Stephanie Kukora - Academia.edu (original) (raw)

Papers by Stephanie Kukora

Acta Paediatrica, Dec 28, 2023

American Journal of Bioethics, Nov 2, 2022

Frontiers in Pediatrics

Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neona... more Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to ident...

The Journal of Pediatrics

Journal of Obstetric, Gynecologic & Neonatal Nursing, 2022

OBJECTIVE To contemporize the Attitudes About Drug Abuse in Pregnancy questionnaire, keep the len... more OBJECTIVE To contemporize the Attitudes About Drug Abuse in Pregnancy questionnaire, keep the length of the modified scale brief to promote use, and test the psychometric properties of the modified scale among perinatal nurses. DESIGN Cross-sectional survey. SETTING Four hospitals in the Midwestern United States. PARTICIPANTS Registered nurses who worked in perinatal units (N = 440). METHODS We collected data from participants using survey methods. Seven experts in perinatal substance use research and clinical care informed scale modifications. We used a split-sample design involving maternal-newborn units (labor, postpartum) and newborn-focused units (NICU, pediatrics). We evaluated construct validity using factor analysis and reliability using Cronbach's alpha. We tested for differences between units using analysis of variance and Tukey's post hoc honest significant difference test of pairwise differences. RESULTS The final modified scale included 13 items that loaded on one factor and showed internal consistency reliability in both samples (α = .88-.91). We found a statistically significant difference in mean score between NICU and pediatric units; however, the absolute difference was small and likely not clinically significant. CONCLUSIONS The Modified Attitudes About Drug Use in Pregnancy scale has initial evidence for validity and reliability, was updated to reflect current terminology in the field, and is a pragmatic tool for use in research.

Background: Effectively preparing medical students to communicate with patients, families, and te... more Background: Effectively preparing medical students to communicate with patients, families, and teams remains a challenge in medical education. Although techniques from medical improvisation have been introduced to teach communication skills in this context, limited evidence exists regarding how such training elicits student involvement, impacts clinical students’ communication skills, and affects medical students’ authentic clinical care interactions. Objective: To implement a medical improvisation-based educational training in the pre-clinical year and gather medical students’ reflections following one year of clinical rotations. Methods: We recruited medical student volunteers to participate in an established medical improvisation curriculum, complete course evaluations, and provide progressive reflections as they began and continued their clinical medical training. Course duration was 2 hours per week for 5 weeks, prior to beginning clinical rotations. Participants completed anon...

BMC Medical Informatics and Decision Making

Background Parents who have to make tracheostomy decisions for their critically ill child may fac... more Background Parents who have to make tracheostomy decisions for their critically ill child may face forecasting errors and wish to learn from peer parents. We sought to develop an intervention with peer parent narratives to help parents anticipate and prepare for future challenges before making a decision. Methods To ensure that the intervention reflects parents’ needs (rather than experts’ opinions), we adapted a user-centered design (UCD) process to identify decision-critical information and refine the presentation format by interviewing parents who had tracheostomy decision making experience. Phase 1 (n = 10) presented 15 possible forecasting errors and asked participants to prioritize and justify the problematic ones. It also asked participants to comment on the draft narratives and preferred delivery mode and time of the intervention. Phase 2 (n = 9 additional parents and 1 previous parent) iteratively collected feedback over four waves of user interviews to guide revisions to t...

Medical Decision Making

Purpose Parents who face goals-of-care tracheostomy decisions may lack an understanding of challe... more Purpose Parents who face goals-of-care tracheostomy decisions may lack an understanding of challenges affecting their child’s and family’s long-term quality of life (QOL) to accurately forecast possible outcomes for decision making. We sought to examine whether and how parents’ narratives of the child’s and family’s long-term QOL influence parental tracheostomy decisions and forecasting. Method We recruited US adult Amazon Mechanical Turk participants ( N = 1966) who self-reported having a child (<6 y old) or planning a pregnancy within 5 y. Participants read a vignette about making a tracheostomy decision for their hypothetical neurologically impaired baby. They were randomized to 1 of the following 4 conditions: 1) Baby QOL narratives, 2) Family QOL narratives, 3) Baby QOL + Family QOL narratives, and 4) control: no narratives. They then made a decision about whether or not to pursue tracheostomy, forecasted their concerns about the baby’s and family’s QOL, reported their value...

Journal of Perinatology

In our response to, “Parental request for non-resuscitation in fetal myelomeningocele repair: an ... more In our response to, “Parental request for non-resuscitation in fetal myelomeningocele repair: an analysis of the novel ethical tensions in fetal intervention” by Wolfe and co-authors, we argue that parental authority should guide resuscitation decision-making for a fetus at risk for preterm delivery as a complication of fetal myelomeningocele (fMMC) repair. Due to the elevated morbidity and mortality risks of combined myelomeningocele, extreme prematurity, and fetal hypoxia, parents’ values regarding the acceptability of possible outcomes should be elicited and their preferences honored. Ethical decision-making in these situations must also consider the broader context of the fetal-maternal dyad. Innovations in fetoscopic approaches to fMMC repair may pose additional complexity to these resuscitation decisions.

BMC Pediatrics, 2022

Background In high income countries, guidelines exist recommending gestational age thresholds for... more Background In high income countries, guidelines exist recommending gestational age thresholds for offering and obligating neonatal resuscitation for extremely preterm infants. In low- and middle- income countries, this approach may be impractical due to limited/inconsistent resource availability and challenges in gestational dating. Scant literature exists on how clinicians in these settings conceptualize viability or make resuscitation decisions for premature infants. Methods Qualitative interviews of interprofessional neonatal clinicians were conducted in Kumasi, Ghana, at Komfo Anokye Teaching Hospital and Suntreso Government Hospital, and in Addis Ababa, Ethiopia, at St. Paul’s Hospital Millennium Medical College. Transcribed interviews were coded through the constant comparative method. Results Three discrete major themes were identified. The principal theme was a respect for all life, regardless of the likelihood for survival. This sense of duty arose from a duty to God, a dut...

Journal of Biosocial Science, 2021

Neonatal mortality is one of the leading causes of under-five mortality globally, with the majori... more Neonatal mortality is one of the leading causes of under-five mortality globally, with the majority of these deaths occurring in low- and middle-income countries. In Ghana, there is a belief in an array of newborn conditions, called Asram, that are thought to have a spiritual, rather than physical, cause. These conditions are predominantly managed by traditional healers as they are considered unable to be treated by allopathic medical providers. Through a series of semi-structured qualitative interviews of medical providers in Kumasi, Ghana, conducted in July–August 2018, this study sought to elucidate perspectives of allopathic medical providers about Asram, including the perceived implications of traditional newborn care patterns on newborn health and higher-level neonatal care. Twenty health care providers participated and represented a tertiary care hospital and a district hospital. Medical providers were universally aware of Asram but varied on the latitude they gave this belie...

Frontiers in Pediatrics, 2021

Background and Objective: In Ethiopia, birth asphyxia causes ~30% of all neonatal deaths and 11–3... more Background and Objective: In Ethiopia, birth asphyxia causes ~30% of all neonatal deaths and 11–31% of deaths among neonates delivered in healthcare facilities that have breathing difficulty at birth. This study aimed to examine the impact of low-dose, high-frequency (LDHF) training for introducing a nurse-led neonatal advanced life support (NALS) service in a tertiary care hospital in Ethiopia.Methods: Through a retrospective cohort study, a total of 12,001 neonates born post-implementation of the NALS service (between June 2017 and March 2019) were compared to 2,066 neonates born before its implementation (between June 2016 and September 2016). Based on when the neonates were born, they were divided into six groups (groups A to F). All deliveries occurred in the inpatient Labor and Delivery Unit (LDU) at St. Paul's Hospital Millennium Medical College. The number of neonatal deaths in the LDU, neonatal intensive care unit (NICU) admission rate, and proportion of neonates with n...

Neonatologists play a pivotal role providing consultation before and after delivery to expectant ... more Neonatologists play a pivotal role providing consultation before and after delivery to expectant parents faced with threatened prematurity, congenital anomalies and genetic disorders, and birth injury. In addition to what to expect when having an infant in the neonatal intensive care unit (NICU), neonatologists must also include goals of care and whether intensive therapies alongside comfort measures are to be provided for life-threatening neonatal conditions. They must be flexible in adapting their consultation style according to the specific medical situation and needs of the expectant parents. Critical skills include what information to provide and how to relay it clearly, as well as how to elicit parents’ values and integrate them in decision-making.

Acta Paediatrica, 2021

Use of composite NICU research outcomes for goals of care counselling creates ethical challenges.... more Use of composite NICU research outcomes for goals of care counselling creates ethical challenges. Acta Paediatr.

Academic Pediatrics, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Section on Hospice and Palliative Medicine Program, 2021