The association of recent simulation training and clinical experience of team leaders with cardiopulmonary resuscitation quality during in-hospital cardiac arrest

OBJECTIVE

We aimed to investigate the association of recent team leader simulation training (<6 months) and years of clinical experience (≥4 years) with chest compression quality during in-hospital cardiac arrest (IHCA).

METHODS

This cohort study of IHCA in four Danish hospitals included cases with data on chest compression quality and team leader characteristics. We assessed the impact of recent simulation training and experienced team leaders on longest chest compression pause duration (primary outcome), chest compression fraction (CCF), and chest compression rates within guideline recommendations using mixed effects models.

RESULTS

Of 157 included resuscitation attempts, 45% had a team leader who recently participated in simulation training and 66% had an experienced team leader. The median team leader experience was 7 years [Q1; Q3: 4; 11]. The median duration of the longest chest compression pause was 16 s [10; 30]. Having a team leader with recent simulation training was associated with significantly shorter longest pause durations (difference: -7.11 s (95%-CI: -12.0; -2.2), p = 0.004), a higher CCF (difference: 3% (95%-CI: 2.0; 4.0%), p < 0.001) and with less guideline compliant chest compression rates (odds ratio: 0.4 (95%-CI: 0.19; 0.84), p = 0.02). Having an experienced team leader was not associated with longest pause duration (difference: -1.57 s (95%-CI: -5.34; 2.21), p = 0.42), CCF (difference: 0.7% (95%-CI: -0.3; 1.7), p = 0.17) or chest compression rates within guideline recommendations (odds ratio: 1.55 (95%-CI: 0.91; 2.66), p = 0.11).

CONCLUSION

Recent simulation training of team leaders, but not years of team leader experience, was associated with shorter chest compression pauses during IHCA.

Effect of simulation-based team training in airway management: a systematic review

Major complications associated with airway management are rare but often have serious consequences. Complications frequently result from failures in communication and teamwork. We performed a systematic review on the effect of simulation-based team training on patient outcomes, healthcare professionals' clinical performance and preparedness for airway management. We included studies with simulation-based team training in airway management as the educational intervention, using any comparator, outcome and design. Two authors independently selected articles and assessed risk of bias using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education. We screened 1248 titles and evaluated 116 full-text articles. Twenty-two studies were included. The Kirkpatrick model for evaluation of training was used to organise outcomes. Four studies reported patient-centred outcomes (Kirkpatrick level 4), and three studies' outcomes related to healthcare professionals' clinical performance (Kirkpatrick level 3). The results were ambiguous and the studies had significant methodological limitations, making it difficult to draw conclusions on the effect of simulation-based team training. To describe preparedness for airway management, we used outcomes related to participants' attitudes or perceptions and outcomes related to knowledge or skills demonstrated in a test setting (Kirkpatrick level 2). Most studies reporting these outcomes were in favour of simulation-based team training, but were prone to bias. We consider the current evidence to be weak and recommend that future research should be based on randomised study designs and patient-centred outcomes.

Tendon vibration-induced inhibition of human and cat triceps surae group I reflexes: evidence of selective Ib afferent fiber activation

In humans, prolonged vibration of the Achilles tendon produced transient depression or abolition of the soleus H-reflex. Recovery of the electrical reflex threshold to previbration values at a constant lower stimulus intensity usually occurred between 10 to 55 min. Electrical stimulation at higher multiples of the reflex threshold produced reflex EMG amplitudes more immediately comparable to previbration controls. When postvibration H-reflexes were completely abolished, poststimulus averaging of voluntarily maintained tonic EMG activity showed evidence of inhibition at a 46-ms latency in contrast to a 32-ms previbration H-reflex latency. In cat, observation of H-reflexes were rare, but stimulus-evoked changes in EMG activity mimicked the postvibration depression seen in humans. Ventral root postvibration reflexes from triceps surae varied in magnitude but were usually depressed or abolished at 1.0 to 1.2 times the electrical reflex threshold. These responses returned to previbration control amplitudes within 20 to 35 min. Magnitude of depression and time to recovery were dependent on the intensity of the electrical stimulus. In five experiments, depression of postvibration reflex activity and recovery were accompanied by gradual recovery in amplitude of the group I volley to previbration amplitudes. Elevated group Ia axonal electrical thresholds, monitored from seven isolated units, were observed to recover to previbration values in parallel with postvibration reflex recovery to control amplitudes. At electrical stimulus intensities greater than 1.4 times the reflex threshold, postvibration reflex responses were often potentiated, probably reflecting posttetanic potentiation of group Ia pathways activated at their higher axonal thresholds. In two observations, postvibration Ib axonal electrical thresholds did not change. Overall, the findings supported the proposal that postvibration depression of soleus H-reflexes in humans or cats is caused by both disfacilitation and autogenetic inhibition due to withdrawal of Ia afferent activation and increased selectivity of Ib afferent fiber stimulation, respectively.

Piggybacking for business and nonprofits: a strategy for hard times

This article explains the conceptual foundations for the piggybacking strategy from the general strategic management, adoption of innovation, product life cycle, specialization and diversified portfolio strategy literatures. The strategic piggybacking strategy is compared and contrasted with the diversified portfolio and specialization strategies. Intention, dynamic investment flow, short vs long term, and mission similarities and differences are addressed. A case is made for considering strategic piggybacking as a synthesis of the specialization and diversified portfolio strategies. The conditions appropriate for adoption of a piggybacking strategy are also discussed.

Strategic piggybacking--a self-subsidization strategy for nonprofit institutions

Nonprofit institutions often find that their socially worthwhile primary missions generate deficits. The author proposes a strategy for funding these shortfalls that is a synthesis of the specialization and diversified portfolio strategies. Following the method of strategic piggybacking, an organization should acquire or develop a business that is new for the institution and that may be unrelated to the institution's primary mission. The purpose of this new activity is to subsidize, at least in part, the deficit-producing primary mission.