Pediatric and neonatal extracorporeal life support technology component utilization: are US clinicians implementing new technology?

The objective of this investigation is to describe recent changes made in extracorporeal life support (ECLS) technology in the US Postal survey to directors and coordinators of all 125 US ECLS centers identified by Extracorporeal Life Support Organization as of November 2010, with follow-up of nonrespondents. Spearman coefficients were used to correlate the method of updating knowledge of ECLS technology with the likelihood of changing technology, and to correlate decision-making hierarchy with the likelihood of changing equipment. The response rate was 75% representing 34 states, and the majority of respondents were ECLS coordinators (56.6%). Respiratory diagnosis is the predominant indication for ECLS at any age. Over 40% of centers are using a hollow-fiber oxygenator for neonates and 80% of pediatric patients. Roller pumps are used in 70% of neonatal and pediatric ECLS. Forty-two percent of centers changed the oxygenator type within the past 3 years, while 30% changed both the oxygenator and pump. Less than 10% of centers reported problems with either oxygenator or pump in both neonates and pediatric ECLS. Forty-six percent of respondents that changed oxygenators cited that the primary reason for changing was "clinical preference/experience," while the other half was split between "FDA approval" and "Research results." In 40% of centers, a multidisciplinary group made decisions on changing technology. This survey indicates that over one-half of ECLS centers implemented new technology within the past 3 years. Knowledge of ECLS technology and safe operation of ECLS circuit components is essential in preventing some of the mechanical complications.

Targeted crisis resource management training improves performance among randomized nursing and medical students.

INTRODUCTION: In this study designed with adequate statistical power to detect relevant training effects, investigators evaluated Crisis Resource Management (CRM) training during a simulated patient crisis. This study is guided by the Team Effectiveness Conceptual Model by Kozlowski and Ilgen. METHODS: An experimental pretest/posttest design was used. Four-member, interdisciplinary teams, each composed of nursing and medical students, were randomly assigned to experimental or control conditions: Basic Life Support plus CRM training or Basic Life Support only, respectively. Team process (task management, teamworking, situation awareness, and interprofessional attitude) and team effectiveness (team error rate and response times) were the outcomes of interest. RESULTS: Experimental teams demonstrated significant improvement in team process measures compared with control teams. CRM training predicted 13% of the variance in task management (P = 0.05), 15% of the variance in teamworking (P = 0.04), and 18% of the variance in situation awareness (P = 0.03). CRM training and task management predicted 22% of the variance (P = 0.04) in team error rate; CRM training and teamworking predicted 35% of the variance (P = 0.01), while CRM training and situation awareness predicted 20% of the variance (P = 0.04) in response time to chest compressions. Both experimental and control teams demonstrated significant improvement in team effectiveness measures. CONCLUSIONS: CRM team training and team practice in an environment of high-fidelity simulation and facilitated debriefing have significant effects on team process and team effectiveness. The conceptual framework is potentially adaptable to additional settings and populations for team-related research and education.

Preterm infants' sympathetic arousal and associated behavioral responses to sound stimuli in the neonatal intensive care unit.

PURPOSE: To evaluate the utility of skin conductance (SC) as a measure of autonomic arousal to sound stimuli in preterm infants. DESIGN: A pilot cross-sectional, correlations study. SUBJECTS: Eleven preterm infants with a mean gestational age of 31.6 weeks without anomalies or conditions associated with neurodevelopmental delay composed the sample. METHODS: On days 5-7 of life, the following infant responses were simultaneously recorded in response to naturally occurring sound stimuli in the NICU: real-time measurements of heart rate, respiratory rate, and oxygen saturations; sympathetic-mediated sweating via SC; and behavioral responses using the Newborn Individualized Developmental Care and Assessment Program naturalistic observation. Baseline sound levels (BSL, <55 dBA) and high sound levels (HSL, >65 dBA) were measured to index patterns of response during a nonhandling period preceding care. RESULTS: Mean heart rate during precare was directly associated with higher SC increases to sound stimuli (r[10] = 0.697, P = .017). The SC during HSL was significantly higher than that during BSL (P < .0001). Males demonstrated higher SC increases to sound stimuli than females (P = .030). Changes in SC induced by increases in sound intensity were associated with lower attention responses (r[10] = -0.92, P < .0001) and lower summated behavioral responses (r[10] = -0.59, P = .054). CONCLUSION: SC provides a noninvasive, sensitive measure of sympathetic arousal that may not be apparent in behavioral cues or states, or determined by standard physiological responses alone.

Methods to improve reliability of video-recorded behavioral data.

Behavioral observation is a fundamental component of nursing practice and a primary source of clinical research data. The use of video technology in behavioral research offers important advantages to nurse scientists in assessing complex behaviors and relationships between behaviors. The appeal of using this method should be balanced, however, by an informed approach to reliability issues. In this article, we focus on factors that influence reliability, such as the use of sensitizing sessions to minimize participant reactivity and the importance of training protocols for video coders. In addition, we discuss data quality, the selection and use of observational tools, calculating reliability coefficients, and coding considerations for special populations based on our collective experiences across three different populations and settings.

Creating cross-disciplinary research alliances to advance nursing science.

PURPOSE: To demonstrate the utility of a developmental approach to building and sustaining cross-disciplinary research alliances. ORGANIZING CONSTRUCT: Cross-disciplinary collaborations offer great promise for advancing an evolving program of research. Funding agencies' commitment to interdisciplinary work further heightens these collaborations. Nurse researchers, however, are not necessarily equipped with the knowledge and skills needed to strategically and successfully build and maintain cross-disciplinary collaborations. METHODS: Successful strategies for forging, extending, and sustaining alliances are organized using a developmental approach and illustrated by exemplars. FINDINGS: The initial phase of forging alliances is focused on creating a limited network to support relatively clear-cut research goals. The cohesive cross-disciplinary team is subsequently extended beyond the initial team to strategically address broader research goals. As the team matures, emphasis shifts toward sustaining the team through shared leadership that more actively focuses on the development of the field than the development of individual programs of research. CONCLUSIONS: The advancement of nursing science requires nurse researchers to rethink the developmental phases of building appropriate research teams. Strategic approaches for forging, extending, and sustaining cross-disciplinary alliances position nurse researchers as leaders in innovative cross-disciplinary research. The development of cross-disciplinary teams supports translational research and, by extension, the science that undergirds practice. CLINICAL RELEVANCE: Research that reflects cross-disciplinary perspectives is particularly well suited to addressing the complex health issues encountered by patients, families, and communities.