Parents' early healthcare transition experiences with preterm and acutely ill infants: a scoping review.

BACKGROUND: Parents undergo multiple transitions following the birth of an ill infant: their infant's illness-health trajectory, neonatal intensive care unit hospitalization and transfers from one healthcare setting to another, while also transitioning to parenthood. The objective of this review was to map and synthesize evidence on the experiences and needs of parents of preterm or ill infants as they transition within and between healthcare settings following birth. METHODS: The scoping review followed Arskey and O'Malley's () framework, enhanced by Levac et al. (). Relevant studies were identified through a comprehensive search strategy of scientific and grey literature databases, online networks, Web of Science and citation lists of relevant articles. Inclusion criteria encompassed a focus on infants undergoing a healthcare transition, and the experiences and needs of parents during transition. Studies were appraised for design quality, and data relevant to parent experiences were extracted and underwent thematic analysis. RESULTS: A total of 7773 records were retrieved, 90 full texts reviewed and 11 articles synthesized that represented a total sample of 435 parents of preterm or ill infants. Parents reported on their experiences in response to their infant's transition within and between hospitals and across levels of neonatal intensive care unit, intermediate and community hospital care. Ten studies used qualitative research methods, while one employed quantitative survey methods. Four key themes were identified: that of parent distress throughout transition, parenting at a distance, sources of stress and sources of support. Parents' stress resulted from not being informed or involved in the transition decision, inadequate communication and perceived differences in cultures of care across healthcare settings. CONCLUSIONS: Opportunities to improve parents' early transition experiences include enhanced engagement, communication, information-sharing and shared decision-making between health care providers and parents. Future areas of research should focus on early transition interventions to advance parent capacity, confidence and closeness as the primary nurturer.

Survival of the Townley knee. 360 cases with 8 (0.1-15) years' follow-up.

We evaluated 360 Townley arthroplasties in 167 OA and in 193 RA knees, performed between 1978-1986. 35 revisions were performed during the follow-up time. The main reasons for revision were aseptic loosening (18 knees), instability (6 knees), and infection (5 knees). The durability of different prosthesis components and of different tibial trays in relation to loosening were analyzed separately. The probability of the prosthesis remaining in situ was 94 percent after 5 years and 89 percent after 10 years. The success rate at 10 years was not significantly higher in arthrosis (94 percent) than in rheumatoid arthritis (85 percent). The other patient-related factors, age, sex, weight, did not influence the results. Comparing the different prosthesis components and the different designs of the tibial tray, we found no differences in success rates.