Teamwork and mental workload in postsurgical pediatric patient handovers: Prospective effect evaluation of an improvement intervention for OR-PICU patient transitions.

Postsurgical handover of pediatric patients from operating rooms (OR) to pediatric intensive care units (PICU) is a critical step. This transition is susceptible to errors and inefficiencies particularly if poor multidisciplinary teamwork occurs. Despite wide adoption of standardized handover interventions, comprehensive investigations into joint effects for patient care and provider outcomes are scarce. We aimed to improve OR-PICU handovers quality and sought to evaluate the intervention with particular attention to patient care effects and provider outcomes. A prospective, before-after-study design with an interrupted-series and a multi-source, mixed-methods evaluation approach was established. Drawing upon a participative plan-do-study-act approach, a standardized, checklist-based handover process was designed and implemented. For effect assessments, we observed OR-PICU handovers on site (pre implementation: n = 31, post: n = 30), respectively, with standardized expert observation and provider self-report tools (n = 111, n = 110). Setting was a tertiary Pediatric University Hospital. Supplementary qualitative, semi-structured interviews were conducted, and a general inductive content analysis approach was used to identify key facilitators and barriers on implementation. Improvement efforts focused on stepwise implementation of (1) standardized handover process and (2) a checklist for multi-professional OR-PICU handover communication. We observed significant increases in team and patient setup (pre: 79.3%, post: 98.6%, p < .01), enhanced team engagement (pre: 50%, post: 81.7%, p < .01), and comprehensive information transfer by the anesthesia sub-team (pre: 78.6%, post: 87.3%, p < .01). Expert-rated teamwork outcomes were consistently higher, yet self-reported teamwork did not change over time. Provider perceived stress and disruptions did not change, mental workload tended to decrease over time (pre: M = 3.2, post: 2.9, p = .08). Comprehensiveness of post-operative patient information reported by PICU physician increased significantly: pre: 65.9%, post: 76.2%, p < .05. After implementation, providers acknowledged the importance of standardized handover practices and associated benefits for facilitation of information transfer and comprehensiveness. Among reported barriers were obstacles during implementation as well as insufficient consideration of professionals' individual workflow after surgery. CONCLUSION:  A multidisciplinary intervention for postsurgical pediatric patient handovers was associated with improved expert-rated teamwork and fewer omissions of key patient information over time. Inconsistent results were obtained for provider-rated mental workload and teamwork outcomes. The findings contribute to a better understanding concerning the interplay of teamwork and provider cognitions in the course of establishing safe patient transitions in pediatric care. WHAT IS KNOWN: • Transfer of critically ill children conveys significant challenges for interprofessional communication and teamwork. Prospective research into interventions for safe and efficient handover practices of OR PICU patient transitions is necessary. • Checklists are assumed to facilitate cognitive load among providers in acute clinical environments. WHAT IS NEW: • A standardized, checklist-based handover intervention was associated with improvements in team set-up and information transfer. Provider outcomes such as mental workload and stress did not change over time. • The combination of teamwork and provider assessments allows a more nuanced understanding of implementation barriers and sustainable effects in course of OR-PICU handover interventions.

Phase angle as predictor of malnutrition in people living with HIV/AIDS.

BACKGROUND: Phase angle (PhA), measured by bioelectrical impedance analysis (BIA) has been studied as an indicator of survival in people living with HIV (PLWH). However, it remains unclear whether PhA is associated with malnutrition or low CD4+ T-cell counts. OBJECTIVE: In this study, we assessed the discriminative capacity of PhA for malnutrition detection using Global Leadership Initiative on Malnutrition (GLIM) criteria in PLWH, aiming to propose cutoff points for this population. METHODS: This retrospective observational study included 427 adult PLWH (13% female). Participants were classified according to malnutrition status by using GLIM criteria. Body composition was assessed by using BIA. CD4+ T-cell counts were determined by flow cytometry. RESULTS: According to GLIM criteria, 30% of the participants were malnourished. Multivariate regression analysis showed that PhA (adjusted odds ratio [OR], 0.10; 95% CI, 0.05-0.18; P < 0.001), fat-mass percentage (adjusted OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), and male sex (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = 0.013) were independently associated with malnutrition. A PhA cutoff of 5.45° in men and 4.95° in women may predict malnutrition with sensitivity and specificity >70%. CONCLUSION: PhA could be a valid, useful, and simple predictor of malnutrition in PLWH.

Relaciones evolutivas entre la memoria de trabajo visuoespacial y la planificación cognitiva en personas sanas con inteligencia normal con edades entre 10 y 30 años / Developmental relationships between visuospatial working memory and cognitive planning in healthy people with normal intelligence aged between 10 and 30 years

Resumen El artículo presenta los resultados de una investigación empírica sobre las relaciones evolutivas entre la memoria de trabajo visuoespacial y la planificación cognitiva en un grupo de 100 personas sanas con inteligencia normal y edades entre 10 y 30 años. Se aplicó el Subtest de Cubos de Corsi, de la Escala de Memoria de Wechsler m y la Torre de Londres. Los análisis de correlación para el rango completo (10-30) demostraron la existencia de una correlación estadísticamente significativa (0.43; p-value < 0.001). En los tres rangos de edad también se encontraron correlaciones estadísticamente significativas (p value < 0.008): 0.44 para el rango 10-15; 0.28 para el rango 16-20; y 0.32 para el rango 21-30. No se encontró un aumento en el funcionamiento ejecutivo asociado con la edad, pese a que la teoría y la evidencia empírica así lo demuestran. Se describen y discuten posibles explicaciones sobre los resultados.

Abstract The article presents the results of a correlational empirical research on the developmental relationships between visuospatial working memory and cognitive planning in a group of 100 healthy people with normal intelligence with ages between 10 and 30 years. The Corsi block test, from the Wechsler Memory Scale III, and the Tower of London were applied. Correlation analyzes for the full range (10-30) demonstrated the existence of a statistically significant correlation (0.43, p-value <0.001). In the three age statistically significant correlations (p value <0.008) were also found: 0.44 for the range 10-15; 0.28 for the range 16-20; and 0.32 for 21-30 range. No increase in executive functioning associated with age was found, although the theory and empirical evidence prove it. Possible explanations for the results are described and discussed.