Archives of Disease in Childhood - Fetal and Neonatal Edition, 2011
Objective To compare the effects of metoclopramide and domperidone on the breast milk output of m... more Objective To compare the effects of metoclopramide and domperidone on the breast milk output of mothers with infants in neonatal intensive care. Design Double-blind randomised controlled trial. Setting Tertiary level neonatal intensive care unit (NICU). Sample Eighty mothers expressing breast milk for their infants (mean gestational age 28 weeks) based in NICU and the amounts expressed fell short of the prescribed target. Intervention Mothers were randomised to receive domperidone or metoclopramide for 10 days (10 mg three times a day). Outcome measures Total milk volume daily for up to 10 days before the medication, 10 days during the trial and up to 10 days after medication. Adverse side effects were also recorded. Results Mothers produced more milk in the domperidone group and achieved a mean of 96.3% increase in milk volume (mean increase/pretrial volume) compared with a 93.7% increase for metoclopramide. After adjusting for the amount of milk produced prior to medication, the mean amount of milk produced while taking medication for those on domperidone was 31.0 ml/24 h (95% CI −5.67 to 67.6) greater than the mean for those on metoclopramide. Seven mothers taking metoclopramide reported side effects and three taking domperidone; a further eight women (of 29) who had a follow-on prescription for metoclopramide also reported side effects. Conclusions Oral domperidone and metoclopramide increased the volume of milk produced by mothers who are expressing to feed their babies in NICU. There were small differences in milk output between the two medications and in the incidence of side effects, but the differences were non-signifi cant.
which permits unrestricted use, distribution, and reproduction in any medium, provided the origin... more which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Jane Scott and colleagues have recently published a paper in the International Breastfeeding Journal showing that health professionals are still giving harmful advice to women with mastitis. We see the management of mastitis as an illustration of health professionals ' management of wider breastfeeding issues. If health professionals don't know how to manage this common problem, how can they be expected to manage less common conditions such as a breast abscess or nipple/breast candidiasis? There is an urgent need for more clinical research into breastfeeding problems and to improve the education of health professionals to enable them to promote breastfeeding and support breastfeeding women. Editorial "Acute mastitis is an all too common disease which has not had the attention it deserves " [1] (p. 635). Mastitis is "an inflammatory cond...
The WestminsterResearch online digital archive at the University of Westminster aims to make the ... more The WestminsterResearch online digital archive at the University of Westminster aims to make the research output of the University available to a wider audience. Copyright and Moral Rights remain with the authors and/or copyright owners. Users are permitted to download and/or print one copy for non-commercial private study or research. Further distribution and any use of material from within this archive for profit-making enterprises or for commercial gain is strictly forbidden.
Archives of disease in childhood. Fetal and neonatal edition, Jan 3, 2016
The length of stay for moderately preterm infants has progressively become shorter in the UK in r... more The length of stay for moderately preterm infants has progressively become shorter in the UK in recent years but staff still commonly inform parents that their baby will go home around their estimated date of delivery (EDD). Parents need as much notice as possible to prepare for the discharge of their baby, and to gain the necessary skills and knowledge to care for their infant safely. We report the use of routinely collected neonatal data to develop and implement a simple centile chart for date of discharge from hospital, which allows staff and parents to predict the likely discharge date more accurately for preterm infants, most of whom now go home more than 3 weeks before their EDD. This information allows better and timelier planning for discharge of such infants, by parents and staff.
BackgroundImproved survival and shorter length of stay (LOS) for preterm infants, together with p... more BackgroundImproved survival and shorter length of stay (LOS) for preterm infants, together with poorly organised discharge planning in some neonatal units, leaves many parents ill prepared to take their babies home, with increased use of out-of-hours services. Despite the importance accorded to family-orientated neonatal care by the Department of Health and the National Institute for Health and Care Excellence, few neonatal units offer structured, family-orientated discharge planning.ObjectivesTo implement a parent-orientated discharge planning approach (Train-to-Home package) for preterm infants and investigate the effects on parental self-efficacy scores, infants’ LOS and change in costs associated with use of health-care resources in the 8 weeks after discharge, before and after implementation.DesignA before-and-after study, investigating the effects of Train-to-Home package during two 11-month periods, immediately before and after its implementation.SettingFour local neonatal un...
By allowing families to increase in size, co-operation between parents and adolescents in infant ... more By allowing families to increase in size, co-operation between parents and adolescents in infant care was encouraged. Young adult pairs were subsequently created with these marmosets which had experience of handling infants to provide a stable basis for breeding 2nd and 3rd generation marmosets in captivity.
By allowing families to increase in size, cooperation between parents and adolescents in infant c... more By allowing families to increase in size, cooperation between parents and adolescents in infant care was encouraged. Young adult pairs were subsequently created with these marmosets which had experience of handling infants to provide a stable basis for breeding 2nd and 3rd generation marmosets in captivity.
The WestminsterResearch online digital archive at the University of Westminster aims to make the ... more The WestminsterResearch online digital archive at the University of Westminster aims to make the research output of the University available to a wider audience. Copyright and Moral Rights remain with the authors and/or copyright owners. Users are permitted to download and/or ...
... PARENTS AND INFANTS, AND THE DEVELOPMENT OF INDEPENDENCE IN THE COMMON MARMOSET (CALLITHRIX J... more ... PARENTS AND INFANTS, AND THE DEVELOPMENT OF INDEPENDENCE IN THE COMMON MARMOSET (CALLITHRIX JACCHUS) BY JENNIFER C . INGRAM ... Api,Li : M 1 : NS Api ,Li : F 2 : Ns 2 : NS 1 : Ns RFR: M RFR: F Family groups : SD = Samson and Delilah ...
Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID... more Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID feasibility trial explored the processes of conducting a randomised control trial (RCT) with people who inject drugs (PWID) in a low threshold agency. Feasibility of the intervention investigated whether offering PWID immediate access to OST via specialist primary care increased numbers in OST at 3 months, compared to offering advice and case management. Methods Un-blinded RCT was conducted at Bristol Drugs Project needle exchange. A total of 311 individuals were eligible and 100 consented to participate. Trial process outcomes involved exploring OST status at 3 months; secondary outcomes were substance use and health related quality of life measures. Results Follow-up was 86%. At 3 months, 51% intervention and 47% of control participants were in OST (OR of success of intervention 1.17 (0.54-2.57). Opioid use reduced by 79% and 73% respectively (OR of intervention success 1.38 (0.5-3.7). Physical and mental health improved but there was little differences between groups. Conclusions The feasibility of conducting the trial was a success, but there was insufficient evidence of an effect compared to intensive case management. Further development and evaluation of case management approaches in low-threshold agencies is warranted.
Ingram JC, Woolridge MW, Greenwood RJ, McGrath L. Maternal predictors of early breast milk output... more Ingram JC, Woolridge MW, Greenwood RJ, McGrath L. Maternal predictors of early breast milk output. Acta Paediatr 1999; 88: 493-9. Stockholm. ISSN 0803-5253 Previous attempts to show a quantitative relationship between maternal hormone levels and early milk output have used small sample sizes and simple correlations. Women of mixed parity and similar socio-economic status and education were recruited to a study using multivariate analysis to look for these associations. Hormone levels (oestradiol, progesterone, prolactin and thyrotropin (TSH)) were determined for 91 mothers at four time points (ante-and postnatally) from fingerprick blood spots by fluoro-immunoassay. Milk output at 1 and 4 weeks was determined from 24-h test weighings. Parity was found to be the most significant factor affecting breast milk volume at 1 wk postpartum (multiparous women delivered 142 ml more milk in 24 h than primiparous women). Total time spent feeding had a strong association with breast milk volume, with increasing time having a negative effect. Multiple regression analysis, controlling for parity and time spent feeding, showed a positive association of milk output at 1 wk with antenatal progesterone and antenatal prolactin levels. At 4 wk, higher postpartum oestradiol levels had a negative association and antenatal progesterone levels a positive association with milk output. This study demonstrates that there are quantitative associations between antenatal maternal hormone levels and breast milk output in the early postnatal period. & Breast milk output, oestradiol, parity, progesterone, prolactin
BackgroundRapid discharge strategies for patients with low-risk chest pain using high-sensitivity... more BackgroundRapid discharge strategies for patients with low-risk chest pain using high-sensitivity troponin assays have been extensively evaluated. The adherence to, and acceptability of such strategies, has largely been explored using quantitative data. The aims of this integrated qualitative study were to explore the acceptability of the limit of detection and ECG discharge strategy (LoDED) to patients and health professionals, and to refine a discharge information leaflet for patients with low-risk chest pain.MethodsPatients with low-risk chest pain who consented to a semi-structured interview were purposively sampled for maximum variation from four of the participating National Health Service sites between October 2018 and May 2019. Two focus groups with ED health professionals at two of the participating sites were completed in April and June 2019.ResultsA discharge strategy based on a single undetectable hs-cTn test (LoDED) was acceptable to patients. They trusted the health pr...
International Journal of Environmental Research and Public Health
This study aimed to develop empirically grounded recommendations and a coherent model of psycholo... more This study aimed to develop empirically grounded recommendations and a coherent model of psychological care derived from the experiences and psychological care needs of COVID-19 frontline doctors, using semi-structured interviews and thematic analysis. Participants were UK frontline doctors specialising in Emergency Medicine, Anaesthetics, or Intensive Care (n = 31) purposively sampled for maximum variation on gender, specialty, ethnicity, and trauma-related distress; most worked in ICU during the pandemic (71%). Four themes were derived: (1) ‘coping strategies’, participants used many, including exercise, mindfulness, and “wait until it gets really bad”; (2) ‘sources of support’, participants valued embedded psychological support, digital services, and informal conversations with colleagues or family, though there was little opportunity; (3) ‘organisational influences on wellbeing’, participants reported a love–hate relationship for concepts like ‘wellbeing’, seen as important but ...
Background The UK has low levels of breastfeeding initiation and continuation, with evident socio... more Background The UK has low levels of breastfeeding initiation and continuation, with evident socioeconomic disparities. To be inclusive, peer-support interventions should be woman-centred rather than breastfeeding-centred. Assets-based approaches to public health focus on the positive capabilities of individuals and communities, rather than their deficits and problems. The Assets-based feeding help Before and After birth (ABA) intervention offers an assets-based approach based on behaviour change theory. Objective To investigate the feasibility of delivering the ABA infant feeding intervention in a randomised controlled trial. Design This was an individually randomised controlled feasibility trial; women were randomised in a 1 : 1 ratio to either the intervention group or the comparator (usual care) group. Setting Two separate English sites were selected because they had an existing breastfeeding peer support service, relatively high levels of socioeconomic disadvantage and low rates...
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2011
Objective To compare the effects of metoclopramide and domperidone on the breast milk output of m... more Objective To compare the effects of metoclopramide and domperidone on the breast milk output of mothers with infants in neonatal intensive care. Design Double-blind randomised controlled trial. Setting Tertiary level neonatal intensive care unit (NICU). Sample Eighty mothers expressing breast milk for their infants (mean gestational age 28 weeks) based in NICU and the amounts expressed fell short of the prescribed target. Intervention Mothers were randomised to receive domperidone or metoclopramide for 10 days (10 mg three times a day). Outcome measures Total milk volume daily for up to 10 days before the medication, 10 days during the trial and up to 10 days after medication. Adverse side effects were also recorded. Results Mothers produced more milk in the domperidone group and achieved a mean of 96.3% increase in milk volume (mean increase/pretrial volume) compared with a 93.7% increase for metoclopramide. After adjusting for the amount of milk produced prior to medication, the mean amount of milk produced while taking medication for those on domperidone was 31.0 ml/24 h (95% CI −5.67 to 67.6) greater than the mean for those on metoclopramide. Seven mothers taking metoclopramide reported side effects and three taking domperidone; a further eight women (of 29) who had a follow-on prescription for metoclopramide also reported side effects. Conclusions Oral domperidone and metoclopramide increased the volume of milk produced by mothers who are expressing to feed their babies in NICU. There were small differences in milk output between the two medications and in the incidence of side effects, but the differences were non-signifi cant.
which permits unrestricted use, distribution, and reproduction in any medium, provided the origin... more which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Jane Scott and colleagues have recently published a paper in the International Breastfeeding Journal showing that health professionals are still giving harmful advice to women with mastitis. We see the management of mastitis as an illustration of health professionals ' management of wider breastfeeding issues. If health professionals don't know how to manage this common problem, how can they be expected to manage less common conditions such as a breast abscess or nipple/breast candidiasis? There is an urgent need for more clinical research into breastfeeding problems and to improve the education of health professionals to enable them to promote breastfeeding and support breastfeeding women. Editorial "Acute mastitis is an all too common disease which has not had the attention it deserves " [1] (p. 635). Mastitis is "an inflammatory cond...
The WestminsterResearch online digital archive at the University of Westminster aims to make the ... more The WestminsterResearch online digital archive at the University of Westminster aims to make the research output of the University available to a wider audience. Copyright and Moral Rights remain with the authors and/or copyright owners. Users are permitted to download and/or print one copy for non-commercial private study or research. Further distribution and any use of material from within this archive for profit-making enterprises or for commercial gain is strictly forbidden.
Archives of disease in childhood. Fetal and neonatal edition, Jan 3, 2016
The length of stay for moderately preterm infants has progressively become shorter in the UK in r... more The length of stay for moderately preterm infants has progressively become shorter in the UK in recent years but staff still commonly inform parents that their baby will go home around their estimated date of delivery (EDD). Parents need as much notice as possible to prepare for the discharge of their baby, and to gain the necessary skills and knowledge to care for their infant safely. We report the use of routinely collected neonatal data to develop and implement a simple centile chart for date of discharge from hospital, which allows staff and parents to predict the likely discharge date more accurately for preterm infants, most of whom now go home more than 3 weeks before their EDD. This information allows better and timelier planning for discharge of such infants, by parents and staff.
BackgroundImproved survival and shorter length of stay (LOS) for preterm infants, together with p... more BackgroundImproved survival and shorter length of stay (LOS) for preterm infants, together with poorly organised discharge planning in some neonatal units, leaves many parents ill prepared to take their babies home, with increased use of out-of-hours services. Despite the importance accorded to family-orientated neonatal care by the Department of Health and the National Institute for Health and Care Excellence, few neonatal units offer structured, family-orientated discharge planning.ObjectivesTo implement a parent-orientated discharge planning approach (Train-to-Home package) for preterm infants and investigate the effects on parental self-efficacy scores, infants’ LOS and change in costs associated with use of health-care resources in the 8 weeks after discharge, before and after implementation.DesignA before-and-after study, investigating the effects of Train-to-Home package during two 11-month periods, immediately before and after its implementation.SettingFour local neonatal un...
By allowing families to increase in size, co-operation between parents and adolescents in infant ... more By allowing families to increase in size, co-operation between parents and adolescents in infant care was encouraged. Young adult pairs were subsequently created with these marmosets which had experience of handling infants to provide a stable basis for breeding 2nd and 3rd generation marmosets in captivity.
By allowing families to increase in size, cooperation between parents and adolescents in infant c... more By allowing families to increase in size, cooperation between parents and adolescents in infant care was encouraged. Young adult pairs were subsequently created with these marmosets which had experience of handling infants to provide a stable basis for breeding 2nd and 3rd generation marmosets in captivity.
The WestminsterResearch online digital archive at the University of Westminster aims to make the ... more The WestminsterResearch online digital archive at the University of Westminster aims to make the research output of the University available to a wider audience. Copyright and Moral Rights remain with the authors and/or copyright owners. Users are permitted to download and/or ...
... PARENTS AND INFANTS, AND THE DEVELOPMENT OF INDEPENDENCE IN THE COMMON MARMOSET (CALLITHRIX J... more ... PARENTS AND INFANTS, AND THE DEVELOPMENT OF INDEPENDENCE IN THE COMMON MARMOSET (CALLITHRIX JACCHUS) BY JENNIFER C . INGRAM ... Api,Li : M 1 : NS Api ,Li : F 2 : Ns 2 : NS 1 : Ns RFR: M RFR: F Family groups : SD = Samson and Delilah ...
Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID... more Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID feasibility trial explored the processes of conducting a randomised control trial (RCT) with people who inject drugs (PWID) in a low threshold agency. Feasibility of the intervention investigated whether offering PWID immediate access to OST via specialist primary care increased numbers in OST at 3 months, compared to offering advice and case management. Methods Un-blinded RCT was conducted at Bristol Drugs Project needle exchange. A total of 311 individuals were eligible and 100 consented to participate. Trial process outcomes involved exploring OST status at 3 months; secondary outcomes were substance use and health related quality of life measures. Results Follow-up was 86%. At 3 months, 51% intervention and 47% of control participants were in OST (OR of success of intervention 1.17 (0.54-2.57). Opioid use reduced by 79% and 73% respectively (OR of intervention success 1.38 (0.5-3.7). Physical and mental health improved but there was little differences between groups. Conclusions The feasibility of conducting the trial was a success, but there was insufficient evidence of an effect compared to intensive case management. Further development and evaluation of case management approaches in low-threshold agencies is warranted.
Ingram JC, Woolridge MW, Greenwood RJ, McGrath L. Maternal predictors of early breast milk output... more Ingram JC, Woolridge MW, Greenwood RJ, McGrath L. Maternal predictors of early breast milk output. Acta Paediatr 1999; 88: 493-9. Stockholm. ISSN 0803-5253 Previous attempts to show a quantitative relationship between maternal hormone levels and early milk output have used small sample sizes and simple correlations. Women of mixed parity and similar socio-economic status and education were recruited to a study using multivariate analysis to look for these associations. Hormone levels (oestradiol, progesterone, prolactin and thyrotropin (TSH)) were determined for 91 mothers at four time points (ante-and postnatally) from fingerprick blood spots by fluoro-immunoassay. Milk output at 1 and 4 weeks was determined from 24-h test weighings. Parity was found to be the most significant factor affecting breast milk volume at 1 wk postpartum (multiparous women delivered 142 ml more milk in 24 h than primiparous women). Total time spent feeding had a strong association with breast milk volume, with increasing time having a negative effect. Multiple regression analysis, controlling for parity and time spent feeding, showed a positive association of milk output at 1 wk with antenatal progesterone and antenatal prolactin levels. At 4 wk, higher postpartum oestradiol levels had a negative association and antenatal progesterone levels a positive association with milk output. This study demonstrates that there are quantitative associations between antenatal maternal hormone levels and breast milk output in the early postnatal period. & Breast milk output, oestradiol, parity, progesterone, prolactin
BackgroundRapid discharge strategies for patients with low-risk chest pain using high-sensitivity... more BackgroundRapid discharge strategies for patients with low-risk chest pain using high-sensitivity troponin assays have been extensively evaluated. The adherence to, and acceptability of such strategies, has largely been explored using quantitative data. The aims of this integrated qualitative study were to explore the acceptability of the limit of detection and ECG discharge strategy (LoDED) to patients and health professionals, and to refine a discharge information leaflet for patients with low-risk chest pain.MethodsPatients with low-risk chest pain who consented to a semi-structured interview were purposively sampled for maximum variation from four of the participating National Health Service sites between October 2018 and May 2019. Two focus groups with ED health professionals at two of the participating sites were completed in April and June 2019.ResultsA discharge strategy based on a single undetectable hs-cTn test (LoDED) was acceptable to patients. They trusted the health pr...
International Journal of Environmental Research and Public Health
This study aimed to develop empirically grounded recommendations and a coherent model of psycholo... more This study aimed to develop empirically grounded recommendations and a coherent model of psychological care derived from the experiences and psychological care needs of COVID-19 frontline doctors, using semi-structured interviews and thematic analysis. Participants were UK frontline doctors specialising in Emergency Medicine, Anaesthetics, or Intensive Care (n = 31) purposively sampled for maximum variation on gender, specialty, ethnicity, and trauma-related distress; most worked in ICU during the pandemic (71%). Four themes were derived: (1) ‘coping strategies’, participants used many, including exercise, mindfulness, and “wait until it gets really bad”; (2) ‘sources of support’, participants valued embedded psychological support, digital services, and informal conversations with colleagues or family, though there was little opportunity; (3) ‘organisational influences on wellbeing’, participants reported a love–hate relationship for concepts like ‘wellbeing’, seen as important but ...
Background The UK has low levels of breastfeeding initiation and continuation, with evident socio... more Background The UK has low levels of breastfeeding initiation and continuation, with evident socioeconomic disparities. To be inclusive, peer-support interventions should be woman-centred rather than breastfeeding-centred. Assets-based approaches to public health focus on the positive capabilities of individuals and communities, rather than their deficits and problems. The Assets-based feeding help Before and After birth (ABA) intervention offers an assets-based approach based on behaviour change theory. Objective To investigate the feasibility of delivering the ABA infant feeding intervention in a randomised controlled trial. Design This was an individually randomised controlled feasibility trial; women were randomised in a 1 : 1 ratio to either the intervention group or the comparator (usual care) group. Setting Two separate English sites were selected because they had an existing breastfeeding peer support service, relatively high levels of socioeconomic disadvantage and low rates...
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Papers by Jenny Ingram