By: Vivian M. Liverance RN COHP 450 PICO presentation By: Vivian M. Liverance RN COHP 450

Introduction and Purpose Among infants less than six months old does traditional swaddling as compared to no swaddling increase the risk of hip dysplasia.

Results of Search Engines used Search words Search results Medline/pubmed Onefile (GALE) Hip dysplasia Infant Swaddling Search results Subject is greatly debated. Few research materials. Internet & The International Hip Dysplasia Institute.

Research Articles Blatt, S. (2015). To swaddle, or not to swaddle? Paleoepidemiology of developmental dysplasia of the hip and the swaddling dilemma among the indigenous populations of North America. American Journal of Human Biology, 27(1), 116-128. doi: 10.1002/ajhb.22622  Fu, M., Liu, J., Huang, G., Huang, Z., Zhang, Z., Wu, P., Wang, B., Yang, Z., & Weiming, L. (2014). Impaired ossification coupled with accelerated cartilage degeneration in developmental dysplasia of the hip: evidences from μCT arthrography in a rat model. Bio Med Central Musculoskeletal Disorders, 15,339. Retrieved from http://0go.galegroup.com.libcat.ferris.edu/

Relationship to PICO To swaddle or not to swaddle relationship between swaddling and hip dysplasia. Impaired ossification relationship between swaddling rats and Sources: Blatt, 2015 , Liu, Huang, Huang, Zhang, Wu, Wang, Yang, & Weiming, 2014

Quantitative research using nonparametric analyses and nominal data. Evaluation Quantitative research using nonparametric analyses and nominal data. To swaddle or not to swaddle. analytic retrospective cohort study. Impaired ossification analytical experimental case- study. Sources: Blatt, 2015 , Liu et al, 2014

To swaddle or not to swaddle Sample 679 adult skeletons. Collection method Systematic review of literature. Remains were analyzed. Findings 390 were suitable. Comparable with modern day findings. Swaddling may not cause hip dysplasia. Source: Blatt, 2015

Impaired Ossification Sample 20 model rats and 12 control rats. Collection method Harvesting and dissection. Findings Dysplasia induced by swaddling. Morphological deformity of the dysplasia hip. Source: Liu et al, 2014

Ethical Considerations To swaddle or not to swaddle Remains were analyzed. Descendents may have rights. Impaired ossification Live rats were used. Humane treatment is a consideration. Sources: Blatt, 2015 , Liu et al, 2014

Strength quality and credibility Credible source Textbook, professional journal, credible websites. Objectively written and informational. Sources that are cited. Relevant and recent. Results must answer research question. Source: Forister & Blessing, 2016

To swaddle or not to swaddle Article is peer reviewed. Authored by Dr. Blatt. Objective and relevant. Has professional sources. Purpose of study. Results of study. Low external and internal validity. No evidence based practice. Sources: Blatt, 2015, Forister & Blessing, 2016

Impaired Ossification Article is peer reviewed. Authored by nine orthopedic specialist. Objective and relevant. Has professional sources. Purpose of study. Results of study. High external and internal validity. Contributes to evidence based practice. Ming Fu -Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Jin Liu-Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University & The Institute for Advancing Translational Medicine in Bone & Joint Disease, School of Chinese Medicine, Hong Kong Baptist University Guangxin Huang-Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Zhiyu Huang-Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Zhiqi Zhang-Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Peihui Wu-Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Bingjun Wang-Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Zibo Yang- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Weiming Liao-Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Sources: Liu et al, 2014, Forister & Blessing, 2016

Neither article relevant to PICO question. Relevancy Neither article relevant to PICO question. To swaddle or not to swaddle. Not generlizable. Sources: Blatt, 2015 , Liu et al, 2014

Impaired ossification Not relevant to swaddling but is relevant to orthopedic outcomes. Affect standards of care for DDH. Article is generalizable. Barriers to using information. Source: Liu et al, 2014

PICO question Among infants less than six months old does traditional swaddling as compared to no swaddling increase the risk of hip dysplasia.

Conclusion Articles to not contribute information to swaddling debate. Little information is available. Few studies available. More information needed.   Source: Wang, Liu, Li, Edmonds, Zhao, Zhang, Zhao, & Wang, 2012

References Blatt, S. (2015). To swaddle, or not to swaddle? Paleoepidemiology of developmental dysplasia of the hip and the swaddling dilemma among the indigenous populations of North America. American Journal of Human Biology, 27(1), 116-128. doi: 10.1002/ajhb.22622 Forister, J. G, & Blessing, J. D. (eds.). (2016). Introduction to research and medical literature for health professionals. (4th ed). Burlington, Massachusetts: Jones & Bartlett

Fu, M., Liu, J., Huang, G., Huang, Z., Zhang, Z., Wu, P., Wang, B., Yang, Z., & Weiming, L. (2014). Impaired ossification coupled with accelerated cartilage degeneration in developmental dysplasia of the hip: Evidences from μCT arthrography in a rat model. Bio Med Central Musculoskeletal Disorders, 15,339. Retrieved from http://0go.galegroup.com.libcat.ferris.edu/ Wang, E., Liu, T., Li, J., Edmonds, E.W., Zhao, Q., Zhang, L., Zhao, X., & Wang, K. (2012). Does swaddling influence developmental dysplasia of the hip?: An experimental study of the traditional straight-leg swaddling model in neonatal rats. Journal of Bone Joint Surgical American Volume, 94(12), 1071- 1077. doi: 10.2106/JBJS.K.00720.