No abstract

Evidence of moderate quality shows that use of plastic wraps or bags compared with routine care led to higher temperatures on admission to NICUs with less hypothermia, particularly for extremely preterm infants. Thermal mattresses and SSC also reduced hypothermia risk when compared with routine care, but findings are based on two or fewer small studies. Caution must be taken to avoid iatrogenic hyperthermia, particularly when multiple interventions are used simultaneously. Limited evidence suggests benefit and no evidence of harm for most short-term morbidity outcomes known to be associated with hypothermia, including major brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotising enterocolitis, and nosocomial infection. Many observational studies have shown increased mortality among preterm hypothermic infants compared with those who maintain normothermia, yet evidence is insufficient to suggest that these interventions reduce risk of in-hospital mortality across all comparison groups. Hypothermia may be a marker for illness and poorer outcomes by association rather than by causality. Limitations of this review include small numbers of identified studies; small sample sizes; and variations in methods and definitions used for hypothermia, hyperthermia, normothermia, routine care, and morbidity, along with lack of power to detect effects on morbidity and mortality across most comparison groups. Future studies should: be adequately powered to detect rarer outcomes; apply standardised morbidity definitions; focus on longer-term outcomes, particularly neurodevelopmental outcomes.

Acute Respiratory Distress Syndrome (ARDS) causes significant morbidity and mortality each year. There is a paucity of information regarding the mechanisms necessary for ARDS resolution. Foxp3+ regulatory T cells (Tregs) have been shown to be an important determinant of resolution in an experimental model of lung injury. We demonstrate that intratracheal delivery of endotoxin (LPS) elicits alveolar epithelial damage from which the epithelium undergoes proliferation and repair. Epithelial proliferation coincided with an increase in Foxp3+ Treg cells in the lung during the course of resolution. To dissect the role that Foxp3+ Treg cells exert on epithelial proliferation, we depleted Foxp3+ Treg cells which led to decreased alveolar epithelial proliferation and delayed lung injury recovery. Furthermore, antibody-mediated blockade of CD103, an integrin, which binds to epithelial expressed E-cadherin decreased Foxp3+ Treg numbers and decreased rates of epithelial proliferation after injury. In a non-inflammatory model of regenerative alveologenesis, left lung pneumonectomy (PNX), we found that Foxp3+ Treg cells enhanced epithelial proliferation. Moreover, Foxp3+ Treg cells co-cultured with primary type II alveolar cells (AT2) directly increased AT2 cell proliferation in a CD103-dependent manner. These studies provide evidence of a new and integral role for Foxp3+ Treg cells in repair of the lung epithelium.

Plastic wraps or bags, skin-to-skin care and transwarmer mattresses all keep preterm infants warmer, leading to higher temperatures on admission to neonatal units and less hypothermia. Given the low NNT, consideration should be given to using these interventions in the delivery suite. However, the small numbers of infants and studies and the absence of long-term follow-up mean that firm recommendations for clinical practice cannot be given. There is a need to conduct large, high quality randomised controlled trials looking at long-term outcomes.

There has been increasing emphasis on the important role that interprofessional education (IPE) must play in educating and developing present and future healthcare professionals. However, clarity is urgently needed regarding appropriate strategies for its timing, content, delivery and assessment. This study focuses on the development of an undergraduate IPE programme for medical and nursing students. It compares learning opportunities in classroom and clinical areas and identifies suitable pedagogical strategies and subject areas. The programme consisted of 2 weeks of classroom‐based learning for all 130 participating students, followed by 6 weeks on shared placement for 35 of the 113 medical and all 17 nursing students. A triangulation of data‐collection methods was used to help strengthen reliability and validity and provide a more comprehensive analysis. In both classroom and clinical areas, successful methods of delivery for IPE were those that enabled exchanges of perspectives. Ward‐based IPE was regarded as particularly effective in encouraging students to begin to feel part of a clinical team. In contrast, classroom‐based learning enabled them to know about teamwork, but not to experience it. Practical issues of shift and timetable incompatibility were the most significant barriers to successful placement‐shared learning. Developments in this area will need to focus on those elements of clinical practice which bring students together for collaborative involvement in activities that maximize the benefits resulting from the investment of time and effort involved. We conclude that undergraduate IPE opportunities have an important role to play in enabling students to learn about the roles and responsibilities of others and the impact of this on their own practice. It should be the first step towards developing practitioners who, whilst retaining their own unique professional identity, are able to understand and respect the roles of other healthcare professionals and work collaboratively to improve patient care.