Lou Halamek

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

• 2023 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 Berg, K. M., Bray, J. E., Ng, K., Liley, H. G., Greif, R., Carlson, J. N., Morley, P. T., Drennan, I. R., Smyth, M., Scholefield, B. R., Weiner, G. M., Cheng, A., Djarv, T., Abelairas-Gomez, C., Acworth, J., Andersen, L. W., Atkins, D. L., Berry, D. C., Bhanji, F., Bierens, J., Couto, T., Borra, V., Boettiger, B. W., Bradley, R. N., Breckwoldt, J., Cassan, P., Chang, W., Charlton, N. P., Chung, S., Considine, J., Costa-Nobre, D. T., Couper, K., Dainty, K. N., Dassanayake, V., Davis, P. G., Dawson, J. A., de Almeida, M., De Caen, A. R., Deakin, C. D., Dicker, B., Douma, M. J., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Fijacko, N., Finn, J. C., Flores, G. E., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A., Guinsburg, R., Hatanaka, T., 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. E., Kloeck, D. A., Kudenchuk, P., Kule, A., Kurosawa, H., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y., Lockey, A. S., Macneil, F., Maconochie, I. K., Madar, R., Hansen, C., Masterson, S., Matsuyama, T., McKinlay, C. D., Meyran, D., Monnelly, V., 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., Ohshimo, S., Olasveengen, T. M., Ong, Y., Orkin, A. M., Parr, M. J., Patocka, C., Perkins, G. D., Perlman, J. M., Rabi, Y., Raitt, J., Ramachandran, S., Ramaswamy, V. V., Raymond, T. T., 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., Singletary, E. M., Skrifvars, M. B., Smith, C. M., Soar, J., Stassen, W., Sugiura, T., Tijssen, J. A., Topjian, A. A., Trevisanuto, D., Vaillancourt, C., Wyckoff, M. H., Wyllie, J. P., Yang, C., Yeung, J., Zelop, C. M., Zideman, D. A., Nolan, J. P. 2024; 195: 109992

  Abstract

  The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

  View details for DOI 10.1016/j.resuscitation.2023.109992

  View details for Web of Science ID 001190927600001

  View details for PubMedID 37937881

• SELF-REGULATING PHYSIOLOGIC RESPONSE AND INTENSITY IN NAVIGATING TIME-SENSITIVE SITUATIONS (SPRINTS) Halamek, L. SAGE PUBLICATIONS LTD. 2024: 669

  View details for Web of Science ID 001307337600660

• Technical Assessment of Simulated Neonatal Intubation Using Multi-angle Video Gu, H., Cranshaw, M., Galindo, R., Alade, T., Pineda, L., McWilliam, P., Powell, D., Kent, N., Fuerch, J., Yamada, N., Halamek, L. SAGE PUBLICATIONS LTD. 2024: 184-186

  View details for Web of Science ID 001307337600217

• Improving teams' clinical performance in the labor and delivery unit using video-assisted debriefing of real-life events Rosvig, L., Hvidman, L., Uldbjerg, N., Kierkegaard, O., Lou, S., Manser, T., Halamek, L., Brogaard, L. WILEY. 2023: 33

  View details for Web of Science ID 001183994700069

• The Need for Simulation-Based Procedural Skills Training to Address Proposed Changes in Accreditation Council for Graduate Medical Education Requirements for Pediatric Residency Programs. Simulation in healthcare : journal of the Society for Simulation in Healthcare Nawathe, P. A., Kessler, D. O., Yurasek, G., Sawyer, T. L., Halamek, L. P., Stone, K., Ramachandra, G., Maa, T., Tofil, N., Doughty, C., Thyagarajan, S., White, M. L., Damazo, R., Calhoun, A. 2023

  View details for DOI 10.1097/SIH.0000000000000757

  View details for PubMedID 37922251

• 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

• The Evolution of Neonatal Patient Safety. Clinics in perinatology Yamada, N. K., Halamek, L. P. 2023; 50 (2): 421-434

  Abstract

  Human factors science teaches us that patient safety is achieved not by disciplining individual health care professionals for mistakes, but rather by designing systems that acknowledge human limitations and optimize the work environment for them. Incorporating human factors principles into simulation, debriefing, and quality improvement initiatives will strengthen the quality and resilience of the process improvements and systems changes that are developed. The future of patient safety in neonatology will require continued efforts to engineer and re-engineer systems that support the humans who are at the interface of delivering safe patient care.

  View details for DOI 10.1016/j.clp.2023.01.005

  View details for PubMedID 37201989

• 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

• Correction: Immediate faculty feedback using debriefing timing data and conversational diagrams. Advances in simulation (London, England) Coggins, A., Hong, S. S., Baliga, K., Halamek, L. P. 2023; 8 (1): 6

  View details for DOI 10.1186/s41077-023-00247-2

  View details for PubMedID 36829245

  View details for PubMedCentralID 8899451

• A Method to Use Haptic Feedback of Laryngoscope Force Vector for Endotracheal Intubation Training Zhou, H., Yang, S., Halamek, L., Nanayakkara, T., IEEE IEEE. 2023: 6810-6816

  View details for DOI 10.1109/ICRA48891.2023.10160755

  View details for Web of Science ID 001036713005037

• 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

• Using Simulation to Support Evidence-Based Design of Safer Health Care Environments. American journal of perinatology Halamek, L. P. 2022

  Abstract

  The design of health care environments and the technologies used within them have tremendous influence on the performance of the professionals who care for patients in those spaces. In turn, the performance of those professionals greatly impacts the safety of the care that is delivered to patients. Active and latent safety errors can be greatly reduced by rigorous testing of the patient care environment. · Prior to the approval of final design specifications and actual construction.. · After construction is complete before the first patients move in.. · On an ongoing basis once patient care is in progress.. While there are numerous types of testing that can be conducted, this manuscript will focus on the use of simulated clinical scenarios in realistic/real physical environments to detect and remediate weaknesses in the design of those environments with a focus on their use in perinatal centers. KEY POINTS: · Environmental design influences human performance.. · Realistic clinical simulation can improve the design.. · Simulation should be done on a continuous basis..

  View details for DOI 10.1055/s-0042-1757453

  View details for PubMedID 36368652

• A Scoping Review and Appraisal of Extracorporeal Membrane Oxygenation Education Literature. ATS scholar Han, P. K., Purkey, N. J., Kuo, K. W., Ryan, K. R., Woodward, A. L., Jahadi, O., Prom, N. L., Halamek, L. P., Johnston, L. C. 2022; 3 (3): 468-484

  Abstract

  Background: Despite a recent rise in publications describing extracorporeal membrane oxygenation (ECMO) education, the scope and quality of ECMO educational research and curricular assessments have not previously been evaluated.Objective: The purposes of this study are 1) to categorize published ECMO educational scholarship according to Bloom's educational domains, learner groups, and content delivery methods; 2) to assess ECMO educational scholarship quality; and 3) to identify areas of focus for future curricular development and educational research.Methods: A multidisciplinary research team conducted a scoping review of ECMO literature published between January 2009 and October 2021 using established frameworks. The Medical Education Research Study Quality Instrument (MERSQI) was applied to assess quality.Results: A total of 1,028 references were retrieved; 36 were selected for review. ECMO education studies frequently targeted the cognitive domain (78%), with 17% of studies targeting the psychomotor domain alone and 33% of studies targeting combinations of the cognitive, psychomotor, and affective domains. Thirty-three studies qualified for MERSQI scoring, with a median score of 11 (interquartile range, 4; possible range, 5-18). Simulation-based training was used in 97%, with 50% of studies targeting physicians and one other discipline.Conclusion: ECMO education frequently incorporates simulation and spans all domains of Bloom's taxonomy. Overall, MERSQI scores for ECMO education studies are similar to those for other simulation-based medical education studies. However, developing assessment tools with multisource validity evidence and conducting multienvironment studies would strengthen future work. The creation of a collaborative ECMO educational network would increase standardization and reproducibility in ECMO training, ultimately improving patient outcomes.

  View details for DOI 10.34197/ats-scholar.2022-0058RE

  View details for PubMedID 36312813

• 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

• State-of-the art training in neonatal resuscitation. Seminars in perinatology Halamek, L. P., Weiner, G. M. 2022: 151628

  Abstract

  Healthcare training has traditionally emphasized acquisition and recall of vast amounts of content knowledge; however, delivering care during resuscitation of neonates requires much more than content knowledge. As the science of resuscitation has progressed, so have the methodologies and technologies used to train healthcare professionals in the cognitive, technical and behavioral skills necessary for effective resuscitation. Simulation of clinical scenarios, debriefing, virtual reality, augmented reality and audiovisual recordings of resuscitations of human neonates are increasingly being used in an effort to improve human and system performance during this life-saving intervention. In the same manner, as evidence has accumulated to support the guidelines for neonatal resuscitation so, too, has affirmation of training methodologies and technologies. This guarantees that training in neonatal resuscitation will continue to evolve to meet the needs of healthcare professionals charged with caring for newborns at one of the most vulnerable times in their lives.

  View details for DOI 10.1016/j.semperi.2022.151628

  View details for PubMedID 35717245

• Immediate faculty feedback using debriefing timing data and conversational diagrams. Advances in simulation (London, England) Coggins, A., Hong, S. S., Baliga, K., Halamek, L. P. 2022; 7 (1): 7

  Abstract

  Debriefing is an essential skill for simulation educators and feedback for debriefers is recognised as important in progression to mastery. Existing assessment tools, such as the Debriefing Assessment for Simulation in Healthcare (DASH), may assist in rating performance but their utility is limited by subjectivity and complexity. Use of quantitative data measurements for feedback has been shown to improve performance of clinicians but has not been studied as a focus for debriefer feedback.A multi-centre sample of interdisciplinary debriefings was observed. Total debriefing time, length of individual contributions and demographics were recorded. DASH scores from simulation participants, debriefers and supervising faculty were collected after each event. Conversational diagrams were drawn in real-time by supervising faculty using an approach described by Dieckmann. For each debriefing, the data points listed above were compiled on a single page and then used as a focus for feedback to the debriefer.Twelve debriefings were included (µ = 6.5 simulation participants per event). Debriefers receiving feedback from supervising faculty were physicians or nurses with a range of experience (n = 7). In 9/12 cases the ratio of debriefer to simulation participant contribution length was ≧ 1:1. The diagrams for these debriefings typically resembled a fan-shape. Debriefings (n = 3) with a ratio < 1:1 received higher DASH ratings compared with the ≧ 1:1 group (p = 0.038). These debriefings generated star-shaped diagrams. Debriefer self-rated DASH scores (µ = 5.08/7.0) were lower than simulation participant scores (µ = 6.50/7.0). The differences reached statistical significance for all 6 DASH elements. Debriefers evaluated the 'usefulness' of feedback and rated it 'highly' (µ= 4.6/5).Basic quantitative data measures collected during debriefings may represent a useful focus for immediate debriefer feedback in a healthcare simulation setting.

  View details for DOI 10.1186/s41077-022-00203-6

  View details for PubMedID 35256014

• Impact of bed height on the biomechanics of healthcare professionals during chest compressions on the neonate: a descriptive pilot study. BMJ open Parent-Nichols, J., Perez, J., Witherell, B., McWilliam, P., Halamek, L. P., Kent, N., Varnum, W., Yamada, N. K. 2021; 11 (9): e047666

  Abstract

  OBJECTIVES: The biomechanics of the healthcare professionals (HCPs) performing the life-saving intervention of chest compressions in the neonatal population is poorly understood. The aim of this pilot study was to describe the variations in body position at a self-selected and a predetermined bed height during neonatal chest compressions. Measures of joint angles, time to postural sway and number of postural adjustments were chosen as indices for the stability of the HCP's position.SETTING: Data were collected at a simulation-based research centre in which the patient care environment was replicated.PARTICIPANTS: HCPs with varying roles working in the neonatal intensive care unit and holding a current Neonatal Resuscitation Program Provider certification were recruited for this study.INTERVENTIONS: Fifteen HCPs performed two trials of chest compressions, each lasting 2min, at a predetermined bed height and a self-selected bed height. Trials were video recorded, capturing upper and lower body movements. Videos were analysed for time to postural sway and number of postural adjustments. Joint angles were measured at the start and end of each trial.RESULTS: A statistically significant difference was found between the two bed height conditions for number of postural adjustments (p=0.02). While not statistically significant, time postural sway was increased in the choice bed height condition (85s) compared with the predetermined bed height (45s). After 30s of chest compressions, mean shoulder and knee angles were smaller for choice bed height (p=0.03, 95%CI Lower=-12.14, Upper=-0.68and p=0.05, 95%CI Lower=3.43, Upper=0.01, respectively). After 1min and 45s of chest compressions, mean wrist angles were smaller in the choice bed height condition (p=0.01, 95%CI Lower=-9.20, Upper=-1.22), stride length decreased between the 30s and 1min 45s marks of the chest compressions in the predetermined height condition (p=0.02).

  View details for DOI 10.1136/bmjopen-2020-047666

  View details for PubMedID 34531209

• 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

• Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery. PloS one Sotto, K. T., Hedli, L. C., Sie, L., Padua, K., Yamada, N., Lee, H., Halamek, L., Daniels, K., Nathan-Roberts, D., Austin, N. S. 2021; 16 (6): e0252888

  Abstract

  OBJECTIVE: This study aimed to begin to address this gap using validated techniques in human factors to perform a participatory user-centered analysis of physical space during emergency Cesarean.METHODS: This study employed a mixed-methods design. Focus group interviews and surveys were administered to a convenience sample (n = 34) of multidisciplinary obstetric teams. Data collected from focus group interviews were used to perform a task and equipment analysis. Survey data were coded and mapped by specialty to identify reported areas of congestion and time spent, and to identify themes related to physical space of the OR and labor and delivery unit.RESULTS: Task analysis revealed complex interdependencies between specialties. Thirty task groupings requiring over 20 pieces of equipment were identified. Perceived areas of congestion and areas of time spent in the OR varied by clinical specialty. The following categories emerged as main challenges encountered during an emergency Cesarean: 1) size of physical space and equipment, 2) layout and orientation, and 3) patient transport.CONCLUSION: User insights on physical space and workflow processes during emergency Cesarean section at the institution studied revealed challenges related to getting the patients into the OR expediently and having space to perform tasks without crowding or staff injury. By utilizing human factors techniques, other institutions may build upon our findings to improve safety during emergency situations on labor and delivery.

  View details for DOI 10.1371/journal.pone.0252888

  View details for PubMedID 34111177

• A Feasibility Study of a Novel Delayed Cord Clamping Cart. Children (Basel, Switzerland) Joshi, N. S., Padua, K. n., Sherman, J. n., Schwandt, D. n., Sie, L. n., Gupta, A. n., Halamek, L. P., Lee, H. C. 2021; 8 (5)

  Abstract

  Delaying umbilical cord clamping (DCC) for 1 min or longer following a neonate's birth has now been recommended for preterm and term newborns by multiple professional organizations. DCC has been shown to decrease rates of iron deficiency anemia, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and blood transfusion. Despite these benefits, clinicians typically cut the umbilical cord without delay in neonates requiring resuscitation and move them to a radiant warmer for further care; this effectively prevents these patients from receiving any benefits from DCC. This study evaluated the feasibility of a delayed cord clamping cart (DCCC) in low-risk neonates born via Cesarean section (CS). The DCCC is a small, sterile cart designed to facilitate neonatal resuscitation while the umbilical cord remains intact. The cart is cantilevered over the operating room (OR) table during a CS, allowing the patient to be placed onto it immediately after birth. For this study, a sample of 20 low-risk CS cases were chosen from the non-emergency Labor and Delivery surgical case list. The DCCC was utilized for 1 min of DCC in all neonates. The data collected included direct observation by research team members, recorded debriefings and surveys of clinicians as well as surveys of patients. Forty-four care team members participated in written surveys; of these, 16 (36%) were very satisfied, 12 (27%) satisfied, 13 (30%) neutral, and 3 (7%) were somewhat dissatisfied with use of the DCCC in the OR. Feedback was collected from all 20 patients, with 18 (90%) reporting that they felt safe with the device in use. This study provides support that utilizing a DCCC can facilitate DCC with an intact umbilical cord.

  View details for DOI 10.3390/children8050357

  View details for PubMedID 33946912

• Understanding the Heterogeneity of Labor and Delivery Units: Using Design Thinking Methodology to Assess Environmental Factors that Contribute to Safety in Childbirth AMERICAN JOURNAL OF PERINATOLOGY Sherman, J. P., Hedli, L. C., Kristensen-Cabrera, A. I., Lipman, S. S., Schwandt, D., Lee, H. C., Sie, L., Halamek, L. P., Austin, N. S., Safety Learning Lab Neonatal Mate 2020; 37 (6): 638–46

  View details for DOI 10.1055/s-0039-1685494

  View details for Web of Science ID 000529912700013

• 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

• Making "Magic" with Engineered Decisions, Data, and Processes: A Hospital Operations Center Celona, J., Halamek, L., Seiver, A., Wu, X. T., Jermaine, C., Xiong, L., Hu, X. H., Kotevska, O., Lu, S. Y., Xu, W. J., Aluru, S., Zhai, C. X., Al-Masri, E., Chen, Z. Y., Saltz, J. IEEE. 2020

  View details for DOI 10.1109/BigData50022.2020.9377972

  View details for Web of Science ID 000662554700004

• Validation of an Instrument for Real-Time Assessment of Neonatal Intubation Skills: A Randomized Controlled Simulation Study. American journal of perinatology Kuijpers, L. J., Binkhorst, M. n., Yamada, N. K., Bouwmeester, R. N., van Heijst, A. F., Halamek, L. P., Hogeveen, M. n. 2020

  Abstract

   This study aimed to evaluate the construct validity and reliability of real-time assessment of a previously developed neonatal intubation scoring instrument (NISI). We performed a randomized controlled simulation study at a simulation-based research and training facility. Twenty-four clinicians experienced in neonatal intubation ("experts") and 11 medical students ("novices") performed two identical elective intubations on a neonatal patient simulator. Subjects were randomly assigned to either the intervention group, receiving predefined feedback between the two intubations, or the control group, receiving no feedback. Using the previously developed NISI, all intubations were assessed, both in real time and remotely on video. Construct validity was evaluated by (1) comparing the intubation performances, expressed as percentage scores, with and without feedback, and (2) correlating the intubation performances with the subjects' level of experience. The intrarater reliability, expressed as intraclass correlation coefficient (ICC), of real-time assessment compared with video-based assessment was determined. The intervention group contained 18 subjects, the control group 17. Background characteristics and baseline intubation scores were comparable in both groups. The median (IQR) change in percentage scores between the first and second intubation was significantly different between the intervention and control group (11.6% [4.7-22.8%] vs. 1.4% [0.0-5.7%], respectively; p = 0.013). The 95% CI for this 10.2% difference was 2.2 to 21.4%. The subjects' experience level correlated significantly with their percentage scores (Spearman's R = 0.70; p <0.01). ICC's were 0.95 (95% CI: 0.89-0.97) and 0.94 (95% CI: 0.89-0.97) for the first and second intubation, respectively. Our NISI has construct validity and is reliable for real-time assessment.· Our neonatal intubation scoring instrument has construct validity.. · Our instrument can be reliably employed to assess neonatal intubation skills directly in real time.. · It is suitable for formative assessment, i.e., providing direct feedback during procedural training..

  View details for DOI 10.1055/s-0040-1715530

  View details for PubMedID 32898921

• Appraisal of a scoring instrument for training and testing neonatal intubation skills ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION Bouwmeester, R. N., Binkhorst, M., Yamada, N. K., Geurtzen, R., van Heijst, A. J., Halamek, L. P., Draaisma, J. T., Hogeveen, M. 2019; 104 (5): F521–F527

  View details for DOI 10.1136/archdischild-2018-315221

  View details for Web of Science ID 000501744900012

• Using briefing, simulation and debriefing to improve human and system performance. Seminars in perinatology Halamek, L. P., Cady, R. A., Sterling, M. R. 2019: 151178

  Abstract

  Safety, effectiveness and efficiency are keys to performance in all high-risk industries; healthcare is no exception, and neonatal-perinatal medicine is one of the highest risk subspecialties within healthcare. Briefing, simulation and debriefing are methods used by professionals in high-risk industries to reduce the overall risk to life and enhance the safety of the human beings involved in receiving and delivering the services provided by those industries. Although relatively new to neonatal-perinatal medicine, briefing, simulation and debriefing are being practiced with increasing frequency and have become embedded in training exercises such as the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics (AAP). This chapter will define these terms and offer examples as to how they are used in high-risk activities including neonatal-perinatal medicine.

  View details for DOI 10.1053/j.semperi.2019.08.007

  View details for PubMedID 31500845

• Simulation in Neonatal-Perinatal Medicine Fellowship Programs. American journal of perinatology Sawyer, T., Stavroudis, T. A., Ades, A., Dadiz, R., Dammann, C. E., Halamek, L. P., Moussa, A., Soghier, L., Gupta, A., Aliaga, S., Umoren, R., French, H., Organization of Neonatal-Perinatal Training Program Directors Task Force on Simulation 2019

  Abstract

  OBJECTIVE: To investigate the use of simulation in neonatal-perinatal medicine (NPM) fellowship programs.STUDY DESIGN: This was a cross-sectional survey of program directors (PDs) and simulation educators in Accreditation Council for Graduate Medical Education (ACGME)- accredited NPM fellowship programs.RESULTS: Responses were received from 59 PDs and 52 simulation educators, representing 60% of accredited programs. Of responding programs, 97% used simulation, which most commonly included neonatal resuscitation (94%) and procedural skills (94%) training. The time and scope of simulation use varied significantly. The majority of fellows (51%) received ≤20hours of simulation during training. The majority of PDs (63%) wanted fellows to receive >20hours of simulation. Barriers to simulation included lack of faculty time, experience, funding, and curriculum.CONCLUSION: While the majority of fellowship programs use simulation, the time and scope of fellow exposure to simulation experiences are limited. The creation of a standardized simulation curriculum may address identified barriers to simulation.

  View details for DOI 10.1055/s-0039-1693465

  View details for PubMedID 31307105

• 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

• Understanding the Heterogeneity of Labor and Delivery Units: Using Design Thinking Methodology to Assess Environmental Factors that Contribute to Safety in Childbirth. American journal of perinatology Sherman, J. P., Hedli, L. C., Kristensen-Cabrera, A. I., Lipman, S. S., Schwandt, D. n., Lee, H. C., Sie, L. n., Halamek, L. P., Austin, N. S. 2019

  Abstract

   There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. We employed design thinking methodology to understand how the design of labor and delivery units impacts safety and identified spaces and systems where improvements are needed. Site visits were conducted at 10 labor and delivery units in California. A multidisciplinary team collected data through observations, measurements, and clinician interviews. In parallel, research was conducted regarding current standards and codes for building new hospitals. Designs of labor and delivery units are heterogeneous, lacking in consistency regarding environmental factors that may impact safety and outcomes. Building codes do not take into consideration workflow, human factors, and patient and clinician experience. Attitude of hospital staff may contribute to improving safety through design. Three areas in need of improvement and actionable through design emerged: (1) blood availability for hemorrhage management, (2) appropriate space for neonatal resuscitation, and (3) restocking and organization methods of equipment and supplies. Design thinking could be implemented at various stages of health care facility building projects and during retrofits of existing units. Through this approach, we may be able to improve hospital systems and environmental factors.

  View details for PubMedID 31013540

• Analyzing the heterogeneity of labor and delivery units: A quantitative analysis of space and design PLOS ONE Austin, N., Kristensen-Cabrera, A., Sherman, J., Schwandt, D., McDonald, A., Hedli, L., Sie, L., Lipman, S., Daniels, K., Halamek, L. P., Lee, H. C. 2018; 13 (12)

  View details for DOI 10.1371/journal.pone.0209339

  View details for Web of Science ID 000454416400058

• Appraisal of a scoring instrument for training and testing neonatal intubation skills. Archives of disease in childhood. Fetal and neonatal edition Bouwmeester, R. N., Binkhorst, M., Yamada, N. K., Geurtzen, R., van Heijst, A. F., Halamek, L. P., Draaisma, J. M., Hogeveen, M. 2018

  Abstract

  OBJECTIVE: To determine the validity, reliability, feasibility and applicability of a neonatal intubation scoring instrument.DESIGN: Prospective observational study.SETTING: Simulation-based research and training centre (Center for Advanced Pediatric and Perinatal Education), California, USA.SUBJECTS: Forty clinicians qualified for neonatal intubation.INTERVENTIONS: Videotaped elective intubations on a neonatal patient simulator were scored by two independent raters. One rater scored the intubations twice. We scored the preparation of equipment and premedication, intubation performance, tube position/fixation, communication, number of attempts, duration and successfulness of the procedure.MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICC) were calculated for intrarater and inter-rater reliability. Kappa coefficients for individual items and mean kappa coefficients for all items combined were calculated. Construct validity was assessed with one-way analysis of variance using the hypothesis that experienced clinicians score higher than less experienced clinicians. The approximate time to score one intubation and the instrument's applicability in another setting were evaluated.RESULTS: ICCs for intrarater and inter-rater reliability were 0.99 (95% CI 0.98 to 0.99) and 0.89 (95% CI 0.35 to 0.96), and mean kappa coefficients were 0.93 (95% CI 0.85 to 1.01) and 0.71 (95% CI 0.56 to 0.92), respectively. There were no differences between the more and less experienced clinicians regarding preparation, performance, communication and total scores. The experienced group scored higher only on tube position/fixation (p=0.02). Scoring one intubation took approximately 15min. Our instrument, developed in The Netherlands, could be readily applied in the USA.CONCLUSIONS: Our scoring instrument for simulated neonatal intubations appears to be reliable, feasible and applicable in another centre. Construct validity could not be established.

  View details for PubMedID 30504442

• Perspectives on periviability counselling and decision-making differed between neonatologists in the United States and the Netherlands ACTA PAEDIATRICA Schrijvers, N. M., Geurtzen, R., Draaisma, J. T., Halamek, L. P., Yamada, N. K., Hogeveen, M. 2018; 107 (10): 1710–15

  Abstract

  American guidelines suggest that neonatal resuscitation be considered at 23 weeks of gestation, one week earlier than in the Netherlands, but how counselling practices differ at the threshold of viability is unknown. This pilot study compared prenatal periviability counselling in the two countries.In 2013, a cross-sectional survey was sent to 121 Dutch neonatologists as part of a nationwide evaluation of prenatal counselling. In this pilot study, the same survey was sent to a convenience sample of 31 American neonatologists in 2014. The results were used to compare the organisation, content and decision-making processes in prenatal counselling at 24 weeks of gestation between the two countries.The survey was completed by 17 (55%) American and 77 (64%) Dutch neonatologists. American neonatologists preferred to meet with parents more frequently, for longer periods of time, and to discuss more intensive care topics, including long-term complications, than Dutch neonatologists. Neonatologists from both countries preferred shared decision-making when deciding whether to initiate intensive care.Neonatologists in the United States and the Netherlands differed in their approach to prenatal counselling at 24 weeks of gestation. Cross-cultural differences may play a role.

  View details for PubMedID 29603788

• Optimal human and system performance during neonatal resuscitation. Seminars in fetal & neonatal medicine Yamada, N. K., Kamlin, C. O., Halamek, L. P. 2018

  Abstract

  Performance in the delivery of care to sick neonates in need of resuscitation has long been defined primarily in terms of the extent of the knowledge possessed and hands-on skill demonstrated by physicians and other healthcare professionals. This definition of performance in neonatal resuscitation is limited by its focus solely on the human beings delivering care and a perceived set of the requisite skills to do so. This manuscript will expand the definition of performance to include all of the skill sets that humans must use to resuscitate newborns as well as the often complex systems in which those humans operate while delivering that care. It will also highlight how the principles of human factors and ergonomics can be used to enhance human and system performance during patient care. Finally, it will describe the role of simulation and debriefing in the assessment of human and system performance.

  View details for DOI 10.1016/j.siny.2018.03.006

  View details for PubMedID 29571705

• Analyzing the heterogeneity of labor and delivery units: A quantitative analysis of space and design. PloS one Austin, N., Kristensen-Cabrera, A., Sherman, J., Schwandt, D., McDonald, A., Hedli, L., Sie, L., Lipman, S., Daniels, K., Halamek, L. P., Lee, H. C. 2018; 13 (12): e0209339

  Abstract

  This study assessed labor and delivery (L&D) unit space and design, and also considered correlations between physical space measurements and clinical outcomes. Design and human factors research has increased standardization in high-hazard industries, but is not fully utilized in medicine. Emergency department and intensive care unit space has been studied, but optimal L&D unit design is undefined. In this prospective, observational study, a multidisciplinary team assessed physical characteristics of ten L&D units. Design measurements were analyzed with California Maternal Quality Care Collaborative (CMQCC) data from 34,161 deliveries at these hospitals. The hospitals ranged in delivery volumes (<1000->5000 annual deliveries) and cesarean section rates (19.6%-39.7%). Within and among units there was significant heterogeneity in labor room (LR) and operating room (OR) size, count, and number of configurations. There was significant homogeneity of room equipment. Delivery volumes correlated with unit size, room counts, and cesarean delivery rates. Relative risk of cesarean section was modestly increased when certain variables were above average (delivery volume, unit size, LR count, OR count, OR configuration count, LR to OR distance, unit utilization) or below average (LR size, OR size, LR configuration count). Existing variation suggests a gold standard design has yet to be adopted for L&D. A design-centered approach identified opportunities for standardization: 1) L&D unit size and 2) room counts based on current or projected delivery volume, and 3) LR and OR size and equipment. When combined with further human factors research, these guidelines could help design the L&D unit of the future.

  View details for PubMedID 30586446

• Training Pediatric Fellows in Palliative Care: a Comparison of Simulation-Based Training and Didactic Education Brock, K., Cohen, H., Sourkes, B., Good, J., Halamek, L. WILEY. 2017: S65–S66

  View details for Web of Science ID 000398571100283

• 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

• Training Pediatric Fellows in Palliative Care: A Pilot Comparison of Simulation Training and Didactic Education. Journal of palliative medicine Brock, K. E., Cohen, H. J., Sourkes, B. M., Good, J. J., Halamek, L. P. 2017

  Abstract

  Pediatric fellows receive little palliative care (PC) education and have few opportunities to practice communication skills.In this pilot study, we assessed (1) the relative effectiveness of simulation-based versus didactic education, (2) communication skill retention, and (3) effect on PC consultation rates.Thirty-five pediatric fellows in cardiology, critical care, hematology/oncology, and neonatology at two institutions enrolled: 17 in the intervention (simulation-based) group (single institution) and 18 in the control (didactic education) group (second institution). Intervention group participants participated in a two-day program over three months (three simulations and videotaped PC panel). Control group participants received written education designed to be similar in content and time.(1) Self-assessment questionnaires were completed at baseline, post-intervention and three months; mean between-group differences for each outcome measure were assessed. (2) External reviewers rated simulation-group encounters on nine communication domains. Within-group changes over time were assessed. (3) The simulation-based site's PC consultations were compared in the six months pre- and post-intervention.Compared to the control group, participants in the intervention group improved in self-efficacy (p = 0.003) and perceived adequacy of medical education (p < 0.001), but not knowledge (p = 0.20). Reviewers noted nonsustained improvement in four domains: relationship building (p = 0.01), opening discussion (p = 0.03), gathering information (p = 0.01), and communicating accurate information (p = 0.04). PC consultation rate increased 64%, an improvement when normalized to average daily census (p = 0.04).This simulation-based curriculum is an effective method for improving PC comfort, education, and consults. More frequent practice is likely needed to lead to sustained improvements in communication competence.

  View details for DOI 10.1089/jpm.2016.0556

  View details for PubMedID 28436742

• Effects of delivery room quality improvement on premature infant outcomes JOURNAL OF PERINATOLOGY Lapcharoensap, W., Bennett, M. V., Powers, R. J., Finer, N. N., Halamek, L. P., Gould, J. B., Sharek, P. J., Lee, H. C. 2017; 37 (4): 349-354

  Abstract

  Delivery room management interventions have been successfully implemented via collaborative quality improvement (QI) projects. However, it is unknown whether these successes translate to reductions in neonatal morbidity and mortality.This was a prospective pre-post intervention study of three nonrandomized hospital groups within the California Perinatal Quality Care Collaborative. A collaborative QI model (Collaborative QI) was compared with a single-site QI model (NICU QI) and a non-participant population when implementing evidence-based delivery room practices. The intervention period was between June 2011 and May 2012. Infants born with gestational age between 22 weeks 0 days and 29 weeks 6 days and birth weight ⩽1500 g were included. Outcomes were mortality and select morbidities (bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC)). Outcomes were compared between the baseline (January 2010 to May 2011) and post-intervention period (June 2012 to May 2013) within each comparison group.Ninety-five hospitals were included with 4222 infants in the baseline period and 4186 infants in the post-intervention period. The Collaborative QI group had significantly reduced odds of developing BPD post-intervention (odds ratio (OR) 0.8, 95% confidence interval (CI) 0.65 to 0.99) or composite BPD-death (OR 0.83, 95% CI 0.69 to 1.00). In both the Collaborative QI and non-participants there were also reductions in IVH, severe IVH, composite severe IVH-death, severe ROP and composite severe ROP-death.Hospitals dedicated to improving delivery room practices can impact neonatal outcomes.Journal of Perinatology advance online publication, 22 December 2016; doi:10.1038/jp.2016.237.

  View details for DOI 10.1038/jp.2016.237

  View details for Web of Science ID 000399264800007

• Opportunities to Foster Efficient Communication in Labor and Delivery Using Simulation. AJP reports Daniels, K., Hamilton, C., Crowe, S., Lipman, S. S., Halamek, L. P., Lee, H. C. 2017; 7 (1): e44-e48

  Abstract

  Introduction Communication errors are an important contributing factor in adverse outcomes in labor and delivery (L&D) units. The objective of this study was to identify common lapses in verbal communication using simulated obstetrical scenarios and propose alternative formats for communication. Methods Health care professionals in L&D participated in three simulated clinical scenarios. Scenarios were recorded and reviewed to identify questions repeated within and across scenarios. Questions that were repeated more than once due to ineffective communication were identified. The frequency with which the questions were asked across simulations was identified. Results Questions were commonly repeated both within and across 27 simulated scenarios. The median number of questions asked was 27 per simulated scenario. Commonly repeated questions focused on three general topics: (1) historical data/information (i.e., estimated gestational age), (2) maternal clinical status (i.e., estimated blood loss), and (3) personnel (i.e., "Has anesthesiologist been called?"). Conclusion Inefficient verbal communication exists in the process of transferring information during obstetric emergencies. These findings can inform improved training and development of information displays to improve teamwork and communication. A visual display that can report static historical information and specific dynamic clinical data may facilitate optimal human performance.

  View details for DOI 10.1055/s-0037-1599123

  View details for PubMedID 28255522

• Effects of delivery room quality improvement on premature infant outcomes. Journal of perinatology Lapcharoensap, W., Bennett, M. V., Powers, R. J., Finer, N. N., Halamek, L. P., Gould, J. B., Sharek, P. J., Lee, H. C. 2016

  Abstract

  Delivery room management interventions have been successfully implemented via collaborative quality improvement (QI) projects. However, it is unknown whether these successes translate to reductions in neonatal morbidity and mortality.This was a prospective pre-post intervention study of three nonrandomized hospital groups within the California Perinatal Quality Care Collaborative. A collaborative QI model (Collaborative QI) was compared with a single-site QI model (NICU QI) and a non-participant population when implementing evidence-based delivery room practices. The intervention period was between June 2011 and May 2012. Infants born with gestational age between 22 weeks 0 days and 29 weeks 6 days and birth weight ⩽1500 g were included. Outcomes were mortality and select morbidities (bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC)). Outcomes were compared between the baseline (January 2010 to May 2011) and post-intervention period (June 2012 to May 2013) within each comparison group.Ninety-five hospitals were included with 4222 infants in the baseline period and 4186 infants in the post-intervention period. The Collaborative QI group had significantly reduced odds of developing BPD post-intervention (odds ratio (OR) 0.8, 95% confidence interval (CI) 0.65 to 0.99) or composite BPD-death (OR 0.83, 95% CI 0.69 to 1.00). In both the Collaborative QI and non-participants there were also reductions in IVH, severe IVH, composite severe IVH-death, severe ROP and composite severe ROP-death.Hospitals dedicated to improving delivery room practices can impact neonatal outcomes.Journal of Perinatology advance online publication, 22 December 2016; doi:10.1038/jp.2016.237.

  View details for DOI 10.1038/jp.2016.237

  View details for PubMedID 28005062

• 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

• Simulation and debriefing in neonatology 2016: Mission incomplete SEMINARS IN PERINATOLOGY Halamek, L. P. 2016; 40 (7): 489-493

  Abstract

  Simulation can be an effective tool to facilitate the acquisition and maintenance of the cognitive, technical and behavioral skills necessary to carry out our mission in neonatology: the delivery of safe, effective and efficient care to our patients. Prominent examples of successful implementation of simulation within neonatology include the Neonatal Resuscitation Program, the International Pediatric Simulation Society, and the International Network for Simulation-Based Pediatric Innovation, Research and Education. Despite these successes much remains to be accomplished. Expanding simulation beyond technical skill acquisition, using simulated environments to conduct research into human and system performance, incorporating simulation into high-stakes skill assessments, embracing the expertise of the more extensive modeling and simulation community and, in general, applying simulation to healthcare with the same degree of gravitas with which it is deployed in other high-risk industries are all tasks that must be completed in order to achieve our mission.

  View details for DOI 10.1053/j.semperi.2016.08.010

  View details for PubMedID 27810117

• Leveraging Health Care Simulation Technology for Human Factors Research: Closing the Gap Between Lab and Bedside HUMAN FACTORS Deutsch, E. S., Dong, Y., Halamek, L. P., Rosen, M. A., Taekman, J. M., Rice, J. 2016; 58 (7): 1082–95

  Abstract

  We describe health care simulation, designed primarily for training, and provide examples of how human factors experts can collaborate with health care professionals and simulationists-experts in the design and implementation of simulation-to use contemporary simulation to improve health care delivery.The need-and the opportunity-to apply human factors expertise in efforts to achieve improved health outcomes has never been greater. Health care is a complex adaptive system, and simulation is an effective and flexible tool that can be used by human factors experts to better understand and improve individual, team, and system performance within health care.Expert opinion is presented, based on a panel delivered during the 2014 Human Factors and Ergonomics Society Health Care Symposium.Diverse simulators, physically or virtually representing humans or human organs, and simulation applications in education, research, and systems analysis that may be of use to human factors experts are presented. Examples of simulation designed to improve individual, team, and system performance are provided, as are applications in computational modeling, research, and lifelong learning.The adoption or adaptation of current and future training and assessment simulation technologies and facilities provides opportunities for human factors research and engineering, with benefits for health care safety, quality, resilience, and efficiency.Human factors experts, health care providers, and simulationists can use contemporary simulation equipment and techniques to study and improve health care delivery.

  View details for PubMedID 27268996

• Implementing Delivery Room Checklists and Communication Standards in a Multi-Neonatal ICU Quality Improvement Collaborative. Joint Commission journal on quality and patient safety / Joint Commission Resources Bennett, S. C., Finer, N., Halamek, L. P., Mickas, N., Bennett, M. V., Nisbet, C. C., Sharek, P. J. 2016; 42 (8): 369-376

  Abstract

  The 2015 American Academy of Pediatrics Neonatal Resuscitation Program (NRP) and International Liaison Committee on Resuscitation (ILCOR) resuscitation guidelines state, "It is still suggested that briefing and debriefing techniques be used whenever possible for neonatal resuscitation." Effective communication and reliable delivery of evidence-based best practices are critical aspects of the 2015 NRP guidelines. To promote optimal communication and best practice-focused checklists use during active neonatal resuscitation, the Readiness Bundle (RB) was integrated within the larger change package deployed in the California Perinatal Quality Care Collaborative's (CPQCC) 12-month Delivery Room Management Quality Improvement Collaborative.The RB consisted of (1) a checklist for high-risk neonatal resuscitations and (2) briefings and debriefings to improve teamwork and communication in the delivery room (DR). Implementation of the RB was encouraged, compliance with the RB was tracked monthly up through 6 months after the completion of the collaborative, and satisfaction with the RB was evaluated.Twenty-four neonatal intensive care units (NICUs) participated in the CPQCCDR collaborative. Before the initiation of the collaborative, the elements of the RB were complied with in 0 of 740 reported deliveries (0%). During the 12-month collaborative, compliance with the RB improved to a median of 71%, which was surpassed in the 6-month period after the collaborative ended (80%). One-hundred percent of responding NICUs would recommend the RB to other NICUs working on improving DR management.The RB was rapidly adopted, with compliance sustained for 6 months after completion of the collaborative. Inclusion of the RB in the next generation of the NRP guidelines is encouraged.

  View details for PubMedID 27456419

• Post-event debriefings during neonatal care: why are we not doing them, and how can we start? JOURNAL OF PERINATOLOGY Sawyer, T., Loren, D., Halamek, L. P. 2016; 36 (6): 415–19

  Abstract

  Post-event debriefings are a foundational behavior of high performing teams. Despite the inherent value of post-event debriefings, the frequency with which they are used in neonatal care is extremely low. If post-event debriefings are so beneficial, why aren't they conducted more frequently? The reasons are many, but solutions are available. In this report, we provide practical advice on conducting post-event debriefing in neonatal care. In addition, we examine the perceived barriers to conducting post-event debriefings, and offer strategies to overcome them. Finally, we consider opportunities to foster a culture change within neonatal care which integrates debriefing as standard daily work. By establishing a safety culture in neonatal care that encourages and facilitates effective post-event debriefings, patient safety can be enhanced and clinical outcomes can be improved.

  View details for PubMedID 27031321

• 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

• Improving Training in Palliative Care for Pediatric Fellows - A Simulation-Based Multi-Institution Trial Brock, K., Cohen, H., Sourkes, B., Good, J., Halamek, L. ELSEVIER SCIENCE INC. 2016: 323–24

  View details for DOI 10.1016/j.jpainsymman.2015.12.141

  View details for Web of Science ID 000373472900067

• Analysis and classification of errors made by teams during neonatal resuscitation RESUSCITATION Yamada, N. K., Yaeger, K. A., Halamek, L. P. 2015; 96: 109-113

  Abstract

  The Neonatal Resuscitation Program (NRP) algorithm serves as a guide to healthcare professionals caring for neonates transitioning to extrauterine life. Despite this, adherence to the algorithm is challenging, and errors are frequent. Information-dense, high-risk fields such as air traffic control have proven that formal classification of errors facilitates recognition and remediation. This study was performed to determine and characterize common deviations from the NRP algorithm during neonatal resuscitation.Audiovisual recordings of 250 real neonatal resuscitations were obtained between April 2003 and May 2004. Of these, 23 complex resuscitations were analyzed for adherence to the contemporaneous NRP algorithm and scored using a novel classification tool based on the validated NRP Megacode Checklist.Seven hundred eighty algorithm-driven tasks were observed. One hundred ninety-four tasks were completed incorrectly, for an average error rate of 23%. Forty-two were errors of omission (28% of all errors) and 107 were errors of commission (72% of all errors). Many errors were repetitive and potentially clinically significant: failure to assess heart rate and/or breath sounds, improper rate of positive pressure ventilation, inadequate peak inspiratory and end expiratory pressures during ventilation, improper chest compression technique, and asynchronous PPV and CC.Errors of commission, especially when performing advanced life support interventions such as positive pressure ventilation, intubation, and chest compressions, are common during neonatal resuscitation and are sources of potential harm. The adoption of error reduction strategies capable of decreasing cognitive and technical load and standardizing communication - strategies common in other industries - should be considered in healthcare.

  View details for DOI 10.1016/j.resuscitation.2015.07.048

  View details for Web of Science ID 000366584500026

• Analysis and classification of errors made by teams during neonatal resuscitation. Resuscitation Yamada, N. K., Yaeger, K. A., Halamek, L. P. 2015; 96: 109-13

  Abstract

  The Neonatal Resuscitation Program (NRP) algorithm serves as a guide to healthcare professionals caring for neonates transitioning to extrauterine life. Despite this, adherence to the algorithm is challenging, and errors are frequent. Information-dense, high-risk fields such as air traffic control have proven that formal classification of errors facilitates recognition and remediation. This study was performed to determine and characterize common deviations from the NRP algorithm during neonatal resuscitation.Audiovisual recordings of 250 real neonatal resuscitations were obtained between April 2003 and May 2004. Of these, 23 complex resuscitations were analyzed for adherence to the contemporaneous NRP algorithm and scored using a novel classification tool based on the validated NRP Megacode Checklist.Seven hundred eighty algorithm-driven tasks were observed. One hundred ninety-four tasks were completed incorrectly, for an average error rate of 23%. Forty-two were errors of omission (28% of all errors) and 107 were errors of commission (72% of all errors). Many errors were repetitive and potentially clinically significant: failure to assess heart rate and/or breath sounds, improper rate of positive pressure ventilation, inadequate peak inspiratory and end expiratory pressures during ventilation, improper chest compression technique, and asynchronous PPV and CC.Errors of commission, especially when performing advanced life support interventions such as positive pressure ventilation, intubation, and chest compressions, are common during neonatal resuscitation and are sources of potential harm. The adoption of error reduction strategies capable of decreasing cognitive and technical load and standardizing communication - strategies common in other industries - should be considered in healthcare.

  View details for DOI 10.1016/j.resuscitation.2015.07.048

  View details for PubMedID 26282500

• Reliability and Validity of the Pediatric Palliative Care Questionnaire for Measuring Self-Efficacy, Knowledge, and Adequacy of Prior Medical Education among Pediatric Fellows JOURNAL OF PALLIATIVE MEDICINE Brock, K. E., Cohen, H. J., Popat, R. A., Halamek, L. P. 2015; 18 (10): 842-848

  Abstract

  Interventions to improve pediatric trainee education in palliative care have been limited by a lack of reliable and valid tools for measuring effectiveness.We developed a questionnaire to measure pediatric fellows' self-efficacy (comfort), knowledge, and perceived adequacy of prior medical education. We measured the questionnaire's reliability and validity.The questionnaire contains questions regarding self-efficacy (23), knowledge (10), fellow's perceived adequacy of prior medical education (6), and demographics. The survey was developed with palliative care experts, and sent to fellows in U.S. pediatric cardiology, critical care, hematology/ oncology, and neonatal-perinatal medicine programs. Measures of reliability, internal consistency, and validity were calculated.One hundred forty-seven fellows completed the survey at test and retest. The self-efficacy and medical education questionnaires showed high internal consistency of 0.95 and 0.84. The test-retest reliability for the Self-Efficacy Summary Score, measured by intraclass correlation coefficient (ICC) and weighted kappa, was 0.78 (item range 0.44-0.81) and 0.61 (item range 0.36-0.70), respectively. For the Adequacy of Medical Education Summary Score, ICC was 0.85 (item range 0.6-0.78) and weighted kappa was 0.63 (item range 0.47-0.62). Validity coefficients for these two questionnaires were 0.88 and 0.92. Fellows answered a mean of 8.8/10 knowledge questions correctly; percentage agreement ranged from 65% to 99%.This questionnaire is capable of assessing self-efficacy and fellow-perceived adequacy of their prior palliative care training. We recommend use of this tool for fellowship programs seeking to evaluate fellow education in palliative care, or for research studies assessing the effectiveness of a palliative care educational intervention.

  View details for DOI 10.1089/jpm.2015.0110

  View details for PubMedID 26185912

• 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

• On the need for precise, concise communication during resuscitation: a proposed solution. journal of pediatrics Yamada, N. K., Halamek, L. P. 2015; 166 (1): 184-187

  View details for DOI 10.1016/j.jpeds.2014.09.027

  View details for PubMedID 25444016

• IMPACT OF STANDARDIZED COMMUNICATION TECHNIQUES ON ERRORS DURING SIMULATED NEONATAL RESUSCITATION Yamada, N. K., Fuerch, J. H., Halamek, L. P. LIPPINCOTT WILLIAMS & WILKINS. 2015: 99–100

  View details for Web of Science ID 000346600700062

• IMPROVING DIAGNOSTIC ACCURACY & EFFICIENCY BY OPTIMIZATION OF BEDSIDE DATA DISPLAY Fuerch, J., Yamada, N. K., Halamek, L. P. LIPPINCOTT WILLIAMS & WILKINS. 2015: 101

  View details for Web of Science ID 000346600700066

• Communication during resuscitation: Time for a change? RESUSCITATION Yamada, N. K., Halamek, L. P. 2014; 85 (12): E191-E192

  View details for DOI 10.1016/j.resuscitation.2014.08.034

  View details for PubMedID 25277341

• Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study PEDIATRICS Lee, H. C., Powers, R. J., Bennett, M. V., Finer, N. N., Halamek, L. P., Nisbet, C., Crockett, M., Chance, K., Blackney, D., von Koehler, C., Kurtin, P., Sharek, P. J. 2014; 134 (5): E1378-E1386

  Abstract

  There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects.This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support.There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12 528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%).Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.

  View details for DOI 10.1542/peds.2014-0863

  View details for Web of Science ID 000344385900014

• Implementation methods for delivery room management: a quality improvement comparison study. Pediatrics Lee, H. C., Powers, R. J., Bennett, M. V., Finer, N. N., Halamek, L. P., Nisbet, C., Crockett, M., Chance, K., Blackney, D., von Köhler, C., Kurtin, P., Sharek, P. J. 2014; 134 (5): e1378-86

  Abstract

  There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects.This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support.There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12 528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%).Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.

  View details for DOI 10.1542/peds.2014-0863

  View details for PubMedID 25332503

• Using simulation to study difficult clinical issues: prenatal counseling at the threshold of viability across american and dutch cultures. Simulation in healthcare Geurtzen, R., Hogeveen, M., Rajani, A. K., Chitkara, R., Antonius, T., Van Heijst, A., Draaisma, J., Halamek, L. P. 2014; 9 (3): 167-173

  Abstract

  Prenatal counseling at the threshold of viability is a challenging yet critically important activity, and care guidelines differ across cultures. Studying how this task is performed in the actual clinical environment is extremely difficult. In this pilot study, we used simulation as a methodology with 2 aims as follows: first, to explore the use of simulation incorporating a standardized pregnant patient as an investigative methodology and, second, to determine similarities and differences in content and style of prenatal counseling between American and Dutch neonatologists.We compared counseling practice between 11 American and 11 Dutch neonatologists, using a simulation-based investigative methodology. All subjects performed prenatal counseling with a simulated pregnant patient carrying a fetus at the limits of viability. The following elements of scenario design were standardized across all scenarios: layout of the physical environment, details of the maternal and fetal histories, questions and responses of the standardized pregnant patient, and the time allowed for consultation.American subjects typically presented several treatment options without bias, whereas Dutch subjects were more likely to explicitly advise a specific course of treatment (emphasis on partial life support). American subjects offered comfort care more frequently than the Dutch subjects and also discussed options for maximal life support more often than their Dutch colleagues.Simulation is a useful research methodology for studying activities difficult to assess in the actual clinical environment such as prenatal counseling at the limits of viability. Dutch subjects were more directive in their approach than their American counterparts, offering fewer options for care and advocating for less invasive interventions. American subjects were more likely to offer a wider range of therapeutic options without providing a recommendation for any specific option.

  View details for DOI 10.1097/SIH.0000000000000011

  View details for PubMedID 24401918

• 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

• The society for obstetric anesthesia and perinatology consensus statement on the management of cardiac arrest in pregnancy. Anesthesia and analgesia Lipman, S., Cohen, S., Einav, S., Jeejeebhoy, F., Mhyre, J. M., Morrison, L. J., Katz, V., Tsen, L. C., Daniels, K., Halamek, L. P., Suresh, M. S., Arafeh, J., Gauthier, D., Carvalho, J. C., Druzin, M., Carvalho, B. 2014; 118 (5): 1003-1016

  Abstract

  This consensus statement was commissioned in 2012 by the Board of Directors of the Society for Obstetric Anesthesia and Perinatology to improve maternal resuscitation by providing health care providers critical information (including point-of-care checklists) and operational strategies relevant to maternal cardiac arrest. The recommendations in this statement were designed to address the challenges of an actual event by emphasizing health care provider education, behavioral/communication strategies, latent systems errors, and periodic testing of performance. This statement also expands on, interprets, and discusses controversial aspects of material covered in the American Heart Association 2010 guidelines.

  View details for DOI 10.1213/ANE.0000000000000171

  View details for PubMedID 24781570

• Variability of characteristics and outcomes following cardiopulmonary resuscitation events in diverse ICU settings in a single, tertiary care children's hospital*. Pediatric critical care medicine Gupta, P., Yan, K., Chow, V., Dao, D. T., Gossett, J. M., Leong, K., Franzon, D., Halamek, L. P., Reddy, S., Berg, R. A., Roth, S. J., Nadkarni, V. M. 2014; 15 (3): e128-41

  Abstract

  The primary objective of this study was to compare and contrast the characteristics and survival outcomes of cardiopulmonary resuscitation for "monitored" events in pediatric patients treated with chest compressions more than or equal to 1 minute in varied ICU settings.Retrospective observational study.Three different specialized ICUs in a single, tertiary care, academic children's hospital.We collected demographic information, preexisting conditions, preevent characteristics, event characteristics, and outcome data. The primary outcome measure was survival to hospital discharge. Secondary outcome measures included return of spontaneous circulation, 24-hour survival, and survival with good neurologic outcome.None.Four hundred eleven patients treated with chest compressions for more than or equal to 1 minute were included in the analysis: 170 patients were located in the cardiovascular ICU, 157 patients in the neonatal ICU, and 84 patients in the PICU. Arrest durations were longer in the cardiovascular ICU than other ICUs. Use of extracorporeal cardiopulmonary resuscitation was more prevalent in the cardiovascular ICU (cardiovascular ICU, 17%; neonatal ICU, 3%; PICU, 4%). Return of spontaneous circulation, 24-hour survival, survival to hospital discharge, and good neurologic outcome were highest among neonatal ICU patients (survival to discharge, 53%) followed by cardiovascular ICU patients (survival to discharge, 46%) and PICU patients (survival to discharge, 36%). In a multivariable model controlling for patient and event characteristics, using cardiovascular ICU as reference, adjusted odds of survival in PICU were 0.33 (95% CI, 0.14-0.76; p = 0.009) and odds of survival in neonatal ICU were 0.80 (95% CI, 0.31-2.11; p = 0.65).Comparative analysis of pediatric patients undergoing cardiopulmonary resuscitation in three different ICU settings demonstrated a significant variation in baseline, preevent, and event characteristics. Although outcomes vary significantly among the three different ICUs, it was difficult to ascertain if this difference was due to variation in the disease process or variation in the location of the patient.

  View details for DOI 10.1097/PCC.0000000000000067

  View details for PubMedID 24413318

• Variability of Characteristics and Outcomes Following Cardiopulmonary Resuscitation Events in Diverse ICU Settings in a Single, Tertiary Care Children's Hospital*. Pediatric critical care medicine Gupta, P., Yan, K., Chow, V., Dao, D. T., Gossett, J. M., Leong, K., Franzon, D., Halamek, L. P., Reddy, S., Berg, R. A., Roth, S. J., Nadkarni, V. M. 2014; 15 (3): e128-41

  View details for DOI 10.1097/PCC.0000000000000067

  View details for PubMedID 24413318

• IMPACT OF A NOVEL DECISION SUPPORT TOOL ON ADHERENCE TO NEONATAL RESUSCITATION PROGRAM ALGORITHM Fuerch, J., Yamada, N. K., Coehlo, P., Vale, B., Halamek, L. P. LIPPINCOTT WILLIAMS & WILKINS. 2014: 154

  View details for Web of Science ID 000336284900047

• IMPACT OF STANDARDIZED COMMUNICATION TECHNIQUES ON ERRORS DURING NEONATAL RESUSCITATION Yamada, N. K., Fuerch, J. H., Halamek, L. P. LIPPINCOTT WILLIAMS & WILKINS. 2014: 266–67

  View details for Web of Science ID 000336284900423

• Simulation as a methodology for assessing the performance of healthcare professionals working in the delivery room. Seminars in fetal & neonatal medicine Halamek, L. P. 2013; 18 (6): 369-372

  Abstract

  Formal evaluation of healthcare professionals has been accomplished primarily through assessment of the ability to recall content knowledge despite the fact that cognitive, technical and behavioral skills are all important aspects of human performance in this domain. In addition human performance is also influenced by elements that are extrinsic to the human being including the systems and subsystems with which they must interact. Rigorous assessment of human and system performance in the actual healthcare environment is extremely challenging for a number of reasons. Simulation provides a methodology by which this performance can be objectively assessed, thereby facilitating the delivery of effective, safe and efficient patient care.

  View details for DOI 10.1016/j.siny.2013.08.010

  View details for PubMedID 24051303

• Simulation-based learning combined with debriefing: trainers satisfaction with a new approach to training the trainers to teach neonatal resuscitation. BMC research notes Amin, H. J., Aziz, K., Halamek, L. P., Beran, T. N. 2013; 6: 251

  Abstract

  Prompt initiation of appropriate neonatal resuscitation skills is critical for the neonate experiencing difficulty transitioning to extra-uterine life. The use of simulation training is considered to be an indispensable tool to address these challenges. Research has yet to examine the effectiveness of simulation and debriefing for preparation of trainers to train others on the use of simulation and debriefing for neonatal resuscitation. This study determines the degree to which experienced NRP instructors or instructor trainers perceived simulation in combination with debriefing to be effective in preparing them to teach simulation to other health care professionals.Participants' perceptions of knowledge, skills, and confidence gained following a neonatal resuscitation workshop (lectures; scenario development and enactment; video recording and playback; and debriefing) were determined using a pre-post test questionnaire design. Questionnaire scores were subjected to factor and reliability analyses as well as pre- and post-test comparisons.A total of 17 participants completed 2 questionnaires. Principal component extraction of 18 items on the pre-test questionnaire resulted in 5 factors: teamwork, ability to run a simulation, skills for simulation, recognizing cues for simulation and ability to debrief. Both questionnaire scores showed good reliability (α: 0.83 - 0.97) and factorial validity. Pre- and post-test comparisons showed significant improvements in participants' perceptions of their ability to: conduct (as an instructor) a simulation (p < .05, η2 .47); participate in a simulation (p < .05, η2 .45); recognize cues (p < .05, η2 .35); and debrief (p < .05, η2 .41).Simulation training increased participants' perceptions of their knowledge, skills, and confidence to train others in neonatal resuscitation.

  View details for DOI 10.1186/1756-0500-6-251

  View details for PubMedID 23827017

  View details for PubMedCentralID PMC3703262

• Editorial: Bringing latent safety threats out into the open. Joint Commission journal on quality and patient safety / Joint Commission Resources Halamek, L. P. 2013; 39 (6): 267-?

  View details for PubMedID 23789164

• Anterolateral congenital diaphragmatic hernia with omphalocele: A case report and literature review AMERICAN JOURNAL OF MEDICAL GENETICS PART A Scahill, M. D., Maak, P., Kunder, C., Halamek, L. P. 2013; 161A (3): 585-588

  Abstract

  The combination of congenital diaphragmatic hernia (CDH) and omphalocele is quite rare but can be seen in several syndromes. We report on a female newborn with this combination that had not been diagnosed prenatally. The patient suffered respiratory failure that persisted despite intensive care support, suggesting severe secondary pulmonary hypoplasia. Autopsy revealed the combination of an anterolateral CDH and omphalocele in the absence of other anomalies. We believe this to be the first such case to be reported in the literature.

  View details for DOI 10.1002/ajmg.a.35703

  View details for Web of Science ID 000315341700025

• Anterolateral congenital diaphragmatic hernia with omphalocele: a case report and literature review. American journal of medical genetics. Part A Scahill, M. D., Maak, P., Kunder, C., Halamek, L. P. 2013; 161 (3): 585-8

  Abstract

  The combination of congenital diaphragmatic hernia (CDH) and omphalocele is quite rare but can be seen in several syndromes. We report on a female newborn with this combination that had not been diagnosed prenatally. The patient suffered respiratory failure that persisted despite intensive care support, suggesting severe secondary pulmonary hypoplasia. Autopsy revealed the combination of an anterolateral CDH and omphalocele in the absence of other anomalies. We believe this to be the first such case to be reported in the literature.

  View details for DOI 10.1002/ajmg.a.35703

  View details for PubMedID 23401132

• The accuracy of human senses in the detection of neonatal heart rate during standardized simulated resuscitation: implications for delivery of care, training and technology design. Resuscitation Chitkara, R., Rajani, A. K., Oehlert, J. W., Lee, H. C., Epi, M. S., Halamek, L. P. 2013; 84 (3): 369-372

  Abstract

  Auscultation and palpation are recommended methods of determining heart rate (HR) during neonatal resuscitation. We hypothesized that: (a) detection of HR by auscultation or palpation will vary by more than ± 15BPM from actual HR; and (b) the inability to accurately determine HR will be associated with errors in management of the neonate during simulated resuscitation.Using a prospective, randomized, controlled study design, 64 subjects participated in three simulated neonatal resuscitation scenarios. Subjects were randomized to technique used to determine HR (auscultation or palpation) and scenario order. Subjects verbalized their numeric assessment of HR at the onset of the scenario and after any intervention. Accuracy of HR determination and errors in resuscitation were recorded. Errors were classified as errors of omission (lack of appropriate interventions) or errors of commission (inappropriate interventions). Cochran's Q and chi square test were used to compare HR detection by method and across scenarios.Errors in HR determination occurred in 26-48% of initial assessments and 26-52% of subsequent assessments overall. There were neither statistically significant differences in accuracy between the two techniques of HR assessment (auscultation vs palpation) nor across the three scenarios. Of the 90 errors in resuscitation, 43 (48%) occurred in association with errors in HR determination.Determination of heart rate via auscultation and palpation by experienced healthcare professionals in a neonatal patient simulator with standardized cues is not reliable. Inaccuracy in HR determination is associated with errors of omission and commission. More reliable methods for HR assessment during neonatal resuscitation are required.

  View details for DOI 10.1016/j.resuscitation.2012.07.035

  View details for PubMedID 22925993

• Comparing the utility of a novel neonatal resuscitation cart with a generic code cart using simulation: a randomised, controlled, crossover trial BMJ QUALITY & SAFETY Chitkara, R., Rajani, A. K., Lee, H. C., Hansen, S. F., Halamek, L. P. 2013; 22 (2): 124-129

  Abstract

  To compare a novel neonatal resuscitation cart (NRC) to a generic code cart (GCC).A prospective, randomised, controlled, crossover trial was performed to compare the utility of the NRC with the GCC during simulated deliveries of extremely low birthweight infants and infants with gastroschisis. Fifteen subjects participated. Mean times and accuracy of equipment and supply retrieval were compared for each scenario using the Wilcoxon test.Mean acquisition times for the NRC were always faster (by 58% to 74%) regardless of scenario (p<0.01). Accuracy of equipment selection did not differ. Ease of use was judged using a Likert scale (1=easiest to use; 5=most difficult), with mean score for NRC 1.1 and GCC 3.7 (p<0.0001). All subjects rated the NRC as easier to use.The NRC was superior to the GCC in acquisition speed, supply selection and ease of use.

  View details for DOI 10.1136/bmjqs-2012-001336

  View details for PubMedID 23112286

• A FINANCIAL COMPARISON SUPPORTING MULTIDISCIPLINARY OBSTETRICS SIMULATION OVER TRADITIONAL NURSING EDUCATION IN LABOR AND DELIVERY EMERGENCY MANAGEMENT Stone, S., Daniels, K., Halamek, L., Puck, A. LIPPINCOTT WILLIAMS & WILKINS. 2013: 128

  View details for Web of Science ID 000312657900068

• The Delivery Room of the Future The Fetal and Neonatal Resuscitation and Transition Suite CLINICS IN PERINATOLOGY Finer, N. N., Rich, W., Halamek, L. P., Leone, T. A. 2012; 39 (4): 931-939

  Abstract

  Despite advances in the understanding of fetal and neonatal physiology and the technology to monitor and treat premature and full-term neonates, little has changed in resuscitation rooms. The authors' vision for the Fetal and Neonatal Resuscitation and Transition Suite of the future is marked by improvements in the amount of physical space, monitoring technologies, portable diagnostic and therapeutic technologies, communication systems, and capabilities and training of the resuscitation team. Human factors analysis will play an important role in the design and testing of the improvements for safe, effective, and efficient resuscitation of the newborn.

  View details for DOI 10.1016/j.clp.2012.09.014

  View details for Web of Science ID 000312623900015

  View details for PubMedID 23164188

• Resuscitation of the Fetus and Newborn Preface CLINICS IN PERINATOLOGY Kumar, P., Halamek, L. P. 2012; 39 (4): XV-XVI

  View details for DOI 10.1016/j.clp.2012.10.001

  View details for Web of Science ID 000312623900002

  View details for PubMedID 23164191

• Nursing department orientation: are we missing the mark? Journal for nurses in staff development : JNSD : official journal of the National Nursing Staff Development Organization Kennedy, J. M., Nichols, A. A., Halamek, L. P., Arafeh, J. M. 2012; 28 (1): 24-26

  Abstract

  Hospitals routinely provide orientation for the new nurses they hire. The evolution of nursing practice is not reflected in the current teaching methods of nursing orientation. The authors examine the past 60 years of nursing department orientation and assert the need to move toward more effective and innovative teaching strategies.

  View details for DOI 10.1097/NND.0b013e318240a6f3

  View details for PubMedID 22261902

• A CROSS-CULTURAL SIMULATION-BASED COMPARISON OF PRENATAL COUNSELING: AMERICAN AND DUTCH NEONATOLOGISTS' PERSPECTIVES Geurtzen, R., Hogeveen, M., Rajani, A., Chitkara, R., Antonius, T. A., Draaisma, J., Halamek, L. P. NATURE PUBLISHING GROUP. 2011: 40

  View details for DOI 10.1038/pr.2011.265

  View details for Web of Science ID 000208870100041

• Comparison of Umbilical Venous and Intraosseous Access During Simulated Neonatal Resuscitation PEDIATRICS Rajani, A. K., Chitkara, R., Oehlert, J., Halamek, L. P. 2011; 128 (4): E954-E958

  Abstract

  Emergent umbilical venous catheter (UVC) placement for persistent bradycardia in the delivery room is a rare occurrence that requires significant skill and involves space constraints. Placement of an intraosseous needle (ION) in neonates has been well described. The ION is already used in the pediatric population and is placed at an anatomic location distant from where chest compressions are performed. In this study we compared time to placement, errors in placement, and perceived ease of use for UVCs and IONs in a simulated delivery room.Forty health care providers were recruited. Subjects were shown an instructional video of both techniques and allowed to practice placement. Subjects participated in 2 simulated neonatal resuscitations requiring intravenous epinephrine. In 1 scenario they were required to place a UVC and in the other an ION. Scenarios were recorded for later analysis of placement time and error rate. Subjects were surveyed regarding the perceived level of difficulty of each technique.The average time required for ION placement was 46 seconds faster than for UVC placement (P < .001). There was no significant difference in the number of errors between UVC and ION placement or in perceived ease of use.In a simulated delivery room setting, ION placement can be performed more quickly than UVC insertion without any difference in technical error rate or perceived ease of use. ION insertion should be considered when rapid intravenous access is required in the neonate at the time of birth, especially by health care professionals who do not routinely place UVCs.

  View details for DOI 10.1542/peds.2011-0657

  View details for PubMedID 21930542

• The Case for OBLS: A Simulation-based Obstetric Life Support Program SEMINARS IN PERINATOLOGY Lipman, S. S., Daniels, K. I., Arafeh, J., Halamek, L. P. 2011; 35 (2): 74-79

  Abstract

  Errors by health care professionals result in significant patient morbidity and mortality, and the labor and delivery ward is one of the highest risk areas in the hospital. Parturients today are of higher acuity than anytime previously, and maternal mortality is increasing. Obstetrical staff must therefore be familiar with emergency protocols geared to the maternal-fetal dyad. However, the medical literature suggests that obstetrical providers are not optimally trained to render care during maternal cardiopulmonary arrest. We describe the evolution of immersive learning and simulation in the Neonatal Resuscitation Program, and suggest the development of a multidisciplinary team, simulation-enhanced obstetric crisis training program (OBLS) may likewise benefit obstetrical health care professionals. OBLS would emphasize high quality basic life support, uterine displacement, use of an automatic external defibrillator, and delivery of the fetus within 5 minutes of maternal arrest should resuscitative efforts prove ineffective.

  View details for DOI 10.1053/j.semperi.2011.01.006

  View details for PubMedID 21440814

• COMPARISON OF UMBILICAL VENOUS AND INTRAOSSEOUS ACCESS DURING SIMULATED NEONATAL RESUSCITATION Western Regional Meeting of the American-Federation-for-Medical-Research Rajani, A., Chitkara, R., Halamek, L. LIPPINCOTT WILLIAMS & WILKINS. 2011: 124–24

  View details for Web of Science ID 000285542500146

• Using the Movie Apollo 13 as a Video Primer in Behavioral Skills for Simulation Trainees and Instructors SIMULATION IN HEALTHCARE Halamek, L. P. 2010; 5 (5): 303-310

  Abstract

  Behavioral skills such as effective communication, teamwork, and leadership are critically important to successful outcomes in patient care, especially in resuscitation situations where correct decisions must be made rapidly. However, historically, these important skills have rarely been specifically addressed in learning programs directed at healthcare professionals. Not only have most healthcare professionals had little or no formal education and training in applying behavioral skills to their patient care activities but also many of those serving as instructors and content experts for training programs have few resources available that clearly illustrate what these skills are and how they may be used in the context of real clinical situations. This represents a serious shortcoming in the education and training of healthcare professionals and stands in distinct contrast to other industries.Aerospace, similar to other high-consequence industries, has a long history of the use of simulation to improve human performance and reduce risk: astronauts and the engineers in Mission Control spend hundreds of hours in simulated flight in preparation for every mission. The value of time spent in the simulator was clearly illustrated during the flight of Apollo 13, the third mission to land men on the moon. The Apollo 13 crew had to overcome a number of life-threatening technical and medical problems, and it was their simulation-based training that allowed them to display the teamwork, ingenuity, and determination needed to return to earth safely.The movie Apollo 13 depicts in a highly realistic manner the events that occurred during the flight, including the actions of the crew in space and those in Mission Control in Houston. Three scenes from this movie are described in this article; each serves as a useful example for healthcare professionals of the importance of simulation-based learning and the application of behavioral skills to successful resolution of crises. This article is meant to serve as a guide as to how this movie and other similar media may be used for facilitated group or independent learning, providing appropriate context and clear examples of key points to be discussed.

  View details for DOI 10.1097/SIH.0b013e3181e5e329

  View details for Web of Science ID 000282961900009

• Lost moon, saved lives: using the movie Apollo 13 as a video primer in behavioral skills for simulation trainees and instructors. Simulation in healthcare : journal of the Society for Simulation in Healthcare Halamek, L. P. 2010; 5 (5): 303-10

  Abstract

  Behavioral skills such as effective communication, teamwork, and leadership are critically important to successful outcomes in patient care, especially in resuscitation situations where correct decisions must be made rapidly. However, historically, these important skills have rarely been specifically addressed in learning programs directed at healthcare professionals. Not only have most healthcare professionals had little or no formal education and training in applying behavioral skills to their patient care activities but also many of those serving as instructors and content experts for training programs have few resources available that clearly illustrate what these skills are and how they may be used in the context of real clinical situations. This represents a serious shortcoming in the education and training of healthcare professionals and stands in distinct contrast to other industries.Aerospace, similar to other high-consequence industries, has a long history of the use of simulation to improve human performance and reduce risk: astronauts and the engineers in Mission Control spend hundreds of hours in simulated flight in preparation for every mission. The value of time spent in the simulator was clearly illustrated during the flight of Apollo 13, the third mission to land men on the moon. The Apollo 13 crew had to overcome a number of life-threatening technical and medical problems, and it was their simulation-based training that allowed them to display the teamwork, ingenuity, and determination needed to return to earth safely.The movie Apollo 13 depicts in a highly realistic manner the events that occurred during the flight, including the actions of the crew in space and those in Mission Control in Houston. Three scenes from this movie are described in this article; each serves as a useful example for healthcare professionals of the importance of simulation-based learning and the application of behavioral skills to successful resolution of crises. This article is meant to serve as a guide as to how this movie and other similar media may be used for facilitated group or independent learning, providing appropriate context and clear examples of key points to be discussed.

  View details for DOI 10.1097/SIH.0b013e3181e5e329

  View details for PubMedID 21330813

• A National Survey of Pediatric Residents and Delivery Room Training Experience JOURNAL OF PEDIATRICS Lee, H. C., Chitkara, R., Halamek, L. P., Hintz, S. R. 2010; 157 (1): 158-U211

  Abstract

  To investigate current delivery room training experience in US pediatric residency programs and the relationship between volume of delivery room training and confidence in neonatal resuscitation skills.Links to a web-based survey were sent to pediatric residency programs and distributed to residents. The survey concerned delivery room attendance during training and comfort level in leading neonatal resuscitation for various scenarios. Comfort level was rated on a 1 to 9 scale. Mixed models accounted for residency programs as random effects.For PL-3s, the mean number of deliveries attended was 60 (standard deviation, 43), ranging from 13 to 143 deliveries for individual residency programs. Residents' confidence level in leading neonatal resuscitation was higher when attending more deliveries, with 90.3% of those attending>48 deliveries having average score 5 or greater vs 51.5% of those attending<21 deliveries. Higher attendance also correlated with confidence in endotracheal intubation and umbilical line placement.Wide variability existed within and among residency programs in number of deliveries attended. Volume of experience correlated with confidence in leading neonatal resuscitation and related procedural skills.

  View details for DOI 10.1016/j.jpeds.2010.01.029

  View details for Web of Science ID 000278649200037

  View details for PubMedID 20304418

  View details for PubMedCentralID PMC2886184

• Simulation: The New "Triple Threat" PEDIATRIC RESEARCH Halamek, L. P. 2010; 67 (2): 130-131

  View details for PubMedID 20081486

• Delivery Room Management of the Newborn PEDIATRIC CLINICS OF NORTH AMERICA Rajani, A. K., Chitkara, R., Halamek, L. P. 2009; 56 (3): 515-?

  Abstract

  Neonatal resuscitation is an attempt to facilitate the dynamic transition from fetal to neonatal physiology. This article outlines the current practices in delivery room management of the neonate. Developments in cardiopulmonary resuscitation techniques for term and preterm infants and advances in the areas of cerebral resuscitation and thermoregulation are reviewed. Resuscitation in special circumstances (such as the presence of congenital anomalies) are also covered. The importance of communication with other members of the health care team and the family is discussed. Finally, future trends in neonatal resuscitation are explored.

  View details for DOI 10.1016/j.pcl.2009.03.003

  View details for PubMedID 19501690

• The simulated delivery-room environment as the future modality for acquiring and maintaining skills in fetal and neonatal resuscitation SEMINARS IN FETAL & NEONATAL MEDICINE Halamek, L. P. 2008; 13 (6): 448-453

  Abstract

  The science underlying neonatal resuscitation is growing exponentially in quantity and quality. So, too, is the knowledge of effective methodologies that facilitate acquisition and maintenance of the cognitive, technical, and behavioral skills necessary to for successful resuscitation of the newborn. One of these methodologies, simulation-based training, offers many advantages over more traditional methodologies: By providing key visual, auditory, and tactile cues it creates a high level of physical, biological, and psychological fidelity to the real environment and thus is able to elicit realistic responses from trainees. Training scenarios coupled with debriefings (where discussion of what went well and what could be improved upon occur in a nonjudgmental fashion) provide rich learning experiences that rival or exceed those in the real clinical environment. Simulation-based training will likely become the standard for not only routine training but also high-stakes assessment such as licensure and board certification.

  View details for DOI 10.1016/j.siny.2008.04.015

  View details for PubMedID 18524705

• Teamwork during resuscitation PEDIATRIC CLINICS OF NORTH AMERICA Weinstock, P., Halamek, L. P. 2008; 55 (4): 1011-?

  Abstract

  Effective resuscitation requires the integration of several cognitive, technical, and behavioral skills. Because resuscitation is performed by teams of health care professionals, these individuals must be able to work together in a coordinated and efficient manner, making teamwork a critical skill for care of patients in distress. Despite the importance of teamwork in health care, little consensus exists as to what it is, how it can most effectively be learned, and how it should be assessed. This article reviews current knowledge on the measurement, training, and importance of teamwork in pediatric resuscitation.

  View details for DOI 10.1016/j.pcl.2008.04.001

  View details for Web of Science ID 000259090300011

  View details for PubMedID 18675031

• Teaching versus learning and the role of simulation-based training in Pediatrics JOURNAL OF PEDIATRICS Halamek, L. 2007; 151 (4): 329–30

  View details for DOI 10.1016/j.jpeds.2007.06.012

  View details for Web of Science ID 000249966800002

  View details for PubMedID 17889060

• Simulation-based medical error disclosure training for pediatric healthcare professionals. Journal for healthcare quality : official publication of the National Association for Healthcare Quality Wayman, K. I., Yaeger, K. A., Sharek, P. J., Trotter, S., Wise, L., Flora, J. A., Halamek, L. P. 2007; 29 (4): 12-19

  Abstract

  Ethical and regulatory guidelines recommend disclosure of medical errors to patients and families. Yet few studies examine how to effectively train healthcare professionals to deliver communications about adverse events to family members of affected pediatric patients. This pilot study uses a preintervention-postintervention study design to investigate the effects of medical error disclosure training in a simulated setting for pediatric oncology nurses (N=16). The results of a paired t test showed statistically significant increases in nurses' communication self-efficacy to carry out medical disclosure (t = 6.68, p < .001). Ratings of setting "realism" and simulation effectiveness were high (21 out of 25 composite score). Findings provide preliminary support for further research on simulation-based disclosure training for healthcare professionals.

  View details for PubMedID 17849675

• Implementation and case-study results of potentially better practices for collaboration between obstetrics and neonatology to achieve improved perinatal outcomes PEDIATRICS Zabari, M., Suresh, G., Tomlinson, M., Lavin, J. P., Larison, K., Halamek, L., Schriefer, J. A. 2006; 118: S153-S158

  Abstract

  The objective of this study was to make improvements in communication and collaboration between neonatal and obstetric specialties. Five NICUs from the Vermont Oxford Network's Evidence-Based Quality Improvement Collaborative in Neonatal and Perinatal Medicine tested potentially better practices that overlap obstetric and NICU care.One area of practice improvement was the management of the pregnancy at the margin of viability. Another included the use of team training and video simulation to improve team performance during high-risk deliveries using aviation-based communication techniques. Another focus of the collaborative was the creation of a multicenter database to measure combined perinatal and neonatal outcomes.The principle outcomes are increased patient satisfaction with teamwork between neonatology and obstetric services and improved team response times for emergent deliveries and the increased use of team communication skills during video simulations of high-risk deliveries.Implementing these potentially better practices can result in improved communication and collaboration related to perinatal and neonatal care.

  View details for DOI 10.1542/peds.2006-0913M

  View details for PubMedID 17079618

• Evaluation and development of potentially better practices for perinatal and neonatal communication and collaboration PEDIATRICS Ohlinger, J., Kantak, A., Lavin, J. P., Fofah, O., Hagen, E., Suresh, G., Halamek, L. P., Schriefer, J. A. 2006; 118: S147-S152

  Abstract

  The obstetric and neonatal exploratory focus group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative 2002 set out to improve collaboration, communication, and coordination between maternal and neonatal caregivers in 3 areas: the pregnancy at 22 to 26 weeks, measurement of maternal outcomes that are linked with neonatal outcomes, and team performance during high-risk delivery. Antepartum and intrapartum maternal attributes and interventions also were considered important measurements to identify practice variations and their relationship to neonatal outcomes for ongoing obstetric and neonatal collaboration.Potentially better practices were developed on the basis of evidence in the literature, expert opinion, and internal analysis at the participating perinatal centers. The potentially better practices include development of local guidelines at each center for the care and counseling of pregnant women who are at risk for delivering at the margin of viability; communication strategies for obstetric and neonatology providers relating to high-risk pregnancy treatment plans; team communication and performance at high-risk deliveries; design of organizational structures and processes that facilitate obstetric and neonatal collaboration; and development of perinatal data to evaluate effects of perinatal practices on maternal, fetal, and neonatal outcomes.As a result of the project, participating centers developed local guidelines for pregnancies between 22 and 26 weeks, created a cross-center maternal database that currently is being linked to neonatal outcomes, and completed a pilot study on video simulation of neonatal-perinatal team communication.Increased understanding of practice variation in the management of care for infants who are at the margins of viability, locally developed guidelines, and a focus on improved team communication during delivery can be accomplished with a multicenter collaborative approach.

  View details for DOI 10.1542/peds.2006-0913L

  View details for Web of Science ID 000243201000012

  View details for PubMedID 17079617

• Continuous positive airway pressure during neonatal resuscitation CLINICS IN PERINATOLOGY Halamek, L. P., Morley, C. 2006; 33 (1): 83-?

  Abstract

  Despite the large body of information regarding the beneficial effects of continuous positive airway pressure (CPAP) in infants with respiratory distress syndrome (RDS) data are insufficient at this time to support or refute its use during neonatal resuscitation. An individualized approach to infants with respiratory distress is recommended.

  View details for DOI 10.1016/j.clp.2005.11.010

  View details for PubMedID 16533635

• Simulating extracorporeal membrane oxygenation emergencies to improve human performance. Part I: methodologic and technologic innovations. Simulation in healthcare Anderson, J. M., Boyle, K. B., Murphy, A. A., Yaeger, K. A., LeFlore, J., Halamek, L. P. 2006; 1 (4): 220-227

  Abstract

  Extracorporeal membrane oxygenation (ECMO) is a form of long-term cardiopulmonary bypass used to treat infants, children, and adults with respiratory and/or cardiac failure despite maximal medical therapy. Mechanical emergencies on extracorporeal membrane oxygenation (ECMO) have an associated mortality of 25%. Thus, acquiring and maintaining the technical, behavioral, and critical thinking skills necessary to manage ECMO emergencies is essential to patient survival. Traditional training in ECMO management is primarily didactic in nature and usually complemented with varying degrees of hands-on training using a water-filled ECMO circuit. These traditional training methods do not provide an opportunity for trainees to recognize and interpret real-time clinical cues generated by human patients and their monitoring equipment. Adult learners are most likely to acquire such skills in an active learning environment. To provide authentic, intensive, interactive ECMO training without risk to real patients, we used methodologies pioneered by the aerospace industry and our experience developing a simulation-based training program in neonatal resuscitation to develop a similar simulation-based training program in ECMO crisis management, ECMO Sim.A survey was conducted at the 19th Annual Children's National Medical Center ECMO Symposium to determine current methods for ECMO training. Using commercially available technology, we linked a neonatal manikin with a standard neonatal ECMO circuit primed with artificial blood. Both the manikin and circuit were placed in a simulated neonatal intensive care unit environment equipped with remotely controlled monitors, real medical equipment and human colleagues. Twenty-five healthcare professionals, all of whom care for patients on ECMO and who underwent traditional ECMO training in the prior year, participated in a series of simulated ECMO emergencies. At the conclusion of the program, subjects completed a questionnaire qualitatively comparing ECMO Sim with their previous traditional ECMO training experience. The amount of time spent engaged in active and passive activities during both ECMO Sim and traditional ECMO training was quantified by review of videotape of each program.Hospitals currently use lectures, multiple-choice exams, water drills, and animal laboratory testing for their ECMO training. Modification of the circuit allowed for physiologically appropriate circuit pressures (both pre- and postoxygenator) to be achieved while circulating artificial blood continuously through the circuit and manikin. Realistic changes in vital signs on the bedside monitor and fluctuations in the mixed venous oxygen saturation monitor were also effectively achieved remotely. All subjects rated the realism of the scenarios as good or excellent and described ECMO Sim as more effective than traditional ECMO training. They reported that ECMO Sim engaged their intellect to a greater degree and better developed their technical, behavioral, and critical thinking skills. Active learning (eg, hands-on activities) comprised 78% of the total ECMO Sim program compared with 14% for traditional ECMO training (P < 0.001). Instructor-led lectures predominated in traditional ECMO training.Traditional ECMO training programs have yet to incorporate simulation-based methodology. Using current technology it is possible to realistically simulate in real-time the clinical cues (visual, auditory, and tactile) generated by a patient on ECMO. ECMO Sim as a training program provides more opportunities for active learning than traditional training programs in ECMO management and is overwhelmingly preferred by the experienced healthcare professionals serving as subjects in this study. Subjects also indicated that they felt that the acquisition of key cognitive, technical, and behavioral skills and transfer of those skills to the real medical domain was better achieved during simulation-based training.

  View details for DOI 10.1097/01.SIH.0000243550.24391.ce

  View details for PubMedID 19088593

• Simulation-based training: opportunities for the acquisition of unique skills. The virtual mentor : VM Halamek, L. P. 2006; 8 (2): 84-87

  View details for DOI 10.1001/virtualmentor.2006.8.2.medu1-0602

  View details for PubMedID 23228536

• Simulating extracorporeal membrane oxygenation emergencies to improve human performance. Part II: assessment of technical and behavioral skills. Simulation in healthcare Anderson, J. M., Murphy, A. A., Boyle, K. B., Yaeger, K. A., Halamek, L. P. 2006; 1 (4): 228-232

  Abstract

  Healthcare professionals are expected to make rapid, correct decisions in critical situations despite what may be a lack of real practical experience in a particular crisis situation. Successful resolution of a medical crisis depends upon demonstration not only of appropriate technical skills but also of key behavioral skills (eg, leadership, communication, and teamwork). We have developed a hands-on, high fidelity, simulation-based training program (ECMO Sim) to provide healthcare professionals with the opportunity to learn and practice the technical and behavioral skills necessary to manage ECMO emergencies.Nine ECMO nurse specialists participated in two sequential randomly assigned simulated ECMO emergencies. The simulated emergencies were captured on videotape and reviewed with the subjects during facilitated debriefings that occurred immediately following each scenario. All videotapes were scored for key technical and behavioral skills by reviewers blinded to the sequence of the scenarios. The ratings of the subjects' technical and behavioral skills in each scenario were compared.Subjects performed key technical skills correctly more often in the second simulated ECMO emergency. In addition, their response times for three out of five specific technical tasks improved from the first to the second simulated emergency by an average of 27 seconds. Subjects' behavioral skills were rated more highly by masked reviewers in the second simulated ECMO emergency. The improvement in comprehensive behavioral scores from the first to the second scenario reached statistical significance in eight of nine subjects.After exposure to high-fidelity simulated ECMO emergencies, subjects demonstrated significant improvements in their technical and behavioral skills. ECMO Sim creates a learning environment that readily supports the acquisition of the technical and behavioral skills that are important in solving clinically significant, potentially life-threatening problems that can occur when patients are on ECMO.

  View details for DOI 10.1097/01.SIH.0000243551.01521.74

  View details for PubMedID 19088594

• Comparing the utility of a standard pediatric resuscitation cart with a pediatric resuscitation cart based on the Broselow tape: A randomized, controlled, crossover trial involving simulated resuscitation scenarios PEDIATRICS Agarwal, S., Swanson, S., Murphy, A., Yaeger, K., Sharek, P., Halamek, L. P. 2005; 116 (3): E326-E333

  Abstract

  Access to resuscitation equipment is a critical component in delivering optimal care in pediatric arrest situations. Historically, children's hospitals and clinics have used a standard pediatric resuscitation cart ("standard cart") in which drawers are organized by intervention (eg, intubation module, intravenous module), requiring multiple drawers to be opened during a code. Many emergency departments, however, use a pediatric resuscitation cart based on the Broselow tape ("Broselow cart") in which each drawer is color coded and organized by patient length and weight ranges; each drawer contains all necessary equipment for resuscitation of a patient in that specific length/weight range. A literature review has revealed no studies examining the utility of either cart.To compare which resuscitation cart organization (standard versus Broselow) allows for faster access to equipment, more accurate selection of appropriately sized equipment, and better user satisfaction. Methodology. We performed a prospective, randomized, controlled, crossover trial in which 21 pediatric health care providers were assigned the role of obtaining the appropriate equipment during 2 standardized, simulated codes alternately using either a standard or Broselow cart. Time to and accuracy of the selection of appropriate medical equipment along with posttesting satisfaction were measured. All simulations were performed in the Center for Advanced Pediatric Education at Stanford University Medical Center (Stanford, CA), a training facility designed to replicate the real medical environment with the technology to allow for videotaping of scenarios.Of the 21 subjects, 62% found the Broselow cart "easy" or "very easy" to use versus 33% for the standard cart. Of the 21 subjects, 67% preferred the Broselow cart, 10% preferred the standard cart, and 23% indicated no preference. Intubation supplies and nasogastric tubes were found significantly faster when using the Broselow cart (mean time: 29.1 and 20 seconds, respectively) versus the standard cart (mean time: 38.7 and 38.2 seconds, respectively). Correct equipment was provided a statistically significant 99% of the time with the Broselow cart versus 83% of the time with the standard cart. Ten percent of the subjects had prior experience with the Broselow cart versus 62% having experience with the standard cart.Despite less prior experience with the Broselow cart, subjects in this study found it easier to use and preferred it over the standard cart. In addition, subjects located intubation equipment and nasogastric tubes significantly faster when using the Broselow cart, and correct equipment was provided significantly more often with the Broselow cart. These data suggest that sites caring for pediatric patients should consider modeling their resuscitation carts after the Broselow cart to enhance provider confidence and patient safety.

  View details for DOI 10.1542/peds.2005-0320

  View details for Web of Science ID 000231576600001

  View details for PubMedID 16061568

• High-fidelity simulation-based training in neonatal nursing. Advances in neonatal care : official journal of the National Association of Neonatal Nurses Yaeger, K. A., Halamek, L. P., Coyle, M., Murphy, A., Anderson, J., Boyle, K., Braccia, K., McAuley, J., Sandre, G. D., Smith, B. 2004; 4 (6): 326-331

  Abstract

  Simulation-based training is a novel approach that facilitates the use of higher order thinking skills. Simulation-based training challenges medical professionals to develop cognitive, technical, and behavioral skills through the use of mannequins, working medical equipment, and human colleagues. During scenarios, trainees must make use of their knowledge base, analyze and synthesize factors contributing to the crises, and evaluate the effects of their actions. Feedback indicates that simulation-based training programs are more pertinent to and better accepted by adult learners than traditional programs. The instructional methodologies used in simulation-based training programs are more in line with the tenets of adult learning.

  View details for PubMedID 15609254

• Validation of simulation-based training in neonatal resuscitation: Use of heart rate variability as marker for mental workload Annual Meeting of the Pediatric-Academic-Societies Murphy, A. A., Kaegi, D. M., Gobble, R., Dubin, A., Howard, S. K., Gaba, D. M., Sowb, Y. A., Halamek, L. P. NATURE PUBLISHING GROUP. 2004: 353A–353A

  View details for Web of Science ID 000220591102074

• A quantitative comparison of traditional extracorporeal membrane oxygenation (ECMO) training with a novel simulation-based ECMO training program (ECMOSim) Anderson, J. M., Murphy, A. A., Boyle, K. B., Yaeger, K. A., DeSandre, G. H., Halamek, L. P. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 365A

  View details for Web of Science ID 000220591102141

• ECMO emergency training: A subjective evaluation of a novel simulation-based ECMO training course (ECMOSim) Anderson, J. M., Boyle, K. B., Yaeger, K. A., Murphy, A. A., Halamek, L. P. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 365A

  View details for Web of Science ID 000220591102143

• A subjective comparison of a standard ECMO recertification course and a novel simulation-based ECMO (ECMOSim) recertification course Anderson, J. M., Boyle, K. B., Murphy, A. A., Yaeger, K. A., Halamek, L. P. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 365A

  View details for Web of Science ID 000220591102142

• Quantitative and qualitative comparison of a novel simulation-based pediatric resuscitation training program with a standard pediatric advanced life support course Anderson, J. M., Murphy, A. A., Yaeger, K. A., Braccia, K., Nawas, C., Barman, P., Halamek, L. P. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 361A

  View details for Web of Science ID 000220591102121

• Comparing perceived ease of use of standard pediatric code cart with pediatric code cart based on Broselow tape Agarwal, S., Swanson, S., Murphy, A., Yaeger, K., Anderson, J., Sharek, P. J., Zarge, R., DiCarlo, J., Halamek, L. P. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 65A–66A

  View details for Web of Science ID 000220591100387

• Objective evaluation of the behavioral skills acquired through simulation-based ECMO training Anderson, J. M., Murphy, A. A., Boyle, K. B., Yaeger, K. A., Swanson, S., Halamek, L. P. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 357A

  View details for Web of Science ID 000220591102097

• Quantitative and qualitative comparison of a novel simulation-based neonatal resuscitation training program with a standard neonatal resuscitation program course Murphy, A. A., Anderson, J. M., Nawas, C., Yaeger, K. A., Boyle, K., Coyle, M. W., Halamek, L. P. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 357A

  View details for Web of Science ID 000220591102098

• Death, dying and delivering difficult news: Simulation-based training improves the skills and confidence of medical students Mosher, P. J., Murphy, A. A., Anderson, J. M., Coyle, M. M., McCauley, F., Boyle, K. B., Yaeger, K. M., Iverson, N., Halamek, L. R. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 362A

  View details for Web of Science ID 000220591102123

• Attitudes towards palliative and end-of-life care in the neonatal intensive care unit Yaeger, K. A., Halamek, L. P., Anderson, J. M., Murphy, A. A., Boyle, K. B., Coyle, M. W., Smith, B., Braccia, K. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 370A

  View details for Web of Science ID 000220591102170

• Validation of simulation-based training in neonatal resuscitation: Use of heart rate variability as a marker for mental workload. Kaegi, D. M., Gobble, R., Dubin, A., Howard, S. K., Gaba, D. M., Sowb, Y. A., Halamek, L. P. B C DECKER INC. 2004: S122

  View details for Web of Science ID 000188254600265

• Attitudes towards palliative and end-of-life care in the neonatal intensive care unit Yaeger, K., Murphy, A., Braccia, K., Coyle, M., Anderson, J., Boyle, K., Smith, B., Halamek, L. B C DECKER INC. 2004: S97

  View details for DOI 10.1097/00042871-200401001-00105

  View details for Web of Science ID 000188254600125

• Training and competency assessment in electronic fetal monitoring: A national survey OBSTETRICS AND GYNECOLOGY Murphy, A. A., Halamek, L. P., Lyell, D. J., Druzin, M. L. 2003; 101 (6): 1243-1248

  Abstract

  To investigate current patterns of training and competency assessment in electronic fetal monitoring (EFM) for obstetrics and gynecology residents and maternal-fetal medicine fellows.A questionnaire was mailed to the directors of all 254 accredited US residencies in obstetrics and gynecology and 61 accredited US fellowships in maternal-fetal medicine. Questions focused on the methods used for teaching and assessing competency in EFM.Two hundred thirty-nine programs (76%) responded to the survey. Clinical experience is used by 219 programs (92%) to teach EFM, both initially and on an ongoing basis. Significantly more residencies than fellowships use written materials and lectures to teach EFM. More than half of all programs require trainees to participate in some type of EFM training at least every 6 months; 23 programs (10%) have no requirement at all. Subjective evaluation is used by 174 programs (73%) to assess competency in EFM. Written or oral examinations, skills checklists, and logbooks are used exclusively by residencies as means of competency assessment. Two thirds of all programs assess EFM skills at least every 6 months; 40 programs (17%), the majority of which are fellowships, have no formal requirement.Most US training programs use supervised clinical experience as both their primary source of teaching EFM and their principal competency assessment tool. Residencies are more likely to have formal instruction and assessment than are fellowships. Few programs are using novel strategies (eg, computers or simulators) in their curriculum.

  View details for DOI 10.1016/S0029-7844(03)00351-0

  View details for PubMedID 12798531

• Toward a new standard in extracorporeal membrane oxygenation (ECMO) training Anderson, J. D., Boyle, K. B., Murphy, A., Halamck, L. P. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2003: 99A

  View details for Web of Science ID 000181897900563

• Evaluation of a novel electronic fetal monitor simulator 11th Annual Medicine Meets Virtual Reality Conference Murphy, A. A., Halamek, L. P., Lyell, D. J., Druzin, M. L. I O S PRESS. 2003: 240–244

  Abstract

  The purpose of this study was to evaluate the content validity and construct validity of a novel electronic fetal monitor (EFM) simulator. Fourteen residents in Gynecology and Obstetrics (OB/GYN) and 7 medical students in their OB/GYN clerkship interpreted 10 fetal heart rate (FHR) tracings and 4 clinical scenarios generated by the EFM simulator. Their responses were scored by experts in maternal-fetal medicine. Construct validity was determined by comparing subjects' scores to their level of experience. Subjects assessed content validity of the EFM simulator by rating the realism of its various elements on a 4-point Likert scale. Residents achieved statistically significant higher mean scores in the description of FHR tracings generated by the simulator than medical students and statistically significant higher mean scores in the correct interpretation of and interventions in 2 of 4 clinical scenarios. Two-thirds of the residents rated the simulator-generated FHR tracings and clinical scenarios as "real" or "very real." The EFM simulator exhibited both content and construct validity, supporting its use in an educational setting.

  View details for PubMedID 15455900

• The advantages of prenatal consultation by a neonatologist. Journal of perinatology Halamek, L. P. 2001; 21 (2): 116-120

  Abstract

  The neonatologist can be a valuable source of information for the pregnant woman and her partner faced with making difficult decisions. In specific clinical situations, a focused, thorough consultation by a neonatologist provides benefits for the parents, their child, the physicians, and the health care delivery system as a whole. Members of the perinatal team should act to facilitate early neonatal consultation in order to ease the transition from the obstetric to the neonatal team after delivery.

  View details for PubMedID 11324357

• Who's teaching neonatal resuscitation to housestaff?: Results of a national survey Annual Congress of the American-Academy-of-Pediatrics Halamek, L. P., Kaegi, D. M. AMER ACAD PEDIATRICS. 2001: 249–55

  Abstract

  This study was designed to investigate current patterns of training in neonatal resuscitation in US residency programs in general pediatrics.A questionnaire was mailed to the chief residents and directors of all US residency programs in general pediatrics to determine who provides supervision and teaching of neonatal resuscitation in the delivery room and neonatal intensive care unit. This questionnaire also inquired as to the use within these residency programs of standardized resuscitation training courses such as Pediatric Advanced Life Support and Neonatal Resuscitation Program.Residents in their third and second years of training are most often cited as responsible for supervision and teaching of neonatal resuscitation in the delivery room, whereas attending neonatologists are cited most frequently as being responsible for these tasks in the neonatal intensive care unit. Pediatric Advanced Life Support is required by virtually all US residency programs, followed in frequency by Neonatal Resuscitation Program and Advanced Cardiac Life Support.Because those in training collectively provide much of the supervision and teaching of neonatal resuscitation, vigilance is required so that appropriate resuscitation skills are developed and maintained. Objective performance markers may be useful in assessing competency in caring for sick newborns.neonatal resuscitation, delivery room, Neonatal Resuscitation Program, Pediatric Advanced Life Support, Advanced Cardiac Life Support.

  View details for PubMedID 11158454

• Time for a new paradigm in pediatric medical education: Teaching neonatal resuscitation in a simulated delivery room environment PEDIATRICS Halamek, L. P., Kaegi, D. M., Gaba, D. M., Sowb, Y. A., Smith, B. C., Smith, B. E., Howard, S. K. 2000; 106 (4)

  Abstract

  Acquisition and maintenance of the skills necessary for successful resuscitation of the neonate are typically accomplished by a combination of completion of standardized training courses using textbooks, videotape, and manikins together with active participation in the resuscitation of human neonates in the real delivery room. We developed a simulation-based training program in neonatal resuscitation (NeoSim) to bridge the gap between textbook and real life and to assess trainee satisfaction with the elements of this program.Thirty-eight subjects (physicians and nurses) participated in 1 of 9 full-day NeoSim programs combining didactic instruction with active, hands-on participation in intensive scenarios involving life-like neonatal and maternal manikins and real medical equipment. Subjects were asked to complete an extensive evaluation of all elements of the program on its conclusion.The subjects expressed high levels of satisfaction with nearly all aspects of this novel program. Responses to open-ended questions were especially enthusiastic in describing the realistic nature of simulation-based training. The major limitation of the program was the lack of fidelity of the neonatal manikin to a human neonate.Realistic simulation-based training in neonatal resuscitation is possible using current technology, is well received by trainees, and offers benefits not inherent in traditional paradigms of medical education.

  View details for PubMedID 11015540

• Not all perfluorochemicals are created equal CRITICAL CARE MEDICINE Halamek, L. P., Dimmitt, R. A., Mickas, N. A. 2000; 28 (8): 3132

  View details for Web of Science ID 000088867300108

  View details for PubMedID 10966336

• Secondary infection presenting as recurrent pulmonary hypertension. Journal of perinatology Hintz, S. R., Benitz, W. E., Halamek, L. P., Van Meurs, K. P., Rhine, W. D. 2000; 20 (4): 262-264

  Abstract

  Primary infection in the neonate, especially group B streptococcal infection, has long been recognized as a cause of persistent pulmonary hypertension of the newborn (PPHN), sometimes requiring treatment with inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO). However, secondary nosocomial infections in the neonatal period have not been widely reported as a cause of severe recurrent pulmonary hypertension (PHTN). We now present two cases of secondary infection in the neonate leading to significant PHTN. In both cases, the infants presented with PPHN soon after birth, requiring transfer to a level 3 neonatal intensive care unit and treatment with high-frequency oscillatory ventilation and iNO. After successful resolution of the initial PPHN, including extubation to nasal cannula, both infants developed signs of severe recurrent PHTN, leading to reintubation, high-frequency oscillatory ventilation and iNO therapy, and consideration of ECMO. In both cases, blood cultures taken at the time of recurrence of PHTN returned positive, one for Staphylococcus epidermidis, the other for methicillin-resistant Staphylococcus aureus. These unusual cases present the possibility of severe recurrent PHTN requiring iNO or ECMO in the setting of secondary infection. We speculate that these infants, although extubated after their first episodes of PHTN, were at risk for recurrence of PHTN due to continued pulmonary vascular reactivity.

  View details for PubMedID 10879342

• Cerebral blood flow and metabolism during partial liquid ventilation in neonatal lambs Dimmitt, R. A., Beckman, S. A., Halamek, L. P., Moss, R. L., Mickas, N. A., Amil, L. A., Falco, D. A., Skarsgard, E. D. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2000: 356A

  View details for Web of Science ID 000086155302103

• Deaths following administration of perfluorochemical administration in juvenile rabbits. Mickas, N. A., Dimmitt, R. A., Falco, D., Beckman, S. A., Moss, R. L., Skarsgard, E. A., Halamek, L. P. LIPPINCOTT WILLIAMS & WILKINS. 2000: 99A

  View details for Web of Science ID 000086346600544

• Cerebral blood flow and metabolism during partial liquid ventilation in neonatal sheep. Beckman, S. A., Dimmitt, R. A., Halamek, L. P., Falco, D. A., Mickas, N. A., Moss, R. L., Amii, L. A., Skarsgard, E. A. LIPPINCOTT WILLIAMS & WILKINS. 2000: 7A

  View details for Web of Science ID 000086346600049

• Congenital diaphragmatic hernia: the perinatalogist's perspective. Pediatrics in review Halamek, L. P., El-Sayed, Y. Y. 1999; 20 (10): e67-70

  View details for PubMedID 10512894

• Salvage laparotomy for failure of peritoneal drainage in necrotizing enterocolitis in extremely low birth weight (ELBW) infants Dimmitt, R. A., Meier, A. H., Skarsgard, E. D., Halamek, L. P., Smith, B. M., Moss, R. L. AMER ACAD PEDIATRICS. 1999: 769–70

  View details for Web of Science ID 000082999600268

• Effect of mental stress on heart rate variability: Validation of simulated operating and delivery room training modules Kaegi, D. M., Halamek, L. P., Van Hare, G. F., Howard, S. K., Dubin, A. M. NATURE PUBLISHING GROUP. 1999: 77A–77A

  View details for Web of Science ID 000079476700447

• Assessing the fidelity of the simulated delivery room for neonatal resuscitation. Kaegi, D. M., Halamek, L. P., Howard, S. K., Smith, B. E., Gaba, D. M., Sowb, Y. A. AMER ACAD PEDIATRICS. 1998: 767–68

  View details for Web of Science ID 000075810500225

• Who's teaching in the delivery room? Halamek, L. P., Kaegi, D. M. AMER ACAD PEDIATRICS. 1998: 767

  View details for Web of Science ID 000075810500224

• Utilization of NRP, PALS, and ACLS in pediatric residency training in the United States. Halamek, L. P., Kaegi, D. M. AMER ACAD PEDIATRICS. 1998: 768

  View details for Web of Science ID 000075810500227

• Supervision and teaching in the NICU. Halamek, L. P., Kaegi, D. M. AMER ACAD PEDIATRICS. 1998: 768

  View details for Web of Science ID 000075810500226

• Heart rate variability as a marker for workload during neonatal resuscitation Kaegi, D. M., Halamek, L. P., Dubin, A., Howard, S. AMER ACAD PEDIATRICS. 1998: 766–67

  View details for Web of Science ID 000075810500223

• Neonatal hypoglycemia, part II: Pathophysiology and therapy International Symposium on Neonatal Hypoglycemia Halamek, L. P., Stevenson, D. K. SAGE PUBLICATIONS INC. 1998: 11–16

  Abstract

  Contemporary research is elucidating both the molecular mechanisms of hypoglycemia-induced neuronal injury and its corresponding clinical manifestations. Recognizing and screening those neonates at highest risk of hypoglycemia-induced injury is an important skill for all physicians responsible for the care of newborns. Appropriate therapy, consisting of either oral or intravenous glucose, should never be delayed while one is awaiting laboratory confirmation of a "low" glucose level.

  View details for PubMedID 9475694

• Kernicteric findings at autopsy in two sick near term infants PEDIATRICS Halamek, L. P., Stevenson, D. K. 1998; 101 (1): 158–59

  View details for DOI 10.1542/peds.101.1.158a

  View details for Web of Science ID 000071331400045

  View details for PubMedID 11345982

• The simulated delivery room as a laboratory for the study of human performance. Halamek, L. P., Howard, S. K., Kaegi, D. M., Smith, B. E., Smith, B. C., Gaba, D. M. LIPPINCOTT WILLIAMS & WILKINS. 1998: 167A–167A

  View details for Web of Science ID 000071684700895

• Neonatal hypoglycemia .1. Background and definition International Symposium on Neonatal Hypoglycemia Halamek, L. P., Benaron, D. A., Stevenson, D. K. SAGE PUBLICATIONS INC. 1997: 675–80

  Abstract

  Hypoglycemia in the neonate remains a common problem. The association of low blood glucose concentrations and abnormal development has prompted extensive research into the anticipation, evaluation, and treatment of neonatal hypoglycemia. Glucose homeostasis in the fetus and neonate is a developmentally regulated dynamic process involving a number of intricate physiologic mechanisms. In addition, the determination of glucose concentrations is dependent upon both the type of tissue analyzed and the limitations of the specific method employed. The complexity of glucose metabolism makes it difficult to precisely define "normal" and "abnormal" glucose levels in preterm and term neonates.

  View details for PubMedID 9415833

• Development of a simulated delivery room for the study of human performance during neonatal resuscitation Halamek, L. P., Howard, S. K., Smith, B. E., Smith, B. C., Gaba, D. M. AMER ACAD PEDIATRICS. 1997: 513–14

  View details for Web of Science ID A1997XU27800200

• The value of neurophysiologic approaches in the anticipation and evaluation of neonatal hypoglycemia International Symposium on Neonatal Hypoglycemia: A Satellite Symposium of the 40th Annual Meeting of the Japan-Society-for-Premature-and-Newborn-Medicine Halamek, L. P., Benaron, D. A., Stevenson, D. K. BLACKWELL SCIENCE. 1997: 33–43

  View details for Web of Science ID A1997XG14300007

• The value of neurophysiologic approaches in the anticipation and evaluation of neonatal hypoglycemia. Acta paediatrica Japonica; Overseas edition Halamek, L. P., Benaron, D. A., Stevenson, D. K. 1997; 39: S33-43

  Abstract

  The association of low blood glucose with central nervous system (CNS) injury was first described in 1937 by Hartmann and Jaudon. In the early 60 years since publication of these observations the effects of hypoglycemia upon the brain remain poorly understood. Technology capable of accurately determining plasma glucose concentrations has been developed. Investigators have sought to establish critical values below which glucose levels should not be allowed to fall. Despite these efforts the definitive level of glucose capable of producing brain injury in any particular patient remains unknown. Glucose homeostasis within the neonatal CNS represents a dynamic process consisting of many interrelated variables including gestational and chronologic age, genotype, relative health, blood flow, metabolic rate and availability of other suitable substrates. New technique for assessing the glucose delivery: consumption ratio and directly monitoring the cellular consequences of glucose deprivation within discrete regions of the brain will help to answer the question 'How long is too low and how long is too long?'

  View details for PubMedID 9200877

• The OOPS procedure (operation on placental support): In utero airway management of the fetus with prenatally diagnosed tracheal obstruction 27th Annual Meeting of the Canadian-Association-of-Paediatric-Surgeons Skarsgard, E. D., Chitkara, U., Krane, E. J., Riley, E. T., Halamek, L. P., Dedo, H. H. W B SAUNDERS CO. 1996: 826–28

  Abstract

  Tracheal obstruction of the newborn caused by cervical masses such as teratomas and cystic hygromas can result in a profound hypoxic insult and even death, owing to an inability to establish an adequate airway after birth. Prenatal sonographic diagnosis of these congenital anomalies permits (1) anticipation of an airway problem at the time of delivery and (2) formulation of an algorithm for airway management while oxygen delivery to the baby is maintained through the placental circulation. This is the report of a fetus in whom a large anterior cervical cystic hygroma was detected by prenatal ultrasonography. A multidisciplinary management team was assembled, and an algorithm for airway management was developed. Elective cesarean delivery of the fetal head and thorax, under conditions of uterine tocolysis, permitted a controlled evaluation of the airway and endotracheal intubation while oxygen supply to the infant was maintained through the placenta. The baby remained intubated, and 2 days later underwent subtotal excision of the cervical cystic hygroma. Pharmacological maintenance of the feto-placental circulation after hysterotomy is an invaluable adjunct to airway management of the neonate with prenatally diagnosed tracheal obstruction.

  View details for PubMedID 8783114

• ALTERED RHOMBOMERE-SPECIFIC GENE-EXPRESSION AND HYOID BONE DIFFERENTIATION IN THE MOUSE SEGMENTATION MUTANT, KREISLER (KR) DEVELOPMENT Frohman, M. A., Martin, G. R., Cordes, S. P., Halamek, L. P., Barsh, G. S. 1993; 117 (3): 925-936

  Abstract

  Rhombomeres appear transiently in the vertebrate hindbrain shortly after neurulation and are thought to represent embryologic compartments in which the expression of different combinations of genes leads to segment-specific differentiation of the developing hindbrain, the cranial ganglia, and the branchial arches. To determine the extent to which gene expression is related to the formation of visible rhombomere boundaries, we have examined, by in situ hybridization, the expression of five rhombomere-specific genes in mouse embryos homozygous for the kreisler (kr) mutation, in which rhombomeres 4-7 are replaced by a smooth morphologically unsegmented neural tube. Using molecular probes specific for Hoxb-1 (Hox-2.9), Hoxb-3 (Hox-2.7), Hoxb-4 (Hox-2.6), Krox-20, or Fgf-3 (Int-2), we found that the kr mutation affects the expression of all the genes we examined, but, surprisingly, the altered patterns of expression are not restricted to that portion of the mutant hindbrain which is morphologically abnormal. Rostral expression boundaries of Hoxb-3 and Hoxb-4 are displaced from their normal positions at r4/5 and r6/7 to the approximate positions of r3/4 and r4/5, respectively. The expression domains of Krox-20 and Fgf-3 are also displaced in a rostral direction and the intensity of Fgf-3 hybridization is greatly reduced. The expression domain of Hoxb-1 is affected differently from the other genes in kr/kr embryos; its rostral boundary at r3/4 is intact but the caudal boundary is displaced from its normal location at r4/5 to the approximate position of r5/6. Because boundaries of gene expression for Hoxb-1 and Hoxb-4 are found in a region of the kr/kr hindbrain that lacks visible rhombomeres, establishment of regional identity, as reflected by differential gene expression, does not require overt segmentation. To investigate whether the altered patterns of gene expression we observed in the kr/kr embryonic hindbrain are associated with morphologic changes in the adult, we examined neural crest-derived tissues of the second and third branchial arches, which normally arise from rhombomeres 4 and 6, respectively. We found that the hyoid bone in kr/kr animals exhibited an accessory process on the greater horn (a third arch structure) most easily explained by ectopic development of a second arch structure (the hyoid lesser horn) in an area normally derived from the third arch.

  View details for Web of Science ID A1993KY54800010

  View details for PubMedID 8100767

• Ultrasound in congenital hip disease. Part II--Prospective study. The Nebraska medical journal HAGGSTROM, J. A., Brown, J. C., Schroeder, B. A., BACH, S. M., HUURMAN, W. W., Esposito, P., Halamek, L. J. 1990; 75 (6): 142-143

  View details for PubMedID 2195365

• Ultrasound in congenital hip disease. Part 1--Review of technique. The Nebraska medical journal HAGGSTROM, J. A., Brown, J. C., Schroeder, B. A., BACH, S. M., Huurman, W. M., Esposito, P., Halamek, L. J. 1990; 75 (6): 134-141

  View details for PubMedID 2195364

• CHILDHOOD-CANCER SURVIVORS KNOWLEDGE OF THEIR DIAGNOSIS AND TREATMENT ANNALS OF INTERNAL MEDICINE Byrne, J., Lewis, S., Halamek, L., Connelly, R. R., Mulvihill, J. J. 1989; 110 (5): 400-403

  Abstract

  To determine what factors correlated with the failure of the survivors of childhood cancer to acknowledge their diagnosis.A follow-up interview with 1928 adults who survived childhood cancer to evaluate the late effects of cancer and its treatment. Cancer was diagnosed in these survivors between 1945 and 1974 before they reached age 20: subjects had to have survived for at least 5 years and to have reached age 21.Fourteen percent of the survivors of malignancies at sites other than the central nervous system said that they had not had cancer. This proportion differed according to the survivors' race, the type of tumor and its treatment, the level of their father's education, the year of diagnosis, and the center where the tumor was diagnosed. Among survivors who knew that they had cancer previously, however, most (81%) correctly identified the type of treatment they had received.Physicians should be aware that a substantial proportion of long-term survivors of childhood cancer may not reveal their past history of cancer and its treatment, and possible clues to the cause of the presenting condition may thus be missed.

  View details for Web of Science ID A1989T552700011

  View details for PubMedID 2916808