An interdisciplinary, family-focused approach to relational learning in neonatal intensive care.

OBJECTIVE: The aim of this study is to show the efficacy of the Program to Enhance Relational and Communication Skills-Neonatal Intensive Care Unit (PERCS-NICU). STUDY DESIGN: In this study, 74 practitioners attended workshops and completed baseline, post-training and follow-up questionnaires. RESULT: On yes/no questions, 93 to 100% reported improved preparation, communication skills and confidence post-training and follow-up. A total of 94 and 83% improved their ability to establish relationships, and 76 and 83% reported reduced anxiety post-training and follow-up, respectively. On Likert items, 59 and 64% improved preparation, 45 and 60% improved communication skills and confidence, 25 and 53% decreased anxiety and 16 and 32% improved relationships post-training and follow-up, respectively. Qualitative themes included integrating new communication and relational abilities, honoring the family perspective, appreciating interdisciplinary collaboration, personal/human connection and valuing the learning. In total, 93% applied skills learned, three-quarters transformed practice and 100% recommended PERCS-NICU. CONCLUSION: After PERCS-NICU, clinicians improved preparation, communication and relational abilities, confidence and reduced anxiety when holding difficult neonatal conversations.

Analysis of enacted difficult conversations in neonatal intensive care.

OBJECTIVE: To analyze the communicative contributions of interdisciplinary professionals and family members in enacted difficult conversations in neonatal intensive care. STUDY DESIGN: Physicians, nurses, social workers, and chaplains (n=50) who attended the Program to Enhance Relational and Communication Skills, participated in a scenario of a preterm infant with severe complications enacted by actors portraying family members. Twenty-four family meetings were videotaped and analyzed with the Roter Interaction Analysis System (RIAS). RESULT: Practitioners talked more than actor-family members (70 vs 30%). Physicians provided more biomedical information than psychosocial professionals (P<0.001), and less psychosocial information than nurses, and social workers and chaplains (P<0.05; P<0.001). Social workers and chaplains asked more psychosocial questions than physicians and nurses (MD=P<0.005; RN=P<0.05), focused more on family's opinion and understanding (MD=P<0.01; RN=P<0.001), and more frequently expressed agreement and approval than physicians (P<0.05). No differences were found across disciplines in providing emotional support. CONCLUSION: Findings suggest the importance of an interdisciplinary approach and highlight areas for improvement such as using silence, asking psychosocial questions and eliciting family perspectives that are associated with family satisfaction.

Clinical chemistry outside laboratories: report of a second survey.

The growth in the use of small portable analysers outside hospital laboratories has been a cause of concern to laboratory practitioners. This has been partly because of a perceived threat to laboratory careers and partly because of fears that the quality of testing would be poor, with a consequent danger of patients being placed at risk. The evidence in this paper indicates that the use of equipment outside laboratories is still increasing in many areas. Despite the fears which have been expressed, little attention is being given to operator training, service costs, safety and many other aspects; only rarely has responsibility for the quality of results been accepted.

Application of robotics In the clinical laboratory.

The basic types of robot are explained, and the performances and costs of some commercial examples are given. The potential advantages and problems of introducing robots into clinical laboratories are identified and the specifcation of a suitable robot is developed. None of the commercially available robots meets all aspects of the specificalion, and currently the purchase of a robot is considered premature for most clinical laboratories.

Preparation and stability of low-cost liquid quality-control serum stabilized with ethanediol.

The use of quality-control serum to monitor laboratory performance is an essential part of any health laboratory. However, laboratories in many countries are disadvantaged because of the non-availability or high cost of commercial quality-control sera. Here we describe the stability of bovine serum stabilized with ethanediol, prepared at low cost by simple techniques that are available in most laboratories.

Cerebral vasoreactivity and arterial gas embolism.

Compression regimens effect redistribution of entrapped cerebral arterial gas emboli by reducing embolus length and/or by increasing local perfusion pressure. Embolus length is related to embolus volume and vessel diameter. It has been assumed without evidence that cerebral arterial gas emboli induce local vasoparalysis and hence that the relevant vessel diameter will not be affected by the treatment regimen. This study tested that assumption. Infusion of gas microbubbles into the femoral artery of upright rabbits caused significant but transient hypertension, respiratory depression, cardiac bradyarrythmia, inhibition of cerebrovascular autoregulation to blood pressure changes, and cerebral arterial gas embolism, with entrapment of long emboli in arterioles of 50-200 micron diameter. Cerebral arterioles constricted and dilated appropriately with sequential changes in ventilation gas mixture both before and after gas embolism. The study demonstrated that cerebral arterial gas emboli did not necessarily inhibit cerebrovascular reactivity and that the effect a compression regimen has on cerebral arteriole diameter should be included in any assessment of its efficacy.

A comparative survey of the results of analyses of blood serum in clinical chemistry laboratories in the United Kingdom.

Since July 1969, portions of the same blood serum have been dispatched to clinical chemistry laboratories in the United Kingdom at 14-day intervals. The results of each serum survey were reported to each of the 390 participants within 11 days of their originally receiving the specimen. During the first 18 months of the survey no overall improvement in the results was seen. Therefore a summary of each laboratory's ability consistently to produce results close to the mean of the method used was calculated and reported as a single figure, the variance index, and sent to all participants at regular intervals together with a histogram distribution of the variance indices of other participants. The subsequent improvement in the overall results is described.