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

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

3. 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.

4. 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), doi:  /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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

16. 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

17. 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), doi: /ajhb Forister, J. G, & Blessing, J. D. (eds.). (2016). Introduction to research and medical literature for health professionals. (4th ed). Burlington, Massachusetts: Jones & Bartlett

18. 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 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), doi: /JBJS.K