Pediatric Code Blue: How Prepared Are We? A Self-Efficacy Assessment Project

Pediatric advanced life support (PALS) recertification every two years is inadequate to maintain proficiency. The authors hypothesized that a standardized, recurring curriculum may enhance retention of cardiopulmonary resuscitation (CPR) skills. Monthly in situ mock code training and an annual online self-directed learning module were implemented for pediatric intensive care unit nurses, pediatric residents, and respiratory therapists at a women and children's hospital. The in situ mock codes were linked to PALS training self-efficacy (pre- and post-mock code) and feedback related surveys. CPR knowledge was assessed using an online module with pre- and post-tests. A total of 82 in situ mock code surveys and 137 online modules were completed over a 20-month period. Medical knowledge (P < .05 for 7/10 questions) and self-confidence improved (P < .001. Several staff reported a negative impact on their patient care assignments in order to participate in the mock code. However, a significant number of participants (65%) concurred with the benefits of monthly mock codes. The curriculum improved CPR efficacy by improving knowledge-based retention as well as self-confidence in their skills.

Transthoracic echocardiography visualization of bicaval dual lumen catheters for veno-venous extracorporeal membrane oxygenation

Bicaval dual lumen catheters improve the efficiency of veno-venous extracorporeal membrane oxygenation by minimizing recirculation with an innovative design, which requires precise placement of three catheter ports in the superior vena cava, right atrium, and inferior vena cava, respectively. However, the exact position of these catheter ports is usually not known during placement because they cannot be visualized with conventional radiography. We performed a retrospective review of our experience over the past year using transthoracic echocardiography to evaluate the position of the catheter ports. From a subcostal, sagittal imaging approach, we were able to identify all three catheter ports in 11 of 11 studies. At least one of the catheter ports was incorrectly positioned in 5 of 11 studies. Further prospective evaluation is necessary to determine if catheter repositioning based on transthoracic echocardiography findings can further improve the clinical efficiency of veno-venous extracorporeal membrane oxygenation.

Sequential result refinement for searching the biomedical literature

Information overload is a problem for users of MEDLINE, the database of biomedical literature that indexes over 17 million articles. Various techniques have been developed to retrieve high quality or important articles. Some techniques rely on using the number of citations as a measurement of an article's importance. Unfortunately, citation information is proprietary, expensive, and suffers from "citation lag." MEDLINE users have a variety of information needs. Although some users require high recall, many users are looking for a "few good articles" on a topic. For these users, precision is more important than recall. We present and evaluate a method for identifying articles likely to be highly cited by using information available at the time of listing in MEDLINE. The method uses a score based on Medical Subject Headings (MeSH) terms, journal impact factor (JIF), and number of authors. This method can filter large MEDLINE result sets (>1000 articles) returned by actual user queries to produce small, highly cited result sets.

A day in the life of PubMed: analysis of a typical day's query log

OBJECTIVE

To characterize PubMed usage over a typical day and compare it to previous studies of user behavior on Web search engines.

DESIGN

We performed a lexical and semantic analysis of 2,689,166 queries issued on PubMed over 24 consecutive hours on a typical day.

MEASUREMENTS

We measured the number of queries, number of distinct users, queries per user, terms per query, common terms, Boolean operator use, common phrases, result set size, MeSH categories, used semantic measurements to group queries into sessions, and studied the addition and removal of terms from consecutive queries to gauge search strategies.

RESULTS

The size of the result sets from a sample of queries showed a bimodal distribution, with peaks at approximately 3 and 100 results, suggesting that a large group of queries was tightly focused and another was broad. Like Web search engine sessions, most PubMed sessions consisted of a single query. However, PubMed queries contained more terms.

CONCLUSION

PubMed's usage profile should be considered when educating users, building user interfaces, and developing future biomedical information retrieval systems.