Janene Fuerch

All Publications

• Characterizing continuous positive airway pressure (CPAP) Belly Syndrome in preterm infants in the neonatal intensive care unit (NICU). Journal of perinatology : official journal of the California Perinatal Association Gu, H., Seekins, J., Ritter, V., Halamek, L. P., Wall, J. K., Fuerch, J. H. 2024

  Abstract

  OBJECTIVE: Reproducibly define CPAP Belly Syndrome (CBS) in preterm infants and describe associated demographics, mechanical factors, and outcomes.STUDY DESIGN: A retrospective case-control study was conducted in infants <32 weeks gestation in the Stanford Children's NICU from January 1, 2020 to December 31, 2021. CBS was radiographically defined by a pediatric radiologist. Data analysis included descriptive statistics and comparator tests.RESULTS: Analysis included 41 infants with CBS and 69 infants without. CBS was associated with younger gestational age (median 27.7 vs 30 weeks, p<0.001) and lower birthweight (median 1.00 vs 1.31kg, p<0.001). Infants with CBS were more likely to receive bilevel respiratory support and higher positive end expiratory pressure. Infants with CBS took longer to advance enteral feeds (median 10 vs 7 days, p=0.003) and were exposed to more abdominal radiographs.CONCLUSIONS: Future CBS therapies should target small infants, prevent air entry from above, and aim to reduce time to full enteral feeds and radiographic exposure.

  View details for DOI 10.1038/s41372-024-01918-2

  View details for PubMedID 38448640

• Novel umbilical catheter securement and protection device for umbilical line securement during laparotomy. American journal of perinatology Salimi Jazi, F., Wood, L., Rafeeqi, T., Yamada, N. K., Fuerch, J. H., Wall, J. K. 2023

  Abstract

  Umbilical catheter malposition rate is high. We compared a Novel Umbilical Securement Device (NUSD) to standard methodologies for NICU patients undergoing laparotomy.Retrospective study was performed on infants undergoing laparotomy from April 2019 to January 2023. Two neonatologists compared position of UAC/UVC on perioperative CXRs in patients with or without NUSD.18 patients underwent laparotomy. 8 patients had NUSD (9 lines), and 10 patients didn't (14 lines). In NUSD group, mean gestational age was 374 weeks and mean birth weight was 2.30.9 kg compared to 318 weeks and 2.11.4 kg in non-NUSD group. The mean age at surgery was 57 and 53 days respectively. No malposition was seen in NUSD group, while 57% of UVCs (28% of lines) were malpositioned post-operatively in non-NUSD group (p: 0.048).NUSD is an umbilical catheter securement device with low malposition rate, specifically during perioperative period with heightened risk for dislodgement.

  View details for DOI 10.1055/a-2182-4221

  View details for PubMedID 37758205

• In Situ Simulation and Clinical Outcomes in Infants Born Preterm. The Journal of pediatrics Chitkara, R., Bennett, M., Bohnert, J., Yamada, N., Fuerch, J., Halamek, L. P., Quinn, J., Padua, K., Gould, J., Profit, J., Xu, X., Lee, H. C. 2023: 113715

  Abstract

  To evaluate impact of a multi-hospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm.Twelve neonatal intensive care units (NICUs) were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Very low birthweight (VLBW) infants born between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room (DR), DR continuous positive airway pressure (CPAP), hypothermia (<36ºC) upon NICU admission, severe intraventricular hemorrhage, and mortality prior to hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect.Between March 2017 and December 2020, a total of 2,626 eligible VLBW births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in Mar-Aug2017 and 76.0% in Jul-Dec 2020 (RR 1.03 [0.94,1.12]; no significant improvement occurred during the study period for both participating and non-participating sites. The effect of in situ simulation on all secondary outcomes was stable.Implementation of a multi-hospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.

  View details for DOI 10.1016/j.jpeds.2023.113715

  View details for PubMedID 37659586

• Neonatal Healthcare Professionals' Experiences When Implementing a Simulation and Debriefing Program in Neonatal Intensive Care Settings: A Qualitative Analysis. Advances in neonatal care : official journal of the National Association of Neonatal Nurses Quinn, J., Quinn, M., Lieu, B., Bohnert, J., Halamek, L. P., Profit, J., Fuerch, J. H., Chitkara, R., Yamada, N. K., Gould, J., Lee, H. C. 2023

  Abstract

  BACKGROUND: Simulation-based training (SBT) and debriefing have increased in healthcare as a method to conduct interprofessional team training in a realistic environment.PURPOSE: This qualitative study aimed to describe the experiences of neonatal healthcare professionals when implementing a patient safety simulation and debriefing program in a neonatal intensive care unit (NICU).METHODS: Fourteen NICUs in California and Oregon participated in a 15-month quality improvement collaborative with the California Perinatal Quality Care Collaborative. Participating sites completed 3 months of preimplementation work, followed by 12 months of active implementation of the simulation and debriefing program. Focus group interviews were conducted with each site 2 times during the collaborative. Content analysis found emerging implementation themes.RESULTS: There were 234 participants in the 2 focus group interviews. Six implementation themes emerged: (1) receptive context; (2) leadership support; (3) culture change; (4) simulation scenarios; (5) debriefing methodology; and (6) sustainability. Primary barriers and facilitators with implementation of SBT centered around having a receptive context at the unit level (eg, availability of resources and time) and multidisciplinary leadership support.IMPLICATIONS FOR PRACTICE AND RESEARCH: NICUs have varying environmental (context) factors and consideration of unit-level context factors and support from leadership are integral aspects of enhancing the successful implementation of a simulation and debriefing program for neonatal resuscitation. Additional research regarding implementation methods for overcoming barriers for both leaders and participants, as well as determining the optimal frequency of SBT for clinicians, is needed. A knowledge gap remains regarding improvements in patient outcomes with SBT.

  View details for DOI 10.1097/ANC.0000000000001085

  View details for PubMedID 37399571

• A Novel Method for Administering Epinephrine During Neonatal Resuscitation. American journal of perinatology Gu, H., Perl, J., Rhine, W., Yamada, N. K., Sherman, J., McMillin, A., Halamek, L., Wall, J. K., Fuerch, J. H. 2023

  Abstract

  To determine if prefilled epinephrine syringes will reduce time to epinephrine administration compared to conventional epinephrine during standardized simulated neonatal resuscitation.Timely and accurate epinephrine administration during neonatal resuscitation is lifesaving in bradycardic infants. Current epinephrine preparation is inefficient and error-prone. For other emergency use drugs, prefilled medication syringes have decreased error and administration time.Twenty-one neonatal intensive care unit (NICU) nurses were enrolled. Each subject engaged in four simulated neonatal resuscitation scenarios involving term or preterm manikins using conventional epinephrine or novel prefilled epinephrine syringes specified for patient weight and administration route. All scenarios were video-recorded. Two investigators analyzed video-recordings for time to epinephrine preparation and administration. Differences between conventional and novel techniques were evaluated using Wilcoxon Signed Rank Tests.Twenty-one subjects completed 42 scenarios with conventional epinephrine and 42 scenarios with novel prefilled syringes. Epinephrine preparation was faster using novel prefilled epinephrine syringes (median = 17.0 sec, IQR 13.3 - 22.8) compared to conventional epinephrine (median = 48.0 sec, IQR 40.5 - 54.9), n = 42, z = 5.64, p < 0.001. Epinephrine administration was also faster using novel prefilled epinephrine syringes (median = 26.9 sec, IQR 22.1 - 33.2) compared to conventional epinephrine (median 57.6 sec, IQR 48.8 - 66.8), n = 42, z = 5.63, p < 0.001. In a post-study survey, all subjects supported the clinical adoption of prefilled epinephrine syringes.During simulated neonatal resuscitation, epinephrine preparation and administration are faster using novel prefilled epinephrine syringes, which may hasten return of spontaneous circulation and be lifesaving for bradycardic neonates in clinical practice.

  View details for DOI 10.1055/a-2082-4729

  View details for PubMedID 37105225

• The Debriefing Assessment in Real Time (DART) tool for simulation-based medical education. Advances in simulation (London, England) Baliga, K., Halamek, L. P., Warburton, S., Mathias, D., Yamada, N. K., Fuerch, J. H., Coggins, A. 2023; 8 (1): 9

  Abstract

  BACKGROUND: Debriefing is crucial for enhancing learning following healthcare simulation. Various validated tools have been shown to have contextual value for assessing debriefers. The Debriefing Assessment in Real Time (DART) tool may offer an alternative or additional assessment of conversational dynamics during debriefings.METHODS: This is a multi-method international study investigating reliability and validity. Enrolled raters (n = 12) were active simulation educators. Following tool training, the raters were asked to score a mixed sample of debriefings. Descriptive statistics are recorded, with coefficient of variation (CV%) and Cronbach's alpha used to estimate reliability. Raters returned a detailed reflective survey following their contribution. Kane's framework was used to construct validity arguments.RESULTS: The 8 debriefings (mu = 15.4 min (SD 2.7)) included 45 interdisciplinary learners at various levels of training. Reliability (mean CV%) for key components was as follows: instructor questions mu = 14.7%, instructor statements mu = 34.1%, and trainee responses mu = 29.0%. Cronbach alpha ranged from 0.852 to 0.978 across the debriefings. Post-experience responses suggested that DARTs can highlight suboptimal practices including unqualified lecturing by debriefers.CONCLUSION: The DART demonstrated acceptable reliability and may have a limited role in assessment of healthcare simulation debriefing. Inherent complexity and emergent properties of debriefing practice should be accounted for when using this tool.

  View details for DOI 10.1186/s41077-023-00248-1

  View details for PubMedID 36918946

• Data-driven longitudinal characterization of neonatal health and morbidity. Science translational medicine De Francesco, D., Reiss, J. D., Roger, J., Tang, A. S., Chang, A. L., Becker, M., Phongpreecha, T., Espinosa, C., Morin, S., Berson, E., Thuraiappah, M., Le, B. L., Ravindra, N. G., Payrovnaziri, S. N., Mataraso, S., Kim, Y., Xue, L., Rosenstein, M. G., Oskotsky, T., Marić, I., Gaudilliere, B., Carvalho, B., Bateman, B. T., Angst, M. S., Prince, L. S., Blumenfeld, Y. J., Benitz, W. E., Fuerch, J. H., Shaw, G. M., Sylvester, K. G., Stevenson, D. K., Sirota, M., Aghaeepour, N. 2023; 15 (683): eadc9854

  Abstract

  Although prematurity is the single largest cause of death in children under 5 years of age, the current definition of prematurity, based on gestational age, lacks the precision needed for guiding care decisions. Here, we propose a longitudinal risk assessment for adverse neonatal outcomes in newborns based on a deep learning model that uses electronic health records (EHRs) to predict a wide range of outcomes over a period starting shortly before conception and ending months after birth. By linking the EHRs of the Lucile Packard Children's Hospital and the Stanford Healthcare Adult Hospital, we developed a cohort of 22,104 mother-newborn dyads delivered between 2014 and 2018. Maternal and newborn EHRs were extracted and used to train a multi-input multitask deep learning model, featuring a long short-term memory neural network, to predict 24 different neonatal outcomes. An additional cohort of 10,250 mother-newborn dyads delivered at the same Stanford Hospitals from 2019 to September 2020 was used to validate the model. Areas under the receiver operating characteristic curve at delivery exceeded 0.9 for 10 of the 24 neonatal outcomes considered and were between 0.8 and 0.9 for 7 additional outcomes. Moreover, comprehensive association analysis identified multiple known associations between various maternal and neonatal features and specific neonatal outcomes. This study used linked EHRs from more than 30,000 mother-newborn dyads and would serve as a resource for the investigation and prediction of neonatal outcomes. An interactive website is available for independent investigators to leverage this unique dataset: https://maternal-child-health-associations.shinyapps.io/shiny_app/.

  View details for DOI 10.1126/scitranslmed.adc9854

  View details for PubMedID 36791208

• Respiratory Failure in an 11-day-old Neonate. NeoReviews Aiden, A. P., Khan, A., Schwenk, H., Fuerch, J. H. 2023; 24 (1): 36-38

  View details for DOI 10.1542/neo.24-1-e36

  View details for PubMedID 36587004

• 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces CIRCULATION Wyckoff, M. H., Greif, R., Morley, P. T., Ng, K., Olasveengen, T. M., Singletary, E. M., Soar, J., Cheng, A., Drennan, I. R., Liley, H. G., Scholefield, B. R., Smyth, M. A., Welsford, M., Zideman, D. A., Acworth, J., Aickin, R., Andersen, L. W., Atkins, D., Berry, D. C., Bhanji, F., Bierens, J., Borra, V., Bottiger, B. W., Bradley, R. N., Bray, J. E., Breckwoldt, J., Callaway, C. W., Carlson, J. N., Cassan, P., Castren, M., Chang, W., Charlton, N. P., Chung, S., Considine, J., Costa-Nobre, D. T., Couper, K., Couto, T., Dainty, K. N., Davis, P. G., de Almeida, M., de Caen, A. R., Deakin, C. D., Djarv, T., Donnino, M. W., Douma, M. J., Duff, J. P., Dunne, C. L., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Finn, J., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A., Guinsburg, R., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M., Kim, H., Kleinman, M., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y., Lockey, A. S., Maconochie, I. K., Madar, R., Hansen, C., Masterson, S., Matsuyama, T., McKinlay, C. D., Meyran, D., Morgan, P., Morrison, L. J., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., O'Neill, B. J., Ong, Y., Orkin, A. M., Paiva, E. F., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Rudiger, M., Sakamoto, T., Sandroni, C., Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Sugiura, T., Tijssen, J. A., Trevisanuto, D., Van de Voorde, P., Wang, T., Weiner, G. M., Wyllie, J. P., Yang, C., Yeung, J., Nolan, J. P., Berg, K. M. 2022; 146 (25): E483-E557

  Abstract

  This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

  View details for DOI 10.1161/CIR.0000000000001095

  View details for Web of Science ID 000928164500001

  View details for PubMedID 36325905

• Respiratory function monitoring during neonatal resuscitation: A systematic review. Resuscitation plus Fuerch, J. H., Thio, M., Halamek, L. P., Liley, H. G., Wyckoff, M. H., Rabi, Y. 2022; 12: 100327

  Abstract

  Positive pressure ventilation via a facemask is critical in neonatal resuscitation, but frequently results in mask leak, obstruction, and inadequate respiratory support. This systematic review aimed to determine whether the display of respiratory function monitoring improved resuscitation or clinical outcomes.Randomized controlled trials comparing outcomes when respiratory function monitoring was displayed versus not displayed for newborns requiring positive pressure ventilation at birth were selected and from databases (last search August 2022), and assessed for risk of bias using Cochrane Risk of Bias Tools for randomized control trials. The study was registered in the Prospective Register of Systematic Reviews. Grading of Recommendations, Assessment, Development and Evaluations was used to assess the certainty of evidence. Treatment recommendations were approved by the Neonatal Life Support Task Force of the International Liaison Committee on Resuscitation. Results reported primary and secondary outcomes and included resuscitation and clinical outcomes.Of 2294 unique articles assessed for eligibility, three randomized controlled trials were included (observational studies excluded) (n = 443 patients). For predefined resuscitation and clinical outcomes, these studies either did not report the primary outcome (time to heart rate ≥ 100 bpm from birth), had differing reporting methods (achieving desired tidal volumes, significant mask leak) or did not find significant differences (intubation rate, air leaks, death before hospital discharge, severe intraventricular hemorrhage, chronic lung disease). Limitations included limited sample size for critical outcomes, inconsistent definitions amongst studies and unreported long-term outcomes.Although respiratory function monitoring has been utilized in clinical care, there is currently insufficient evidence to suggest its benefit for newborn infants receiving respiratory support for resuscitation at birth.PROSPERO CRD42021278169 (registered November 27, 2021).The International Liaison Committee on Resuscitation provided support that included access to software platforms and teleconferencing.

  View details for DOI 10.1016/j.resplu.2022.100327

  View details for PubMedID 36425449

  View details for PubMedCentralID PMC9678959

• 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces RESUSCITATION Wyckoff, M. H., Greif, R., Morley, P. T., Ng, K., Olasveengen, T. M., Singletary, E. M., Soar, J., Cheng, A., Drennan, I. R., Liley, H. G., Scholefield, B. R., Smyth, M. A., Welsford, M., Zideman, D. A., Acworth, J., Aickin, R., Andersen, L. W., Atkins, D., Berry, D. C., Bhanji, F., Bierens, J., Borra, V., Boettiger, B. W., Bradley, R. N., Bray, J. E., Breckwoldt, J., Callaway, C. W., Carlson, J. N., Cassan, P., Castren, M., Chang, W., Charlton, N. P., Chung, S., Considine, J., Costa-Nobre, D. T., Couper, K., Couto, T., Dainty, K. N., Davis, P. G., de Almeida, M., de Caen, A. R., Deakin, C. D., Djarv, T., Donnino, M. W., Douma, M. J., Duff, J. P., Dunne, C. L., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Finn, J., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A., Guinsburg, R., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M., Kim, H., Kleinman, M., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y., Lockey, A. S., Maconochie, I. K., Madar, R., Hansen, C., Masterson, S., Matsuyama, T., McKinlay, C. D., Meyran, D., Morgan, P., Morrison, L. J., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., O'Neill, B. J., Ong, Y., Orkin, A. M., Paiva, E. F., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Ruediger, M., Sakamoto, T., Sandroni, C., Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Sugiura, T., Tijssen, J. A., Trevisanuto, D., Van de Voorde, P., Wang, T., Weiner, G. M., Wyllie, J. P., Yang, C., Yeung, J., Nolan, J. P., Berg, K. M. 2022; 181: 208-288

  Abstract

  This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

  View details for DOI 10.1016/j.resuscitation.2022.10.005

  View details for Web of Science ID 001072601200001

  View details for PubMedID 36336195

• Pilot study of the DART tool - an objective healthcare simulation debriefing assessment instrument. BMC medical education Baliga, K., Coggins, A., Warburton, S., Mathias, D., Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2022; 22 (1): 636

  Abstract

  BACKGROUND: Various rating tools aim to assess simulation debriefing quality, but their use may be limited by complexity and subjectivity. The Debriefing Assessment in Real Time (DART) tool represents an alternative debriefing aid that uses quantitative measures to estimate quality and requires minimal training to use. The DART isuses a cumulative tally of instructor questions (IQ), instructor statements (IS) and trainee responses (TR). Ratios for IQ:IS and TR:[IQ+IS] may estimate the level of debriefer inclusivity and participant engagement.METHODS: Experienced faculty from four geographically disparate university-affiliated simulation centers rated video-based debriefings and a transcript using the DART. The primary endpoint was an assessment of the estimated reliability of the tool. The small sample size confined analysis to descriptive statistics and coefficient of variations (CV%) as an estimate of reliability.RESULTS: Ratings for Video A (n=7), Video B (n=6), and Transcript A (n=6) demonstrated mean CV% for IQ (27.8%), IS (39.5%), TR (34.8%), IQ:IS (40.8%), and TR:[IQ+IS] (28.0%). Higher CV% observed in IS and TR may be attributable to rater characterizations of longer contributions as either lumped or split. Lower variances in IQ and TR:[IQ+IS] suggest overall consistency regardless of scores being lumped or split.CONCLUSION: The DART tool appears to be reliable for the recording of data which may be useful for informing feedback to debriefers. Future studies should assess reliability in a wider pool of debriefings and examine potential uses in faculty development.

  View details for DOI 10.1186/s12909-022-03697-w

  View details for PubMedID 35989331

• Turning Practicing Surgeons Into Health Technology Innovators: Outcomes From the Stanford Biodesign Faculty Fellowship SURGICAL INNOVATION Fuerch, J. H., Wang, P., Van Wert, R., Denend, L. 2021: 1553350620984338

  Abstract

  Background. The Stanford Biodesign Faculty Fellows program was established in 2014 to train Stanford Medical and Engineering faculty in a repeatable innovation process for health technology translation while also being compatible with the busy clinical schedules of surgical faculty members. Methods. Since 2014, 62 faculty members have completed the fellowship with 42% (n = 26) coming from 14 surgical subspecialties. This eight-month, needs-based innovation program covers topics from identifying unmet health-related needs, to inventing new technology, developing plans for intellectual property (IP), regulatory, reimbursement, and business models to advance the technologies toward patient care. Results/Conclusion. Intake and exit survey results from three years of program participants (n = 36) indicate that the fellowship is a valuable hands-on educational program capable of improving awareness and experience with skill sets required for health technology innovation and entrepreneurship.

  View details for DOI 10.1177/1553350620984338

  View details for Web of Science ID 000621156000001

  View details for PubMedID 33599567

• Lessons Learned from a Collaborative to Develop a Sustainable Simulation-Based Training Program in Neonatal Resuscitation: Simulating Success. Children (Basel, Switzerland) Arul, N. n., Ahmad, I. n., Hamilton, J. n., Sey, R. n., Tillson, P. n., Hutson, S. n., Narang, R. n., Norgaard, J. n., Lee, H. C., Bergin, J. n., Quinn, J. n., Halamek, L. P., Yamada, N. K., Fuerch, J. n., Chitkara, R. n. 2021; 8 (1)

  Abstract

  Newborn resuscitation requires a multidisciplinary team effort to deliver safe, effective and efficient care. California Perinatal Quality Care Collaborative's Simulating Success program was designed to help hospitals implement on-site simulation-based neonatal resuscitation training programs. Partnering with the Center for Advanced Pediatric and Perinatal Education at Stanford, Simulating Success engaged hospitals over a 15 month period, including three months of preparatory training and 12 months of implementation. The experience of the first cohort (Children's Hospital of Orange County (CHOC), Sharp Mary Birch Hospital for Women and Newborns (SMB) and Valley Children's Hospital (VCH)), with their site-specific needs and aims, showed that a multidisciplinary approach with a sound understanding of simulation methodology can lead to a dynamic simulation program. All sites increased staff participation. CHOC reduced latent safety threats measured during team exercises from 4.5 to two per simulation while improving debriefing skills. SMB achieved 100% staff participation by identifying unit-specific hurdles within in situ simulation. VCH improved staff confidence level in responding to neonatal codes and proved feasibility of expanding simulation across their hospital system. A multidisciplinary approach to quality improvement in neonatal resuscitation fosters engagement, enables focus on patient safety rather than individual performance, and leads to identification of system issues.

  View details for DOI 10.3390/children8010039

  View details for PubMedID 33445638

• The Value of Surgical Data-Impact on the Future of the Surgical Field. Surgical innovation August, A. T., Sheth, K. n., Brandt, A. n., deRuijter, V. n., Fuerch, J. H., Wall, J. n. 2021: 15533506211003538

  Abstract

  The combination of computing power, connectivity, and big data has been touted as the future of innovation in many fields, including medicine. There has been a groundswell of companies developing tools for improving patient care utilizing healthcare data, but procedural specialties, like surgery, have lagged behind in benefitting from data-based innovations, given the lack of data that is well structured. While many companies are attempting to innovate in the surgical field, some have encountered difficulties around collecting surgical data, given its complex nature. As there is no standardized way in which to interact with healthcare systems to purchase these data, the authors attempt to characterize the various ways in which surgical data are collected and shared. By surveying and conducting interviews with various surgical technology companies, at least 3 different methods to collect surgical data were identified. From this information, the authors conclude that an attempt to outline best practices should be undertaken that benefits all stakeholders.

  View details for DOI 10.1177/15533506211003538

  View details for PubMedID 33830831

• A Neonatal Intensive Care Unit's Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative. Children (Basel, Switzerland) Eckels, M. n., Zeilinger, T. n., Lee, H. C., Bergin, J. n., Halamek, L. P., Yamada, N. n., Fuerch, J. n., Chitkara, R. n., Quinn, J. n. 2020; 7 (11)

  Abstract

  Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality. In Simulating Success, a 15-month quality improvement (QI) project, the Center for Advanced Pediatric and Perinatal Education (CAPE) and California Perinatal Quality Care Collaborative (CPQCC) provided outreach and training on neonatal simulation and debriefing fundamentals to individual teams, including community hospital settings, and assisted in implementing a sustainable program at each site. The primary Aim was to conduct two simulations a month, with a goal of 80% neonatal intensive care unit (NICU) staff participation in two simulations during the implementation phase. While the primary Aim was not achieved, in-situ simulations led to the identification of latent safety threats and improvement in system processes. This paper describes one unit's QI collaborative experience implementing an in-situ neonatal simulation and debriefing program.

  View details for DOI 10.3390/children7110202

  View details for PubMedID 33137897

• Novel Neonatal Umbilical Catheter Protection and Stabilization Device in In vitro Model of Catheterized Human Umbilical Cords: Effect of Material and Venting on Bacterial Colonization. American journal of perinatology Wood, L. S., Fuerch, J. H., Dambkowski, C. L., Chehab, E. F., Torres, S., Shih, J. D., Venook, R., Wall, J. K. 2019

  Abstract

  OBJECTIVE: Umbilical central lines deliver life-saving medications and nutrition for neonates; however, complications associated with umbilical catheters (UCs) occur more frequently than in adults with central lines (i.e., line migration, systemic infection). We have developed a device for neonatal UC protection and stabilization to reduce catheter exposure to bacteria compared with the standard of care: "goal post" tape configuration. This study analyzes the effect of device venting and material on bacterial load of human umbilical cords in vitro.STUDY DESIGN: Catheters were inserted into human umbilical cord segments in vitro, secured with plastic or silicone vented prototype versus tape, and levels of bacterial colonization were compared between groups after 7 days of incubation.RESULTS: Nonvented plastic prototype showed increased bacterial load compared with goal post (p=0.04). Colonization was comparable between the goal post and all vented plastic prototypes (p≥0.30) and when compared with the vented silicone device (p=1).CONCLUSION: A novel silicone device does not increase external bacterial colonization compared with the current standard of care for line securement, and may provide a safe, convenient alternative to standard adhesive tape for UC stabilization. Future studies are anticipated to establish safety in vivo, alongside benefits such as migration and infection reduction.

  View details for DOI 10.1055/s-0039-1700542

  View details for PubMedID 31739365

• Developing safe devices for neonatal care. Seminars in perinatology Fuerch, J. H., Sanderson, P., Barshi, I., Liley, H. 2019: 151176

  Abstract

  Currently, the majority of medical devices are designed for adults; some are then miniaturized for use in neonates. This process neglects population-specific testing that would ensure that the medical devices used for neonates are actually safe and effective for that group. Incorporating human-centered design principles and utilizing methods to evaluate devices that include simulation and clinical testing can improve the safety of devices used in caring for neonates. However, significant regulatory, financial, social and ethical barriers to development remain. In order to overcome these barriers and create a pipeline of safe and effective neonatal medical devices, specific incentives are required.

  View details for DOI 10.1053/j.semperi.2019.08.005

  View details for PubMedID 31662216

• Ergonomic Challenges Inherent in Neonatal Resuscitation. Children (Basel, Switzerland) Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2019; 6 (6)

  Abstract

  Neonatal resuscitation demands that healthcare professionals perform cognitive and technical tasks while working under time pressure as a team in order to provide efficient and effective care. Neonatal resuscitation teams simultaneously process and act upon multiple data streams, perform ergonomically challenging technical procedures, and coordinate their actions within a small physical space. An understanding and application of human factors and ergonomics science broadens the areas of need in resuscitation research, and will lead to enhanced technologies, systems, and work environments that support human limitations and maximize human performance during neonatal resuscitation.

  View details for DOI 10.3390/children6060074

  View details for PubMedID 31163596

• Simulation-Based Patient-Specific Multidisciplinary Team Training in Preparation for the Resuscitation and Stabilization of Conjoined Twins AMERICAN JOURNAL OF PERINATOLOGY Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2017; 34 (6): 621-626

  Abstract

  The resuscitation of conjoined twins is a rare and complex clinical challenge. We detail how patient-specific, in situ simulation can be used to prepare a large, multidisciplinary team of health care professionals (HCPs) to deliver safe, efficient, and effective care to such patients. In this case, in situ simulation allowed an 18-person team to address the clinical and ergonomic challenges anticipated for this neonatal resuscitation. The HCPs trained together as an intact team in the actual delivery room environment to probe for human and system weaknesses prior to this unique delivery, and optimized communication, teamwork, and other behavioral skills as they prepared for the simultaneous resuscitation of two patients who were physically joined to one another.

  View details for DOI 10.1055/s-0036-1593808

  View details for Web of Science ID 000400074500016

• Simulation-Based Patient-Specific Multidisciplinary Team Training in Preparation for the Resuscitation and Stabilization of Conjoined Twins. American journal of perinatology Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2016: -?

  Abstract

  The resuscitation of conjoined twins is a rare and complex clinical challenge. We detail how patient-specific, in situ simulation can be used to prepare a large, multidisciplinary team of health care professionals (HCPs) to deliver safe, efficient, and effective care to such patients. In this case, in situ simulation allowed an 18-person team to address the clinical and ergonomic challenges anticipated for this neonatal resuscitation. The HCPs trained together as an intact team in the actual delivery room environment to probe for human and system weaknesses prior to this unique delivery, and optimized communication, teamwork, and other behavioral skills as they prepared for the simultaneous resuscitation of two patients who were physically joined to one another.

  View details for PubMedID 27832667

• Impact of Standardized Communication Techniques on Errors during Simulated Neonatal Resuscitation. American journal of perinatology Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2016; 33 (4): 385-392

  Abstract

  Aim Current patterns of communication in high-risk clinical situations, such as resuscitation, are imprecise and prone to error. We hypothesized that the use of standardized communication techniques would decrease the errors committed by resuscitation teams during neonatal resuscitation. Methods In a prospective, single-blinded, matched pairs design with block randomization, 13 subjects performed as a lead resuscitator in two simulated complex neonatal resuscitations. Two nurses assisted each subject during the simulated resuscitation scenarios. In one scenario, the nurses used nonstandard communication; in the other, they used standardized communication techniques. The performance of the subjects was scored to determine errors committed (defined relative to the Neonatal Resuscitation Program algorithm), time to initiation of positive pressure ventilation (PPV), and time to initiation of chest compressions (CC). Results In scenarios in which subjects were exposed to standardized communication techniques, there was a trend toward decreased error rate, time to initiation of PPV, and time to initiation of CC. While not statistically significant, there was a 1.7-second improvement in time to initiation of PPV and a 7.9-second improvement in time to initiation of CC. Conclusions Should these improvements in human performance be replicated in the care of real newborn infants, they could improve patient outcomes and enhance patient safety.

  View details for DOI 10.1055/s-0035-1565997

  View details for PubMedID 26485251

• Modification of the Neonatal Resuscitation Program Algorithm for Resuscitation of Conjoined Twins. American journal of perinatology Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2016; 33 (4): 420-424

  Abstract

  There are no national or international guidelines for the resuscitation of conjoined twins. We have described how the U.S. Neonatal Resuscitation Program algorithm can be modified for delivery room resuscitation of omphaloischiopagus conjoined twins. In planning for the delivery and resuscitation of these patients, we considered the challenges of providing cardiopulmonary support to preterm conjoined twins in face-to-face orientation and with shared circulation via a fused liver and single umbilical cord. We also demonstrate how in situ simulation can be used to prepare a large, multidisciplinary team of health care professionals to deliver safe, efficient, and effective care to such patients.

  View details for DOI 10.1055/s-0035-1563713

  View details for PubMedID 26461924

• Impact of a novel decision support tool on adherence to Neonatal Resuscitation Program algorithm RESUSCITATION Fuerch, J. H., Yamada, N. K., Coelho, P. R., Lee, H. C., Halamek, L. P. 2015; 88: 52-56

  Abstract

  Studies have shown that healthcare professionals (HCPs) display a 16-55% error rate in adherence to the Neonatal Resuscitation Program (NRP) algorithm. The aim of this study was to evaluate adherence to the Neonatal Resuscitation Program algorithm by subjects working from memory as compared to subjects using a decision support tool that provides auditory and visual prompts to guide implementation of the Neonatal Resuscitation Program algorithm during simulated neonatal resuscitation.Healthcare professionals (physicians, nurse practitioners, obstetrical/neonatal nurses) with a current NRP card were randomized to the control or intervention group and performed three simulated neonatal resuscitations. The scenarios were evaluated for the initiation and cessation of positive pressure ventilation (PPV) and chest compressions (CC), as well as the frequency of FiO2 adjustment. The Wilcoxon rank sum test was used to compare a score measuring the adherence of the control and intervention groups to the Neonatal Resuscitation Program algorithm.Sixty-five healthcare professionals were recruited and randomized to the control or intervention group. Positive pressure ventilation was performed correctly 55-80% of the time in the control group vs. 94-95% in the intervention group across all three scenarios (p<0.0001). Chest compressions were performed correctly 71-81% of the time in the control group vs. 82-93% in the intervention group in the two scenarios in which they were indicated (p<0.0001). FiO2 was addressed three times more frequently in the intervention group compared to the control group (p<0.001).Healthcare professionals using a decision support tool exhibit significantly fewer deviations from the Neonatal Resuscitation Program algorithm compared to those working from memory alone during simulated neonatal resuscitation.

  View details for DOI 10.1016/j.resuscitation.2014.12.016

  View details for PubMedID 25555358

• The Neonatal Resuscitation Program: Current Recommendations and a Look at the Future INDIAN JOURNAL OF PEDIATRICS Kumar, P., Yamada, N. K., Fuerch, J. H., Halamek, L. P. 2014; 81 (5): 473-480

  Abstract

  The Neonatal Resuscitation Program (NRP) consists of an algorithm and curriculum to train healthcare professionals to facilitate newborn infants' transition to extrauterine life and to provide a standardized approach to the care of infants who require more invasive support and resuscitation. This review discusses the most recent update of the NRP algorithm and recommended guidelines for the care of newly born infants. Current challenges in training and assessment as well as the importance of ergonomics in the optimization of human performance are discussed. Finally, it is recommended that in order to ensure high-performing resuscitation teams, members should be selected and retained based on objective performance criteria and frequent participation in realistic simulated clinical scenarios.

  View details for DOI 10.1007/s12098-013-1332-0

  View details for Web of Science ID 000335739000011

  View details for PubMedID 24652267

• A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Epstein, L. H., Roemmich, J. N., Robinson, J. L., Paluch, R. A., Winiewicz, D. D., Fuerch, J. H., Robinson, T. N. 2008; 162 (3): 239-245

  Abstract

  To assess the effects of reducing television viewing and computer use on children's body mass index (BMI) as a risk factor for the development of overweight in young children.Randomized controlled clinical trial.University children's hospital.Seventy children aged 4 to 7 years whose BMI was at or above the 75th BMI percentile for age and sex.Children were randomized to an intervention to reduce their television viewing and computer use by 50% vs a monitoring control group that did not reduce television viewing or computer use.Age- and sex-standardized BMI (zBMI), television viewing, energy intake, and physical activity were monitored every 6 months during 2 years.Children randomized to the intervention group showed greater reductions in targeted sedentary behavior (P < .001), zBMI (P < .05), and energy intake (P < .05) compared with the monitoring control group. Socioeconomic status moderated zBMI change (P = .01), with the experimental intervention working better among families of low socioeconomic status. Changes in targeted sedentary behavior mediated changes in zBMI (P < .05). The change in television viewing was related to the change in energy intake (P < .001) but not to the change in physical activity (P =.37).Reducing television viewing and computer use may have an important role in preventing obesity and in lowering BMI in young children, and these changes may be related more to changes in energy intake than to changes in physical activity.

  View details for Web of Science ID 000253672100007

  View details for PubMedID 18316661

  View details for PubMedCentralID PMC2291289