You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Effect of Family-centered Care on Improving Parental Satisfaction and Reducing Readmission among Premature Infants: A Randomized Controlled Trial.
Abstract 1:
INTRODUCTION Healthcare quality is usually evaluated through analysing medical outcomes including neonatal readmission and patient and family satisfaction . Parental involvement in neonatal care is considered as one of the most important factors , which directly affects these outcomes . The aim of the present study was to determine the effect of family-centered care including maternal participation , presence , and information about neonatal care , on maternal satisfaction and neonatal readmission ; the care services were provided by the primiparous mothers of preterm infants . MATERIAL S AND METHODS One hundred and ten primiparous mothers with preterm infants participated in this clinical trial . All sample s were r and omly divided into family-centered care ( FCC ) and control groups , through simple r and om sampling . The FCC program , which consisted of information about neonatal care , maternal presence , and participation in the care process , was implemented in the FCC group , while the control group was provided with routine care . Data were obtained using demographic and satisfaction question naires and readmission checklist . RESULTS In the FCC group , the mean score of satisfaction increased after the implementation of the program ( 22.36 and 59.28 before and after the program , respectively ) ( p<0.001 ) ; however , this increase in the control group was not significant . The obtained results regarding the different aspects of satisfaction indicated that mothers in the FCC group were more satisfied with maternal presence in the neonatal intensive care unit ( NICU ) , compared with aspects of information and participation . In addition , the number of neonatal readmission was less in the FCC group compared with the control group , and the mean duration of hospitalization was 6.96 and 12.96 days in the FCC and control groups , respectively ( p<0.001 ) . CONCLUSION FCC program seems to be effective in increasing maternal satisfaction and decreasing neonatal readmission . Therefore , it seems necessary that healthcare authorities of the departments of obstetrics and gynecology in Iran provide the opportunity for the implementation of such programs in clinical environments , which follow the policy of parental absence and participation in the intensive care units


Title 2:
Documenting the NICU design dilemma: parent and staff perceptions of open ward versus single family room units
Abstract 2:
Objective : With neonatal intensive care units ( NICUs ) evolving from multipatient wards toward family-friendly , single-family room units , the study objective was to compare satisfaction levels of families and health-care staff across these differing NICU facility design s. Study Design : This prospect i ve study documented , by means of institutional review board-approved question naire survey protocol s , the perceptions of parents and staff from two contrasting NICU environments . Result : Findings showed that demographic subgroups of parents and staff perceived the advantages and disadvantages of the two facility design s differently . Staff perceptions varied with previous experience , acclimation time and employment position , whereas parental perceptions revealed a naiveté bias through surveys of transitional parents with experience in both NICU facilities . Conclusion : Use of transitional parent surveys showed a subject naiveté bias inherent in perceptions of inexperienced parents . Grouping all survey participants demographically provided more informative interpretations of data , and revealed staff perceptions to vary with position , previous training and hospital experience


Title 3:
Parental involvement and kangaroo care in European neonatal intensive care units: A policy survey in eight countries
Abstract 3:
Objective : To compare , in a large representative sample of European neonatal intensive care units , the policies and practice s regarding parental involvement and holding babies in the kangaroo care position  as well as differences in the tasks mothers and fathers are allowed to carry out . Design : Prospect i ve multicenter survey . Setting : Neonatal intensive care units in eight European countries ( Belgium , Denmark , France , Italy , The Netherl and s , Spain , Sweden , and the United Kingdom ) . Patients : Patients were not involved in this study . Interventions : None . Measurements and Main Results : A structured question naire was mailed to 362 units ( response rate 78 % ) ; only units with ≥50 very-low-birth-weight annual admissions were considered for this study . Facilities for parents such as reclining chairs near the babies ’ cots , beds , and a dedicated room were common , but less so in Italy and Spain . All units in Sweden , Denmark , the United Kingdom , and Belgium reported encouraging parental participation in the care of the babies , whereas policies were more restrictive in Italy ( 80 % of units ) , France ( 73 % ) , and Spain ( 41 % ) . Holding babies in the kangaroo care position was widespread . However , in the United Kingdom , France , Italy , and Spain , many units applied restrictions regarding its frequency ( sometimes or on parents request only , rather than routinely ) , method ( conventional rather than skin-to-skin ) , and clinical conditions ( especially mechanical ventilation and presence of umbilical lines ) that would prevent its practice . In these countries , fathers were routinely  offered kangaroo care  less frequently than mothers ( p < .001 ) and less often it was skin-to-skin ( p < .0001 ) . Conclusions : This study showed that , although the majority of units in all countries reported a policy of encouraging both parents to take part in the care of their babies , the intensity and ways of involvement as well as the role played by mothers and fathers varied within and between countries


Title 4:
A quasi-experimental trial on individualized, developmentally supportive family-centered care.
Abstract 4:
OBJECTIVE To evaluate the impact of individualized , developmentally supportive family-centered care on infant physiological variables , growth , behavioral stress cues , return to sleep state , medical and developmental progress , complications , re source utilization , parental perception of the neonatal intensive-care unit experience , and overall parental satisfaction . DESIGN Quasi-experimental , repeated measures design . SETTING Developmental and a control nursery in a 78-bed , level II/III neonatal intensive-care unit . PARTICIPANTS A convenience sample of 114 premature infants and their parents . INTERVENTIONS Control group infants received the routine neonatal intensive-care unit st and ard of care . Experimental infants received routine care plus the addition of individualized , developmentally supportive family-centered interventions . MAIN OUTCOME MEASURES Between groups , there were no statistically significant differences in demographic factors , days to medical or developmental milestones , length of stay , or direct cost/case . Repeated measures analysis of variance determined that at every point of data collection , the average number of baseline , activity , and postactivity stress cues were lower in the developmentally supportive group . Infants in the developmental group had 8 % less sedatives/narcotics and 15 % less vasopressors costs than the control group . There were no differences in complication rates , parental perceptions of the neonatal intensive-care unit experience , or parental satisfaction between groups . CONCLUSIONS Preterm infants who received developmentally supportive family-centered care demonstrated fewer behavioral stress cues and comparable short-term outcomes and re source utilization than infants who received routine care


Title 5:
Impact of a family-centered care initiative on NICU care, staff and families
Abstract 5:
Objective : Family-centered care is becoming a st and ard of care in neonatal intensive care units ( NICUs ) . The purpose of this study was to evaluate the impact of a national program design ed to promote family-centered care in NICUs and to provide information and comfort to families during the NICU hospitalization of their newborn . Study Design : A quasi-experimental , post-only design was utilized , examining eight March of Dimes NICU Family Support ® ( NFS ) sites . Data were gathered via telephone interviews with NICU administrators and surveys of both NICU staff and NICU families . Result : NICU administrators interviewed identified benefits of NFS , including culture change and additional support to families . Surveys of NICU staff showed that NFS  enhances the overall quality of NICU care result ing in less stressed , more informed and confident parents . Surveys of NICU families showed that NFS both reduced their stress and made them feel more confident as their baby 's parent . Conclusion : March of Dimes NFS has had a positive impact on the stress level , comfort level and parenting confidence of NICU families . In addition , it has enhanced the receptivity of staff to the presence and benefits of family-centered care


Title 6:
Parent and nurse perceptions on the quality of family-centred care in 11 European NICUs.
Abstract 6:
BACKGROUND Family-centred care ( FCC ) is a state-of-the-art practice in neonatal intensive care units ( NICU ) based on its shown benefits on the well-being of both infants and parents . However , there is no systematic knowledge about how FCC is implemented in different European context s. OBJECTIVES To describe parents ' presence and the quality of FCC  from the perspectives of mothers , fathers and nurses in 11 European NICUs . METHODS A prospect i ve survey was conducted in Finl and , Sweden , Norway , Estonia , Spain and Italy . The perceived quality of FCC  was measured using 8 text-message questions sent to the parents ' mobile phones , one question each day , during the infant 's hospital stay . Nurses answered corresponding questions through a Web question naire during a 3-month period . The responses were rated on a 7-point Likert scale . Parents who were not present in the unit during the day used a " 0 " response . RESULTS A total of 262 families of preterm infants born before 35 gestational weeks participated in the study . Mothers gave 5045 responses , fathers gave 3971 responses and nurses gave 11,132 answers . The mothers were present during 92.7 % and the fathers during 77.9 % of the study days . The mothers rated the quality of FCC  slightly higher than the fathers did ( 5.8 [ 95 % CI 5.7 - 5.9 ] vs. 5.7 [ 95 % CI 5.6 - 5.8 ] , mean difference of 0.12 [ 95 % CI 0.05 - 0.2 ] , p<0.001 ) . There was wide variation in the parents ' presence and the quality of FCC  between the units . The weakest aspects of FCC were emotional support , parents ' participation in decision-making and fathers ' participation in infant care . The perceived quality of FCC  between the nurses and parents were comparable . CONCLUSIONS This study showed a high perceived quality of FCC  in 11 European units , as indicated by both parents and nurses . The innovative data - collection method and instrument successfully quantified each unit 's FCC profile for further quality improvement and should be trialled in other NICUs and countries
We evaluated 11 studies published from January 2006 to March 2016 : two studies vali date d a parent satisfaction question naire , and nine developed or modified previous question naires to use as outcome measures in their local setting s. Most instruments were not tested on reliability and validity .