Improve the clinical effective decision of the oral feeding readiness in preterm infants: Revise and validate the TC-POFRAS

2021 ◽  
pp. 1-9
Author(s):  
G. Hao ◽  
A. Ni ◽  
Y.J. Chang ◽  
K. Hall ◽  
S.H. Lee ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Health Professionals ◽  
Time Frame ◽  
Oral Feeding ◽  
Optimal Time ◽  
Limited Information ◽  
Readiness Assessment ◽  
Gag Reflex ◽  
Global Accuracy ◽  
The One

BACKGROUND: Currently there is limited information to guide health professionals regarding the optimal time frame to initiate safe and effective oral feedings to preterm infants. The study aims to revise and validate a streamlined version of the “Traditional Chinese-Preterm Oral Feeding Readiness Assessment Scale”, the TC-POFRAS®, and evaluate its construct validity in the clinical decisions regarding feeding readiness of preterm infants. METHODS: Eighty-one clinically stable preterm infants were assessed using the TC-POFRAS for oral feeding readiness. Item-total correlation analysis was used to check if any item was inconsistent with the averaged TC-POFRAS scores. Cronbach’s α coefficient was used to evaluate the inter-item consistency. Exploratory factor analysis was used to determine the coherence of variables to reorganize assessment domains. The revised version of TC-POFRAS (TC-POFRAS®) was developed and a new cut-off score based on discriminant accuracy was established. RESULTS: Based on the results from statistical analysis, five items (“lips posture,” “tongue posture,” “biting reflex,” “gag reflex,” and “tongue cupping”) were deleted from the original TC-POFRAS to form the TC-POFRAS®. The TC-POFRAS®’s global accuracy was 92.1%. The cut-off value of 19 was the one that presented the most optimization of sensitivity based on specificity. The TC-POFRAS® was reconstructed into corrected gestational age and five behavioral domains. CONCLUSIONS: The TC-POFRAS® is considered a valid, safe, and accurate objective instrument to assist health professionals to initiate oral feeding of the preterm infants.

scholarly journals Clinical validation of the Preterm Oral Feeding Readiness Assessment Scale

2013 ◽  
Vol 21 (spe) ◽  
pp. 140-145 ◽  
Author(s):  
Cristina Ide Fujinaga ◽  
Suzana Alves de Moraes ◽  
Nelma Ellen Zamberlan-Amorim ◽  
Thaíla Corrêa Castral ◽  
Andreara de Almeida e Silva ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Sensitivity And Specificity ◽  
Breast Feeding ◽  
Health Professionals ◽  
Roc Curves ◽  
Oral Feeding ◽  
Assessment Scale ◽  
Feeding Practice ◽  
Readiness Assessment ◽  
Global Accuracy

INTRODUCTION: Health professionals have great difficulties to establish the adequate and safe time to start breast feeding in preterm infants. There is a need to develop a standardized tool to help health professionals to comprehensively evaluate preterm infant readiness to transition preterm infants´ feeding from gastric to oral, and encourage breast feeding practice in neonatal units. Aims: To clinical validate the accuracy of a Preterm Oral Feeding Readiness Assessment Scale with 60 clinically stable preterm infants. METHODS: Global accuracy, sensitivity and specificity of Preterm Oral Feeding Readiness Assessment Scale cut-offs, compared to milk intake through translactation, were estimated through ROC curves (Receiver Operating Characteristic Curves). RESULTS: The global accuracy of Preterm Oral Feeding Readiness Assessment Scale was 74.38%. The highest sensitivity and specificity were obtained for three cut-offs: 28, 29 and 30. Since higher specificity (75.68%) for the Preterm Oral Feeding Readiness Assessment Scale was found at a score cut-off=of 30 showed higher specificity (75.68%), it should be used as a cut-off score to select initiate breastfeeding the preterm newborns' oral feeding readiness. CONCLUSION: The Preterm Oral Feeding Readiness Assessment Scale is considered valid to assist health professionals to initiate preterm feeding in view of promoting safe and objective breastfeeding.

scholarly journals Readiness for oral feeding and oral motor function in preterm infants

Revista CEFAC ◽  
2017 ◽  
Vol 19 (4) ◽  
pp. 503-509 ◽  
Author(s):  
Raquel Coube de Carvalho Yamamoto ◽  
Leila Sauer Prade ◽  
Geovana de Paula Bolzan ◽  
Angela Regina Maciel Weinmann ◽  
Márcia Keske-Soares
Keyword(s):  
Preterm Infants ◽  
Motor Function ◽  
Oral Feeding ◽  
Motor Dysfunction ◽  
Assessment Tools ◽  
Assessment Scale ◽  
Readiness Assessment ◽  
Motor Assessment ◽  
Oral Motor ◽  
Oral Motor Function

ABSTRACT Objective: this study aimed at investigating the Schedule Oral Motor Assessment (SOMA) tool to be used with preterm infants and to compare its results with the Preterm Oral Feeding Readiness Assessment Scale (POFRAS) to start oral feeding. Methods: a cross-sectional and quantitative study, consisting in a sample of 45 healthy and clinically stable preterm infants, assessed at their first oral feeding with two tools: the Schedule Oral Motor Assessment and Preterm Oral Feeding Readiness Assessment Scale. Stata 10.0 software was used for data analysis. Results: 10 preterm infants with readiness for oral feeding showed normal oral motor function, and 16, presented with oral motor dysfunction, did not show readiness for feeding (p <0.05). The time of transition for full oral feeding was 13.5 (± 8.1) days for preterm infants with better results in both assessment tools, and 17.7 (± 10.9) days for those who did not show readiness for oral feeding and had oral motor dysfunction to initiate oral feeding, resulting in a given clinical relevance, even showing no significance (p> 0.05). Conclusion: these results suggest that the Schedule Oral Motor Assessment can be an adjunctive method for evaluation of the oral motor function at the first oral feeding in preterm infants.

scholarly journals Effectiveness of Cue-Based Feeding Versus Scheduled Feeding in Preterm Infants Using Comprehensive Feeding Assessment Scales: A Randomized Clinical Trial

2020 ◽  
Vol 30 (6) ◽  
Author(s):  
Farideh Kamran ◽  
Ahmad Reza Khatoonabadi ◽  
Mahshid Aghajanzadeh ◽  
Abbas Ebadi ◽  
Yaser Faryadras ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
P Value ◽  
Readiness Assessment ◽  
Feeding Group ◽  
Postmenstrual Age ◽  
Duration Of Hospitalization

Background: One of the most critical criteria in making ready an infant for discharge from the neonatal intensive care unit (NICU) is full oral feeding attainment. Objectives: The present study aimed at investigating the effectiveness of cue-based feeding in preterm infants. Methods: A randomized clinical trial study was designed to compare 37 preterm infants at a gestational age of ≤ 34 weeks in the cue-based feeding group (n = 18) and the scheduled feeding group (n = 19). All participants were evaluated by the Preterm Infant Oral Feeding Readiness Assessment Scale (PIOFRAS) and Early Feeding Skill (EFS) scale in four different stages. Outcome measures were weight (grams per day), duration of full oral feeding achievement, duration of hospitalization, postmenstrual age (PMA), and the score of PIOFRAS and EFS. A P-value of less than 0.05 has been considered statistically significant. Results: The duration of full oral feeding achievement was shorter in the cue-based feeding group (3.55 ± 1.24 vs 6.68 ± 2.00, P < 0.001). Infants were discharged earlier in the cue-based feeding group (15.55 ± 5.38 vs 27.10 ± 7.90, P < 0.001). The mean score of PIOFRAS only on the day of discharge in the cue-based feeding group was more than the scheduled feeding group (32.61 ± 1.14 vs 31.90 ± 0.87, P = 0.03). The score of EFS in each dimension was inconsistent in each stage, and differences were observed between two groups in the full oral feeding stage. Conclusions: Although PIOFRAS and EFS demonstrated no difference significantly in most of the stages of achievement in oral feeding between the cue-based feeding group and the scheduled feeding, the process of attainment of oral feeding and discharge from the hospital was more rapid in the cue-based feeding group.

Identification of a Pivotal Period in the Oral Feeding Progression of Preterm Infants

2018 ◽  
Vol 36 (05) ◽  
pp. 530-536 ◽  
Author(s):  
Sandra Fucile ◽  
Sarah Phillips ◽  
Kelly Bishop ◽  
Meagan Jackson ◽  
Taylor Yuzdepski ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Motor Skills ◽  
Tube Feeding ◽  
Time Frame ◽  
Oral Feeding ◽  
High Risk Population ◽  
Feeding Difficulties ◽  
Oral Motor ◽  
Enteral Tube Feeding ◽  
Degree Of Maturity

Objective Preterm infants are at risk of encountering oral feeding difficulties which impede on the transition to independent oral feeds. The objective of this study was to identify a pivotal period where regressions are most likely to occur during their oral feeding progression. Study Design This is a retrospective study on 101 infants born <35 weeks' gestation. The sample was separated into two groups, infants who experienced a regression during their oral feeding progression and those who did not. A pivotal period was defined as a time frame where setbacks (a decrease in oral feed attempts by one) are most likely to occur at the start (1–2 oral feed attempts per day), middle (3–5 oral feed attempts per day), or end (6–8 oral feed attempts per day) of the oral feeding progression. Result Eighty-two percent of infants experienced setbacks; 45% of all setbacks occurred at the middle time frame (p = 0.03). Infants' degree of maturity and enteral tube feeding intolerances were associated with increased occurrence of setbacks (p = 0.04). Conclusion The midpoint in the oral feeding progression is a pivotal period where setbacks are most likely to occur. This time frame can be used by clinicians to evaluate oral-motor skills for earlier provision of interventions to reduce the occurrence of oral feeding difficulties in this high-risk population.

The Green New Deal

2019 ◽  
Author(s):  
Robert C. Hockett
Keyword(s):  
New Deal ◽  
Large Scale ◽  
Public Investment ◽  
Climate Science ◽  
Time Frame ◽  
White Paper ◽  
Good News ◽  
Carbon Neutrality ◽  
The One ◽  
In Virtue Of

This white paper lays out the guiding vision behind the Green New Deal Resolution proposed to the U.S. Congress by Representative Alexandria Ocasio-Cortez and Senator Bill Markey in February of 2019. It explains the senses in which the Green New Deal is 'green' on the one hand, and a new 'New Deal' on the other hand. It also 'makes the case' for a shamelessly ambitious, not a low-ball or slow-walked, Green New Deal agenda. At the core of the paper's argument lies the observation that only a true national mobilization on the scale of those associated with the original New Deal and the Second World War will be up to the task of comprehensively revitalizing the nation's economy, justly growing our middle class, and expeditiously achieving carbon-neutrality within the twelve-year time-frame that climate science tells us we have before reaching an environmental 'tipping point.' But this is actually good news, the paper argues. For, paradoxically, an ambitious Green New Deal also will be the most 'affordable' Green New Deal, in virtue of the enormous productivity, widespread prosperity, and attendant public revenue benefits that large-scale public investment will bring. In effect, the Green New Deal will amount to that very transformative stimulus which the nation has awaited since the crash of 2008 and its debt-deflationary sequel.

Somatoform disorders: diseases of the civilization

2020 ◽  
pp. 25-30
Author(s):  
I. Kukhtevich
Keyword(s):  
Health Professionals ◽  
Somatoform Disorders ◽  
Neuropsychiatric Disorders ◽  
The Other ◽  
Significant Part ◽  
Organic Basis ◽  
Autonomic Disorders ◽  
The One ◽  
Somatic Diseases

Functional autonomic disorders occupy a significant part in the practice of neurologists and professionals of other specialties as well. However, there is no generally accepted classification of such disorders. In this paper the authors tried to show that functional autonomic pathology corresponds to the concept of somatoform disorders combining syndromes manifested by visceral, borderline psychopathological, neurological symptoms that do not have an organic basis. The relevance of the problem of somatoform disorders is that on the one hand many health professionals are not familiar enough with manifestations of borderline neuropsychiatric disorders, often forming functional autonomic disorders, and on the other hand they overestimate somatoform symptoms that are similar to somatic diseases.

Construct Validity

2017 ◽  
Author(s):  
Richard McCleary ◽  
David McDowall ◽  
Bradley J. Bartos
Keyword(s):  
Time Series ◽  
Construct Validity ◽  
Hypothesis Test ◽  
Secondary Data ◽  
Time Frame ◽  
Primary Data ◽  
Optimal Time ◽  
Intervention Model ◽  
Right Hand ◽  
The Right

Chapter 8 focuses on threats to construct validity arising from the left-hand side time series and the right-hand side intervention model. Construct validity is limited to questions of whether an observed effect can be generalized to alternative cause and effect measures. The “talking out” self-injurious behavior time series, shown in Chapter 5, are examples of primary data. Researchers often have no choice but to use secondary data that were collected by third parties for purposes unrelated to any hypothesis test. Even in those less-than-ideal instances, however, an optimal time series can be constructed by limiting the time frame and otherwise paying attention to regime changes. Threats to construct validity that arise from the right-hand side intervention model, such as fuzzy or unclear onset and responses, are controlled by paying close attention to the underlying theory. Even a minimal theory should specify the onset and duration of an impact.

scholarly journals Risk Assessment of Circuit Breakers Using Influence Diagrams with Interval Probabilities

Symmetry ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 737
Author(s):  
Jelena D. Velimirovic ◽  
Aleksandar Janjic
Keyword(s):  
Power System ◽  
Predictive Modelling ◽  
Optimal Time ◽  
Influence Diagrams ◽  
Circuit Breakers ◽  
Interval Probability ◽  
Complex Power ◽  
Interval Width ◽  
Credal Sets ◽  
The One

This paper deals with uncertainty, asymmetric information, and risk modelling in a complex power system. The uncertainty is managed by using probability and decision theory methods. More specifically, influence diagrams—as extended Bayesian network functions with interval probabilities represented through credal sets—were chosen for the predictive modelling scenario of replacing the most critical circuit breakers in optimal time. Namely, based on the available data on circuit breakers and other variables that affect the considered model of a complex power system, a group of experts was able to assess the situation using interval probabilities instead of crisp probabilities. Furthermore, the paper examines how the confidence interval width affects decision-making in this context and eliminates the information asymmetry of different experts. Based on the obtained results for each considered interval width separately on the action to be taken over the considered model in order to minimize the risk of the power system failure, it can be concluded that the proposed approach clearly indicates the advantages of using interval probability when making decisions in systems such as the one considered in this paper.

The Effect of Individualized Developmental Care Practices in Preterm Infants

2019 ◽  
Vol 27 (2) ◽  
pp. 97-104
Author(s):  
Dilek Küçük Alemdar ◽  
Sevil İnal
Keyword(s):  
Breast Milk ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Oral Feeding ◽  
Control Group ◽  
Developmental Care ◽  
Significant Difference ◽  
Care Practices ◽  
Maternal Voice

Background: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. Methods: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. Results: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. Conclusion: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.

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