Impact of an embedded simulation team training programme in a paediatric intensive care unit: a prospective, single-centre, longitudinal study.

PURPOSE: To evaluate the impact of an embedded simulation-based team training programme on perceived performance and to compare the effect over different phases of the programme. METHODS: This was a prospective, single-centre, longitudinal study over the first 2 years of the programme. A total of 219 multidisciplinary health-care professionals participated in simulation sessions, followed by anonymous evaluation questionnaires. The programme was divided into three different phases: introductory (first 6 months), intermediate (second 6 months) and established phase (second year). RESULTS: A total of 88.7% of participants evaluated the impact on overall practice as effective, 56.5% reported a highly effective impact. A total of 90.9% (391/430) of questions on non-technical skills (communication and teamwork) showed an effective impact, 55.6% a highly effective impact, whereas only 70.2% (262/373) of questions on technical skills showed an effective impact. There was a significant (p < 0.001) increased score for effective impact in all categories between the introductory and intermediate phase, which was maintained throughout the established phase. Overall, 72.7% of the participants felt more confident to attend a future critical event, 32.5% were highly confident. In the longitudinal analysis there was a stepwise significant (p < 0.05) increase of confidence of participants. In a subgroup analysis (n = 143) there was a significant (p < 0.001) higher confidence in participants who had attended at least 3 sessions (90.7 vs. 61%). CONCLUSION: There is a 6- to 12-month learning curve in the implementation of an embedded multidisciplinary team training programme. Repeated exposure to simulation is most beneficial to crisis resource management training and single, isolated exposure may not be sufficient.

Retrospective assessment of dryland soil stability in relation to grazing and climate change.

Accelerated soil erosion is an aspect of dryland degradation that is affected by repeated intense drought events and land management activities such as commercial livestock grazing. A soil stability index (SSI) that detects the erosion status and susceptibility of a landscape at the pixel level, i.e., stable, erosional, or depositional pixels, was derived from the spectral properties of an archived time series (from 1972 to 1997) of Landsat satellite data of a commercial ranch in northeastern Utah. The SSI was retrospectively validated with contemporary field measures of soil organic matter and erosion status that was surveyed by US federal land management agencies. Catastrophe theory provided the conceptual framework for retrospective assessment of the impact of commercial grazing and soil water availability on the SSI. The overall SSI trend was from an eroding landscape in the early drier 1970s towards stable conditions in the wetter mid-1980s and late 1990s. The landscape catastrophically shifted towards an extreme eroding state that was coincident with the "The Great North American Drought of 1988". Periods of landscape stability and trajectories toward stability were coincident with extremely wet El Niño events. Commercial grazing had less correlation with soil stability than drought conditions. However, the landscape became more susceptible to erosion events under multiple droughts and grazing. Land managers now have nearly a year warning of El Niño and La Niña events and can adjust their management decisions according to predicted landscape erosion conditions.