle-feeding is recommended immediately after cleft lip repair, the patients will experience less stress and crying, placing less tension on the wound than with alternative feeding methods. Breastfeeding or bottle-feeding will result in more weight gain, facilitating wound healing.