Objective: To determine clinical consensus and non-consensus in regard to evidence-based statements about feeding infants with complex CHD, with a focus on human milk. Areas of non-consensus may indicate discrepancies between research findings and practice, with consequent variation in feeding management. Materials and Methods: A modified Delphi survey validated key feeding topics (round 1), and determined consensus on evidence-based statements (rounds 2 and 3). Patients (n=25) were an interdisciplinary group of clinical experts from across the United States of America. Descriptive analysis used SPSS Statistics (Version 26.0). Thematic analysis of qualitative data provided context for quantitative data. Results: Round 1 generated 5 key topics (human milk, developing oral feeding skills, clinical feeding practice, growth failure, and parental concern about feeding) and 206 evidence-based statements. The final results included 110 (53.4%) statements of consensus and 96 (46.6%) statements of non-consensus. The 10 statements of greatest consensus strongly supported human milk as the preferred nutrition for infants with complex CHD. Areas of non-consensus included the adequacy of human milk to support growth, need for fortification, safety, and feasibility of direct breastfeeding, issues related to tube feeding, and prevention and treatment of growth failure. Conclusions: The results demonstrate clinical consensus about the importance of human milk, but reveal a need for best practices in managing a human milk diet for infants with complex CHD. Areas of non-consensus may lead to clinical practice variation. A sensitive approach to these topics is needed to support family caregivers in navigating feeding concerns.

Introduction: Lactating parents of infants hospitalised for critical congenital heart disease (CHD) face significant barriers to direct breastfeeding. While experiences of directly breastfeeding other hospitalised neonates have been described, studies including infants with critical CHD are scarce. There is no evidence-based standard of direct breastfeeding care for these infants, and substantial practice variation exists. Aim: To explain how direct breastfeeding is established with an infant hospitalised for critical CHD, from lactating parents’ perspectives. Materials & Methods: This study is a qualitative grounded dimensional analysis of interviews with 30 lactating parents of infants with critical CHD who directly breastfed within 3 years. Infants received care from 26 United States cardiac centres; 57% had single ventricle physiology. Analysis included open, axial, and selective coding; memoing; member checking; and explanatory matrices. Results: Findings were represented by a conceptual model, “Wayfinding through the ‘ocean of the great unknown’.” The core process of Wayfinding involved a nonlinear trajectory requiring immense persistence in navigating obstacles, occurring in a context of life-and-death consequences for the infant. Wayfinding was characterised by three subprocesses: navigating the relationship with the healthcare team; protecting the direct breastfeeding relationship; and doing the long, hard work. Primary influencing conditions included relentless concern about weight gain, the infant’s clinical course, and the parent’s previous direct breastfeeding experience Conclusions: For parents, engaging in the Wayfinding process to establish direct breastfeeding was feasible and meaningful – though challenging. The conceptual model of Wayfinding explains how direct breastfeeding can be established and provides a framework for research and practice.

Over the past 3 decades, there have been attempts to define breastfeeding for scientific research. However, a lack of clarity remains, with concurrent ambiguity in clinical practice and insufficient inclusion of the parent perspective. Furthermore, previous concept analyses of "breastfeeding" may not fully represent what it means for an infant to be breastfed. Therefore, this concept analysis sought to define "breastfed" in the context of Western healthcare research, clinical practice, and the parent perspective. Informed by Rodgers' evolutionary method, a literature search resulted in 16 representative articles, with related terms, attributes, antecedents, and consequences identified. Analysis of the literature resulted in a theoretical definition of breastfed as a valuable process, experience, or characteristic that involves human milk consumption by an infant through a variety of delivery methods. To be breastfed relies on the existence of lactation, whether from a parent or another source, and depends upon the inten-

While there is a great deal of scholarly inquiry focusing on student teaching experiences in the field of classroom education, there are few resources devoted to student teaching in the context of the applied music lesson. In this article, a teacher educator in the field of piano pedagogy uses self-study to combine reflection on personal experience with academic research. This results in recommendations for best practices in developing successful applied music student teaching experiences, as well as in models to aid in evaluation of this teaching. The conclusions of this self-study not only aid applied music teacher educators in developing an artistic, effective pedagogy of applied music instruction, but also expand the limited academic writing about student teaching in the piano pedagogy curriculum.

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Translational Study of Current SET Guidelines 361L ower extremity peripheral artery disease (PAD) affects 5.8-10.7% of people in the United States >40 yr of age. 1 Individuals with PAD have greater functional impairment, more rapid functional decline, and higher rates of mobility loss than those without PAD. 2-4 Supervised exercise therapy (SET) is a cornerstone of treatment for improving walking capacity and physical function for individuals with claudication. 5,6 Since SET has only recently become a reimbursable service through the Centers for Medicare & Medicaid Services, 7 its clinical effectiveness in the US clinical rehabilitation setting is still unknown. Specifically, it is unknown how effective the current expert opinion-based SET guidelines are when implemented in clinical practice. 6,8 Currently, aerobic exercise is the focus of SET, with the gold standard modality being intermittent treadmill walking training (TM walking) to moderate levels of claudication. 9,10 However, TM walking is not feasible in some patients with PAD who enroll in SET. 6 Other possible aerobic exercise modalities that may be utilized include stationary cycling, upper-body ergometry (UBE), and total body recumbent stepping (TBRS).Current SET guidelines state that aerobic exercise therapy should be individualized to help ensure that all patients wishing to participate see as much benefit as possible. 6,8 An important consideration is selection of an appropriate primary aerobic exercise training modality that is guided by the exercise provider. 6,8,9 To date, no study has investigated the clinical effectiveness of guideline-directed exercise