Bio

Bio


Amber Trickey, PhD, MS, CPH is Senior Biostatistician of the S-SPIRE Center. She supports multidisciplinary teams in research design, implementation, and analysis. In 14 years of health services research, with 7 years focused in surgery, Dr. Trickey has collaborated with diverse investigators, including attending physicians, residents, nurses, psychologists, and engineers. Dr. Trickey obtained degrees in epidemiology and biostatistics, evaluated data quality in trauma care, and led data validation studies using a surgical registry (NSQIP) and administrative claims. Dr. Trickey has contributed to public and private grants on surgical safety, simulation-based training, team communication, error disclosure, and quality metrics.

Professional

Professional Affiliations and Activities


  • Chapter Leader, University of Texas School of Public Health, Institute for Healthcare Improvement Open School (2009 - 2011)
  • Member, Research & Development Committee, American College of Surgeons Accredited Education Institutes (2016 - Present)
  • Member, AcademyHealth (2017 - Present)

Publications

All Publications


  • Evaluating Surgical Residents' Patient-Centered Communication Skills: Practical Alternatives to the "Apprenticeship Model" JOURNAL OF SURGICAL EDUCATION Newcomb, A., Trickey, A. W., Lita, E., Dort, J. 2018; 75 (3): 613–21

    Abstract

    The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to assess communication skills and provide feedback to residents. We aimed to develop a feasible data collection process that generates objective clinical performance information to guide training activities, inform ACGME milestone evaluations, and validate assessment instruments.Residents care for patients in the surgical clinic and in the hospital, and participate in a communication curriculum providing practice with standardized patients (SPs). We measured perception of resident communication using the 14-item Communication Assessment Tool (CAT), collecting data from patients at the surgery clinic and surgical wards in the hospital, and from SP encounters during simulated training scenarios. We developed a handout of CAT example behaviors to guide patients completing the communication assessment.Independent academic medical center.General surgery residents.The primary outcome is the percentage of total items patients rated "excellent;" we collected data on 24 of 25 residents. Outpatient evaluations resulted in significantly higher scores (mean 84.5% vs. 68.6%, p < 0.001), and female patients provided nearly statistically significantly higher ratings (mean 85.2% vs. 76.7%, p = 0.084). In multivariate analysis, after controlling for patient gender, visit reason, and race, (1) residents' CAT scores from SPs in simulation were independently associated with communication assessments in their concurrent patient population (p = 0.017), and (2) receiving CAT example instructions was associated with a lower percentage of excellent ratings by 9.3% (p = 0.047).Our data collection process provides a model for obtaining meaningful information about resident communication proficiency. CAT evaluations of surgical residents by the inpatient population had not previously been described in the literature; our results provide important insight into relationships between the evaluations provided by inpatients, clinic patients, and SPs in simulation. Our example behaviors guide shows promise for addressing a common concern, minimizing ceiling effects when measuring physician-patient communication.

    View details for DOI 10.1016/j.jsurg.2017.09.011

    View details for Web of Science ID 000434907100012

    View details for PubMedID 28993121

  • Clinical Predictors of Positive Postoperative Blood Cultures ANNALS OF SURGERY Copeland-Halperin, L. R., Stodghill, J., Emery, E., Trickey, A. W., Dort, J. 2018; 267 (2): 297–302

    Abstract

    To define clinical features of surgical patients in whom postoperative blood cultures are likely to identify pathogens.Bacteremia is a worrisome postoperative complication and blood cultures (BCx) are routinely used for evaluation of postoperative bacteremia, but are costly and not always diagnostic. Better methods are needed to select patients in whom BCx identify pathogens.We reviewed records of patients ≥18 years old with BCx drawn ≤10 days after surgery in 2013 seeking independent predictors of positive cultures by simple and multiple logistic regression models with statistical significance at α = 0.05.Of 1804 BCx, excluding contaminants yielded 1780 cultures among 746 patients for analysis. The yield was low, with only 4% identifying potential pathogens. Positive BCx were most common after cardiac, ear/nose/throat, obstetric, and urologic procedures [odds ratio (OR) =10.3, P < 0.001 vs low-yield procedures: eg, gynecologic, neurosurgical, plastic surgical, podiatric, transplant]. Cultures more often grew pathogens when drawn in association with higher peak temperature (Tmax, P = 0.001) and longer interval from procedure to Tmax (P = 0.001). Antibiotic therapy at time of culture reduced yield (2.9% with vs 5.5% without antibiotics, P = 0.007). Multivariable logistic regression analysis found antibiotics at culture, procedure specialty, Tmax, and postoperative timing of Tmax were associated with blood culture results.Ordering blood cultures based on fever or another single predictor inconsistently identifies pathogens. Our dataset, the largest available, identify clinical predictors in the first 10 postoperative days to guide identification of patients with bacteremia.

    View details for DOI 10.1097/SLA.0000000000002077

    View details for Web of Science ID 000424031700042

    View details for PubMedID 27893534

  • All in: expansion of the acquisition of data for outcomes and procedure transfer (ADOPT) program to an entire SAGES annual meeting hands-on hernia course. Surgical endoscopy Dort, J., Trickey, A., Paige, J., Schwarz, E., Cecil, T., Coleman, M., Dunkin, B. 2018

    Abstract

    Continuing professional development (CPD) for the surgeon has been challenging because of a lack of standardized approaches of hands-on courses, resulting in poor post-course outcomes. To remedy this situation, SAGES has introduced the ADOPT program, implementing a standardized, long-term mentoring program as part of its hernia hands-on course. Previous work evaluating the pilot program showed increased adoption of learned procedures as well as increased confidence of the mentored surgeons. This manuscript describes the impact of such a program when it is instituted across an entire hands-on course.Following collection of pre-course benchmark data, all participants in the 2016 SAGES hands-on hernia course underwent structured, learner-focused instruction during the cadaveric lab. All faculty had completed a standardized teaching course in the Lapco TT format. Subsequently, course participants were enrolled in a year-long program involving longitudinal mentorship, webinars, conference calls, and coaching. Information about participant demographics, training, experience, self-reported case volumes, and confidence levels related to procedures were collected via survey 3 months prior to 9 months after the course.Twenty surgeons participated in the SAGES ADOPT 2016 hands-on hernia program. Of these, seventeen completed pre-course questionnaires (85%), ten completed the 3-month questionnaire (50%), and four completed the 9-month questionnaire (20%). Nine of ten respondents of the 3-month survey (90%) reported changes in their practice. In the 9-month survey, significant increases in the annualized procedural volumes were reported for open primary ventral hernia repair, open components separation, and mesh insertion for ventral hernia repair (p < 0.001).The expansion of the ADOPT program to an entire hands-on hernia course is both feasible and beneficial, with evidence of Kirkpatrick Levels 1-4a training effectiveness. This expanded success suggests that it is a useful blueprint for the CPD of surgeons wishing to learn new techniques and procedures for their patients.

    View details for DOI 10.1007/s00464-018-6196-y

    View details for PubMedID 29717374

  • Exploration of Portal Activation by Patients in a Healthcare System CIN-COMPUTERS INFORMATICS NURSING Mook, P. J., Trickey, A. W., Krakowski, K., Majors, S., Theiss, M., Fant, C., Friesen, M. 2018; 36 (1): 18–26

    Abstract

    A study of patient portal utilization was conducted at a not-for-profit healthcare system in Northern Virginia. The healthcare system serves more than 2 million people each year. The encounters with the portal included 461 700 different patients occurring between July 2014 and June 2015. Univariate analysis and multivariable logistic regression indicated associations between patient portal activation and predictive factors. Multiple findings emerged: patient portal activation was greater for English-speaking patients; differences in portal activation were observed by patient age; and patients who had an identified primary care provider were more likely to use the portal. The implications were that patients who have limited English skills and have economic challenges may be less engaged. This review demonstrates the importance of understanding the population using a patient portal and provides insight for future development on how to engage patients to interact with their providers through the portals.

    View details for DOI 10.1097/CIN.0000000000000392

    View details for Web of Science ID 000419841900004

    View details for PubMedID 29049084

  • Survivability of Existing Peripheral Intravenous Access Following Blood Sampling in a Pediatric Population. Journal of pediatric nursing O'Neil, S. W., Friesen, M. A., Stanger, D., Trickey, A. W. 2018

    Abstract

    Although pediatric patients report venipuncture as their most feared experience during hospitalization, blood sampling from peripheral intravenous accesses (PIVs) is not standard of care. Blood sampling from PIVs has long been considered by healthcare personnel to harm the access. In an effort to minimize painful procedures, pediatric nursing staff conducted a prospective, observational study to determine if blood sampling using existing PIVs resulted in the loss of the access. The ability to obtain the sample from the PIV was measured along with patient and PIV characteristics.Specimen collection using 100 existing PIVs was attempted on pediatric inpatients. Each PIV was observed for functionality, infiltration, occlusion, and dislodgement following collection and again in 4h. Frequencies of PIV loss and successful blood sampling were calculated. Patient age, PIV gauge, access site, and PIV age were evaluated for associations with successful sampling using chi-square tests, Fisher's exact tests, and logistic regression.PIV survivability was reported at 99%. The ability to obtain a complete specimen was reported at 76% and found to be significantly related to PIV age and site. Size of PIV and patient's age were not significantly related to successful sampling.Encouraging rates of PIV survivability and collectability suggest blood sampling from PIVs to be a valuable technique to minimize painful and distressful procedures.Nursing practice was changed in this pediatric department. Patients and families are saved the pain and distress of venipuncture. Nurses reported saving time and personal distress by avoiding the venipuncture procedure.

    View details for DOI 10.1016/j.pedn.2018.02.009

    View details for PubMedID 29525119

  • Low socioeconomic status is associated with lower weight-loss outcomes 10-years after Roux-en-Y gastric bypass. Surgical endoscopy Carden, A., Blum, K., Arbaugh, C. J., Trickey, A., Eisenberg, D. 2018

    Abstract

    Roux-en-Y gastric bypass (RYGB) is the criterion standard operation for weight loss. Low socioeconomic status (SES) is common in the Veteran population undergoing bariatric surgery, but the impact of SES on long-term weight-loss outcomes is not known. We hypothesize that low socioeconomic status is associated with less weight loss after gastric bypass in long-term follow-up.We performed a retrospective review of patients undergoing RYGB at a single Veterans Affairs (VA) hospital. Patients with at least 10 years of follow-up data in the electronic health record were included in the analysis. Weight loss was measured as percent excess body mass index loss (%EBMIL). The primary predictor variable, median household income, was determined using zip codes of patient residences matched to publicly available 2010 U.S. census data. Univariate relationships between income, weight loss, and other patient characteristics were evaluated. We calculated a multivariate generalized linear model of %EBMIL to estimate independent relationships with median household income quartile while controlling for patients' age, race, sex, and VA distance.Complete 10-year follow-up data were available for 83 of 92 patients (90.2%) who underwent RYGB between 2001 and 2007 and survived at least 10 years. The majority of patients were male (79.5%) and white (73.5%). The mean 10-year %EBMIL was 57.8% (SD: 29.5%, range - 36.0% - 132.8%). In univariate analysis, income was significantly associated with race (p < 0.001) and median distance to the VA bariatric center (p = 0.034), but income did not differ by gender (p = 0.73) or age (p = 0.45). Multivariate analysis revealed significantly lower 10-year %EBMIL for patients with the lowest income compared to patients with low-mid income (p = 0.03) and mid-high income (p = 0.01), after controlling for gender, race, age, and VA distance.Low socioeconomic status is associated with lower weight-loss outcomes, 10 years after RYGB. Durable weight loss is observed in all income groups.

    View details for DOI 10.1007/s00464-018-6318-6

    View details for PubMedID 29987570

  • Morbidity and mortality conference is not sufficient for surgical quality control: Processes and outcomes of a successful attending Physician Peer Review committee AMERICAN JOURNAL OF SURGERY Reines, H., Trickey, A. W., Donovan, J. 2017; 214 (5): 780–85

    Abstract

    Physician Peer Review (PPR) is required by The Joint Commission to assure examination of individual and group outcomes. Although surgeons may utilize Morbidity and Mortality (M&M) conference, applying these data to determine Focused Professional Practice Evaluations involves outcomes review. A PPR Committee of senior surgeons was created. This report describes one institution's surgical PPR process and results.A two-year (2014-2015) retrospective review of significant non-trauma complications and unanticipated deaths evaluated by PPR was performed. A faculty questionnaire evaluated perceptions of quality outcomes reporting.Of 395 reviewed cases, almost half (48.9%) demonstrated no care improvement opportunities, 48.6% revealed possible improvements, 2% were deviations from standard of care, and 0.5% represented unacceptable care. Although most surgeons (94%) wanted to know their complication rates, only 41% reported maintaining an outcomes database.As a complement to M&M, PPR is a valuable tool in the evaluation of individual surgical quality and can be the basis for further quality improvement opportunities. This process has been largely successful; only a small number of significant concerns were discovered.

    View details for DOI 10.1016/j.amjsurg.2017.04.008

    View details for Web of Science ID 000415221700002

    View details for PubMedID 28502556

  • Hands-on 2.0: improving transfer of training via the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Acquisition of Data for Outcomes and Procedure Transfer (ADOPT) program SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Dort, J., Trickey, A., Paige, J., Schwarz, E., Dunkin, B. 2017; 31 (8): 3326–32

    Abstract

    Practicing surgeons commonly learn new procedures and techniques by attending a "hands-on" course, though trainings are often ineffective at promoting subsequent procedure adoption in practice. We describe implementation of a new program with the SAGES All Things Hernia Hands-On Course, Acquisition of Data for Outcomes and Procedure Transfer (ADOPT), which employs standardized, proven teaching techniques, and 1-year mentorship. Attendee confidence and procedure adoption are compared between standard and ADOPT programs.For the pilot ADOPT course implementation, a hands-on course focusing on abdominal wall hernia repair was chosen. ADOPT participants were recruited among enrollees for the standard Hands-On Hernia Course. Enrollment in ADOPT was capped at 10 participants and limited to a 2:1 student-to-faculty ratio, compared to the standard course 22 participants with a 4:1 student-to-faculty ratio. ADOPT mentors interacted with participants through webinars, phone conferences, and continuous email availability throughout the year. All participants were asked to provide pre- and post-course surveys inquiring about the number of targeted hernia procedures performed and related confidence level.Four of 10 ADOPT participants (40%) and six of 22 standard training participants (27%) returned questionnaires. Over the 3 months following the course, ADOPT participants performed more ventral hernia mesh insertion procedures than standard training participants (median 13 vs. 0.5, p = 0.010) and considerably more total combined procedures (median 26 vs. 7, p = 0.054). Compared to standard training, learners who participated in ADOPT reported greater confidence improvements in employing a components separation via an open approach (p = 0.051), and performing an open transversus abdominis release, though the difference did not achieve statistical significance (p = 0.14).These results suggest that the ADOPT program, with standardized and structured teaching, telementoring, and a longitudinal educational approach, is effective and leads to better transfer of learned skills and procedures to clinical practice.

    View details for DOI 10.1007/s00464-016-5366-z

    View details for Web of Science ID 000409037100032

    View details for PubMedID 28039640

  • Two-Year Experience Implementing a Curriculum to Improve Residents' Patient-Centered Communication Skills. Journal of surgical education Trickey, A. W., Newcomb, A. B., Porrey, M., Piscitani, F., Wright, J., Graling, P., Dort, J. 2017

    Abstract

    OBJECTIVES: Surgery milestones from The Accreditation Council for Graduate Medical Education have encouraged a focus on training and assessment of residents' nontechnical skills, including communication. We describe our 2-year experience implementing a simulation-based curriculum, results of annual communication performance assessments, and resident evaluations.DESIGN: Eight quarterly modules were conducted on various communication topics. Former patient volunteers served as simulation participants (SP) who completed annual assessments using the Communication Assessment Tool (CAT). During these 2 modules, communication skills were assessed in the following standardized scenarios: (1) delivering bad news to a caregiver of a patient with postoperative intracerebral hemorrhage and (2) primary care gallstone referral with contraindications for cholecystectomy. SP-CAT ratings were evaluated for correlations by individual and associations with trainee and SP characteristics. Surgical patient experience surveys are evaluated during the curriculum.SETTING: Independent academic medical center surgical simulation center.PARTICIPANTS: Twenty-five surgery residents per year in 2015 to 2017.RESULTS: Residents have practiced skills in a variety of scenarios including bad news delivery, medical error disclosure, empathic communication, and end-of-life conversations. Residents report positive learning experiences from the curriculum (90% graded all modules A/A+). Confidence ratings rose following each module (p < 0.001) and in the second year (p < 0.001). Annual assessments yielded insights into skills level, and relationships to resident confidence levels and traits. Communication scores were not associated with resident gender or postgraduate year. Over the course of the curriculum implementation, surgical patients have reported that doctors provided explanations with improved clarity (p = 0.042).CONCLUSIONS: The simulation-based SP-CAT has shown initial evidence of usability, content validity, relationships to observed communication behaviors and residents' skills confidence. Evaluations of different scenarios may not be correlated for individuals over time. The communication curriculum paralleled improvements in patient experience concerning surgeons' clear explanations. An ongoing surgery resident communication curriculum has numerous educational, assessment, and institutional benefits.

    View details for DOI 10.1016/j.jsurg.2017.07.014

    View details for PubMedID 28756146

  • EVIDENCE-BASED PRACTICE: VIDEO-DISCHARGE INSTRUCTIONS IN THE PEDIATRIC EMERGENCY DEPARTMENT JOURNAL OF EMERGENCY NURSING Wood, E. B., Harrison, G., Trickey, A., Friesen, M., Stinson, S., Rovelli, E., McReynolds, S., Presgrave, K. 2017; 43 (4): 316–21

    Abstract

    While a high quality discharge from a Pediatric Emergency Department helps caregivers feel informed and prepared to care for their sick child at home, poor adherence to discharge instructions leads to unnecessary return visits, negative health outcomes, and decreased patient satisfaction. Nurses at the Inova Loudoun Pediatric ED utilized the Johns Hopkins Model of Evidence Based Practice to answer the following question: Among caregivers who have children discharged from the ED, does the addition of video discharge instructions (VDI) to standard written/verbal discharge instructions (SDI) result in improved knowledge about the child's diagnosis, treatment, illness duration, and when to seek further medical care?A multidisciplinary team reviewed available evidence and created VDI for three common pediatric diagnoses: gastroenteritis, bronchiolitis, and fever. Knowledge assessments were collected before and after delivery of discharge instructions to caregivers for both the SDI and VDI groups.Analysis found that the VDI group achieved significantly higher scores on the post test survey (P < .001) than the SDI group, particularly regarding treatment and when to seek further medical care. After integrating the best evidence with clinical expertise and an effective VDI intervention, the team incorporated VDI into the discharge process.VDI offer nurses an efficient, standardized method of providing enhanced discharge instructions in the ED. Future projects will examine whether VDI are effective for additional diagnoses and among caregivers for whom English is not the primary language.

    View details for DOI 10.1016/j.jen.2016.11.003

    View details for Web of Science ID 000407303200008

    View details for PubMedID 28359707

  • Talk the Talk: Implementing Commasnication Curriculum for Surgical Residents JOURNAL OF SURGICAL EDUCATION Newcomb, A. B., Trickey, A. W., Porrey, M., Wright, J., Piscitani, F., Graling, P., Dort, J. 2017; 74 (2): 319–28

    Abstract

    The Accreditation Council for Graduate Medical Education milestones provide a framework of specific interpersonal and communication skills that surgical trainees should aim to master. However, training and assessment of resident nontechnical skills remains challenging. We aimed to develop and implement a curriculum incorporating interactive learning principles such as group discussion and simulation-based scenarios to formalize instruction in patient-centered communication skills, and to identify best practices when building such a program.The curriculum is presented in quarterly modules over a 2-year cycle. Using our surgical simulation center for the training, we focused on proven strategies for interacting with patients and other providers. We trained and used former patients as standardized participants (SPs) in communication scenarios.Surgical simulation center in a 900-bed tertiary care hospital.Program learners were general surgery residents (postgraduate year 1-5). Trauma Survivors Network volunteers served as SPs in simulation scenarios.We identified several important lessons: (1) designing and implementing a new curriculum is a challenging process with multiple barriers and complexities; (2) several readily available facilitators can ease the implementation process; (3) with the right approach, learners, faculty, and colleagues are enthusiastic and engaged participants; (4) learners increasingly agree that communication skills can be improved with practice and appreciate the curriculum value; (5) patient SPs can be valuable members of the team; and importantly (6) the culture of patient-physician communication appears to shift with the implementation of such a curriculum.Our approach using Trauma Survivors Network volunteers as SPs could be reproduced in other institutions with similar programs. Faculty enthusiasm and support is strong, and learner participation is active. Continued focus on patient and family communication skills would enhance patient care for institutions providing such education as well as for institutions where residents continue on in fellowships or begin their surgical practice.

    View details for DOI 10.1016/j.jsurg.2016.09.009

    View details for Web of Science ID 000397836000019

    View details for PubMedID 27825662

  • Interrater Reliability of Hospital Readmission Evaluations for Surgical Patients AMERICAN JOURNAL OF MEDICAL QUALITY Trickey, A. W., Wright, J. M., Donovan, J., Reines, H., Dort, J. M., Prentice, H. A., Graling, P. R., Moynihan, J. J. 2017; 32 (2): 201–7

    Abstract

    Value-based purchasing initiatives have helped shift attention to the accuracy of hospital readmission information at the most clinically detailed level. The purpose of this study was to determine the interrater reliability (IRR) of surgical experts in assessing surgical inpatient readmissions for categorical causes, relation to index procedure, and potential preventability. Cases were selected from the American College of Surgeons National Surgical Quality Improvement Program local database. Of 1840 cases, 156 patients (8.5%) were readmitted within 30 days of the procedure. Surgical site infection was the most common readmission cause (32%), followed by obstruction or ileus (17%). IRR was moderate for readmission cause (60% agreement, κ = 0.51), substantial for readmission in relation to surgical procedure (92%, κ = 0.70), and lowest for potential preventability of readmissions (57%, κ = 0.18). Results suggest that readmission cause and relation to surgical procedure can be determined with moderate to high degree of IRR, while preventability of readmissions may require stricter definitions to improve IRR.

    View details for DOI 10.1177/1062860615623854

    View details for Web of Science ID 000396202100013

    View details for PubMedID 26911664

  • Resident Operative Experience at Independent Academic Medical Centers-A Comparison to the National Cohort. Journal of surgical education Joshi, A. R., Trickey, A. W., Jarman, B. T., Kallies, K. J., Josloff, R., Dort, J. M., Kothuru, R. 2017; 74 (6): e88–e94

    Abstract

    Independent Academic Medical Centers (IAMCs) comprise one-third of U.S. general surgery training programs. It is unclear whether IAMCs offer qualitatively or quantitatively different operative experiences than the national cohort. We analyzed a large representative sample of IAMCs to compare operative volume and variety, with a focus on low-volume procedures.Accreditation Council for Graduate Medical Education Program Case Reports from 27 IAMCs were collected and analyzed for 3 academic years (2012-2015). IAMCs were compared to the national cohort for specific defined category volumes and selected low-volume cases. One-sample two-way t-tests were calculated comparing IAMC totals to national program averages.IAMCs had a median of 3 chief residents per year (range: 1-6). IAMCs reported significantly more "total major" procedures in 2013-2014 (p = 0.046). Other case totals were statistically similar between IAMCs and the national cohort for "total major", "surgeon chief", "surgeon junior", and "teaching assistant" cases. In 2013-2014, IAMCs reported more laparoscopic complex (138.3 vs. 110.6, p = 0.010) and alimentary tract cases (276.5 vs. 253.5, p = 0.019). IAMC esophagogastroduodenoscopy case totals were higher in 2013-2014 (55.9 vs. 41, p = 0.038) and 2014-2015 (47.8 vs. 41, p = 0.047). IAMCs had fewer pancreas cases than the national cohort in all three years by about three cases per resident (p ≤ 0.026). In 2012-2013 IAMCs reported fewer (by about one) esophagectomy, gastrectomy, and abdominal perineal resections. No differences were observed in the following selected procedures: open common bile duct exploration, inguinal hernia, laparoscopic appendectomy, laparoscopic cholecystectomy, and colonoscopy.The IAMCs studied appear to provide equivalent exposure to specific subcategories mandated by the Accreditation Council for Graduate Medical Education and American Board of Surgery. Graduates of IAMCs gain similar operative experience in low-volume, defined categories when compared to the national cohort. Certain specific cases subject to regionalization pressure are less well represented among IAMCs. This has important implications for medical students applying to surgery residency.

    View details for DOI 10.1016/j.jsurg.2017.05.020

    View details for PubMedID 28602526

  • Assessment of Surgery Residents' Interpersonal Communication Skills: Validation Evidence for the Communication Assessment Tool in a Simulation Environment. Journal of surgical education Trickey, A. W., Newcomb, A. B., Porrey, M., Wright, J., Bayless, J., Piscitani, F., Graling, P., Dort, J. 2016; 73 (6): e19-e27

    Abstract

    Although development of trainees' competency in interpersonal communication is essential to high-quality patient-centered surgical care, nontechnical skills present assessment challenges for residency program directors. The Communication Assessment Tool (CAT) demonstrated internal reliability and content validity for general surgery residents, though the tool has not yet been applied in simulation. The study provides validation evidence for using the CAT to assess surgical residents' interpersonal communication skills in simulation scenarios.Simulations of delivering bad news were completed by 21 general surgery residents during a mandatory communication curriculum. Upon completion of the 10-minute scenario, standardized participants (SPs) assessed performance using the 14-item CAT rating scale and individually provided feedback to residents. Discrete communication behaviors were recorded on video review by a trained blinded observer. The traits emotional intelligence questionnaire short form (TEIQue-SF) was completed by the residents 6 months later. SP-CAT ratings are evaluated with respect to learner characteristics, observed behaviors, and TEIQue results.Surgical simulation center in a 900-bed tertiary care hospital.General surgery residents were targeted learners. Trauma survivors network volunteers served as SPs, acting as a family member of a patient who developed an intracerebral hemorrhage following a small bowel procedure.Discrete communication behaviors were reliably assessed by the observer (interrater reliability with trainer: 89% agreement, κ = 0.77). SP-CAT ratings ranged from 34 to 61. Higher SP-CAT ratings were correlated with positive communication behaviors (Spearman ρ = 0.42, p = 0.056). Total TEIQue was positively related to SP-CAT ratings (ρ = 0.42, p = 0.061). The TEIQue emotionality factor was strongly correlated with SP-CAT ratings (ρ = 0.52, p = 0.016).The CAT demonstrates content validity in a simulation environment with former patients acting as SPs. This study provides validation evidence relating the SP-CAT to discrete observations of communication behaviors by a trained, reliable observer as well as residents' self-reported emotional intelligence traits.

    View details for DOI 10.1016/j.jsurg.2016.04.016

    View details for PubMedID 27216300

  • Characteristics of Independent Academic Medical Center Faculty. Journal of surgical education Joshi, A. R., Trickey, A. W., Kallies, K., Jarman, B., Dort, J., Sidwell, R. 2016; 73 (6): e48-e53

    Abstract

    Little is known about the characteristics of teaching faculty in US surgical residencies based at Independent Academic Medical Centers (IAMCs). The purpose of this study was to survey teaching faculty at IAMCs to better define their common characteristics.An online, anonymous survey was distributed through program officials at 96 IAMCs to their faculty and graduates. Respondents were asked about their demographic information, training history, board certification, clinical practice, and exposure to medical students. Student t-tests and chi-square tests were calculated to evaluate associations between faculty characteristics.Independent Academic Medical Center general surgery training programs PARTICIPANTS: A total of 128 faculty at 14 IAMCs participated in the study.In total, 128 faculty from 14 programs responded to the survey. The mean age of faculty respondents was 52 years and 81% were men. 58% were employed by a nonuniversity hospital, and 28% by a multispecialty practice. 79% of respondents were core faculty. The mean length of time since graduation from surgery residency was 19 years. 86% were currently board certified. 55% of those who were currently board certified had an additional certification. 45% had trained in an IAMC, 50% in an university program, and 5% in a military program. 73% were actively practicing general surgeons, with the majority (70%) performing between 101 and 400 cases annually. The vast majority of faculty (90%) performed <200 endoscopies annually, with 44% performing none. 84% and 35% provided ER and trauma coverage, respectively. 81% listed mentorship as their primary motivation for teaching residents. 23% received a stipend for this teaching. 95% were involved in medical student teaching. Faculty who completed training at university programs had more additional certifications compared with those with IAMC training (67% vs. 43%, p = 0.007). Certification differences by program type were consistent across age and time since residency completion. Age was not associated with residency program type (p = 0.87) nor additional certifications (p = 0.97).IAMC faculty and graduates are overwhelmingly involved in general surgery, and most faculty have additional certifications. 90% of faculty have clinical exposure to medical students. Faculty at IAMCs were as likely to have been trained at an university program as an IAMC. In a time of increasing surgeon subspecialization and anxiety about the ability of 5-year training programs to train well-rounded surgeons, IAMCs appear to be a repository of consistent general surgical training.

    View details for DOI 10.1016/j.jsurg.2016.05.006

    View details for PubMedID 27321985

  • Deep vein thrombosis screening and risk factors in a high-risk trauma population JOURNAL OF SURGICAL RESEARCH Michetti, C. P., Franco, E., Coleman, J., Bradford, A., Trickey, A. W. 2015; 199 (2): 545–51

    Abstract

    Trauma patients requiring acute inpatient rehabilitation are significantly injured, with increased risk for deep vein thrombosis (DVT). We evaluated routine screening for occult DVT in such patients, and analyzed DVT risk factors.Data from level I trauma center patients discharged to a single acute rehabilitation center (ARC) from 2007-2011 were retrospectively reviewed. Routine lower extremity duplex was performed on ARC admission. Follow-up data were collected for patients with occult DVT (ARC DVT). DVT predictors were evaluated using logistic regression.Of 622 patients, 534 (86%) had screening duplex; 26 (4.8%) had an ARC DVT. A majority of 442 patients (71%) received enoxaparin prophylaxis in hospital, for a median 64% of hospital days. Of ARC DVT patients, 17 received full anticoagulation and 16 received vena cava filters. Thirty-seven patients had DVT diagnosed in the hospital (hospital DVT) before discharge to ARC. Hospital DVT and ARC DVT groups were comparable except shorter median hospital length of stay and lower head abbreviated injury scale in ARC DVT patients. On multivariate analysis, increased intensive care unit length of stay, age >65 y, a lower percentage of hospital days receiving chemoprophylaxis, and delayed initiation of chemoprophylaxis were significantly predictive of DVT after adjustment for sex, mechanism, injury severity score, and admission systolic blood pressure. Presence of pelvic fractures and ages 50-65 y also posed an increased risk.The incidence of occult DVT on ARC admission is low in trauma patients. Several risk factors for DVT in the trauma ARC population were identified. Nonselective screening of all trauma patients on admission to ARC is not supported by this analysis.

    View details for DOI 10.1016/j.jss.2015.04.069

    View details for Web of Science ID 000364433600037

    View details for PubMedID 25998183

  • Applicant Characteristics Associated With Selection for Ranking at Independent Surgery Residency Programs. Journal of surgical education Dort, J. M., Trickey, A. W., Kallies, K. J., Joshi, A. R., Sidwell, R. A., Jarman, B. T. 2015; 72 (6): e123-9

    Abstract

    This study evaluated characteristics of applicants selected for interview and ranked by independent general surgery residency programs and assessed independent program application volumes, interview selection, rank list formation, and match success.Demographic and academic information was analyzed for 2014-2015 applicants. Applicant characteristics were compared by ranking status using univariate and multivariable statistical techniques. Characteristics independently associated with whether or not an applicant was ranked were identified using multivariable logistic regression modeling with backward stepwise variable selection and cluster-correlated robust variance estimates to account for correlations among individuals who applied to multiple programs.The Electronic Residency Application Service was used to obtain applicant data and program match outcomes at 33 independent surgery programs.All applicants selected to interview at 33 participating independent general surgery residency programs were included in the study.Applicants were 60% male with median age of 26 years. Birthplace was well distributed. Most applicants (73%) had ≥1 academic publication. Median United States Medical Licensing Exams (USMLE) Step 1 score was 228 (interquartile range: 218-240), and median USMLE Step 2 clinical knowledge score was 241 (interquartile range: 231-250). Residency programs in some regions more often ranked applicants who attended medical school within the same region. On multivariable analysis, significant predictors of ranking by an independent residency program were: USMLE scores, medical school region, and birth region. Independent programs received an average of 764 applications (range: 307-1704). On average, 12% interviews, and 81% of interviewed applicants were ranked. Most programs (84%) matched at least 1 applicant ranked in their top 10.Participating independent programs attract a large volume of applicants and have high standards in the selection process. This information can be used by surgery residency applicants to gauge their candidacy at independent programs. Independent programs offer a select number of interviews, rank most applicants that they interview, and successfully match competitive applicants.

    View details for DOI 10.1016/j.jsurg.2015.04.021

    View details for PubMedID 26073713

  • Factors and Influences That Determine the Choices of Surgery Residency Applicants. Journal of surgical education Jarman, B. T., Joshi, A. R., Trickey, A. W., Dort, J. M., Kallies, K. J., Sidwell, R. A. 2015; 72 (6): e163-71

    Abstract

    We sought to evaluate characteristics of residency applicants selected to interview at independent general surgery programs, identify residency information resources, assess if there is perceived bias toward university or independent programs, and determine what types of programs applicants prefer.An electronic survey was sent to applicants who were selected to interview at a participating independent program. Open-ended responses regarding reasons for program-type bias were submitted. Multivariable logistic regression models were estimated to identify applicant characteristics associated with program-type preference.Independent general surgery residency programs.A total, of 1220 applicants were selected to interview at one of 33 independent programs.In total, 670 surveys were completed (55% response rate). Demographics of respondents were similar to the full invited population. Median United States Medical Licensing Examination Step 1 and Step 2 scores were between 230 to 239 and 240 to 249, respectively. Most applicants reported receiving general information about surgery residency programs and specific information about independent programs from residency program websites. 34% of respondents perceived an imbalanced representation of program types, with 96% of those reporting bias toward university programs.Applicants selected to interview at independent programs are competitive for general surgery training and primarily use residency program websites for information gathering. Bias is common toward university programs for a variety of perceived reasons. This information will be useful in applicant evaluation and selection, serve as a stimulus to update program websites, and challenge independent program directors to work to alleviate bias against their programs.

    View details for DOI 10.1016/j.jsurg.2015.05.017

    View details for PubMedID 26143518

  • Laparoscopic Cholecystectomy Performed by Acute Care Surgeons and General Surgeons AMERICAN SURGEON Michetti, C. P., Griffen, M., Tran, H., Crosby, M. E., Trickey, A. W. 2015; 81 (5): E220–E221

    View details for Web of Science ID 000354895700013

    View details for PubMedID 25975316

  • Description of the Moderate Brain Injured Patient and Predictors of Discharge to Rehabilitation ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Rogers, S., Richards, K. C., Davidson, M., Weinstein, A. A., Trickey, A. W. 2015; 96 (2): 276–82

    Abstract

    To describe patients with moderate traumatic brain injury (TBI) treated and discharged at levels I and II trauma centers in the United States; and to describe the predictors of discharge to rehabilitation after acute care.Retrospective, cross-sectional, descriptive study.Trauma centers.Patients with moderate TBI (N=2087; age range, 18-64 y) as reported in the 2010 National Sample Project.None.Discharge destination (rehabilitation vs home with no services).Multivariate logistic regression models revealed that demographic, clinical, and financial characteristics influenced the likelihood of being discharged to rehabilitation. Increased age, increased severity, Medicare use, longer length of stay, and trauma center locations in the Midwest and Northeast all increased the likelihood of discharge to rehabilitation.The decision to discharge a person with moderate TBI from acute care to rehabilitation appears to be based on factors other than just clinical need. These findings should be considered in creating more equitable access to postacute rehabilitation services for patients with moderate TBI because they risk long-term physical and cognitive problems and have the potential for productive lives with treatment.

    View details for DOI 10.1016/j.apmr.2014.09.018

    View details for Web of Science ID 000348751800014

    View details for PubMedID 25305630

  • An Evidence-Based Medicine Curriculum Improves General Surgery Residents' Standardized Test Scores in Research and Statistics. Journal of graduate medical education Trickey, A. W., Crosby, M. E., Singh, M., Dort, J. M. 2014; 6 (4): 664-668

    Abstract

    The application of evidence-based medicine to patient care requires unique skills of the physician. Advancing residents' abilities to accurately evaluate the quality of evidence is built on understanding of fundamental research concepts. The American Board of Surgery In-Training Examination (ABSITE) provides a relevant measure of surgical residents' knowledge of research design and statistics.We implemented a research education curriculum in an independent academic medical center general residency program, and assessed the effect on ABSITE scores.The curriculum consisted of five 1-hour monthly research and statistics lectures. The lectures were presented before the 2012 and 2013 examinations. Forty residents completing ABSITE examinations from 2007 to 2013 were included in the study. Two investigators independently identified research-related item topics from examination summary reports. Correct and incorrect responses were compared precurriculum and postcurriculum. Regression models were calculated to estimate improvement in postcurriculum scores, adjusted for individuals' scores over time and postgraduate year level.Residents demonstrated significant improvement in postcurriculum examination scores for research and statistics items. Correct responses increased 27% (P < .001). Residents were 5 times more likely to achieve a perfect score on research and statistics items postcurriculum (P < .001).Residents at all levels demonstrated improved research and statistics scores after receiving the curriculum. Because the ABSITE includes a wide spectrum of research topics, sustained improvements suggest a genuine level of understanding that will promote lifelong evaluation and clinical application of the surgical literature.

    View details for DOI 10.4300/JGME-D-14-00117

    View details for PubMedID 26140115

    View details for PubMedCentralID PMC4477558

  • Using NSQIP to Investigate SCIP Deficiencies in Surgical Patients With a High Risk of Developing Hospital-Associated Urinary Tract Infections AMERICAN JOURNAL OF MEDICAL QUALITY Trickey, A. W., Crosby, M. E., Vasaly, F., Donovan, J., Moynihan, J., Reines, H. 2014; 29 (5): 381–87

    Abstract

    The study objectives were to identify risk factors for surgical patients who develop postoperative urinary tract infections (UTIs) and to characterize urethral catheter practices at the study hospital. Patients from the 2006-2010 institutional National Surgical Quality Improvement Program database were evaluated. Patients with UTIs within 30 postoperative days (n = 116) were compared to patients without UTIs (n = 8685) using multivariable logistic regression. A nested case-control study evaluated the effects of catheter practices on postoperative UTI using conditional logistic regression. Independent predictors of UTI were sex, age, inpatient stay, functional status, renal failure, preoperative transfusion, and preoperative hospital stay. Compared with controls, patients with UTI more often maintained catheters for >2 postoperative days (66% vs 43%, P < .001) and had longer mean catheter duration (11.6 vs 5.1 days, P < .001). Study findings led to institutional recommendations to reduce catheter-associated UTIs. Quality improvement initiatives can increase awareness of performance enhancement opportunities and encourage collaborative, interdisciplinary improvement through shared objectives.

    View details for DOI 10.1177/1062860613503363

    View details for Web of Science ID 000341284000002

    View details for PubMedID 24045369

  • Are pediatric concussion patients compliant with discharge instructions? JOURNAL OF TRAUMA AND ACUTE CARE SURGERY Hwang, V., Trickey, A. W., Lormel, C., Bradford, A. N., Griffen, M. M., Lawrence, C. P., Sturek, C., Stacey, E., Howell, J. M. 2014; 77 (1): 117–22

    Abstract

    Concussions are commonly diagnosed in pediatric patients presenting to the emergency department (ED). The primary objective of this study was to evaluate compliance with ED discharge instructions for concussion management.A prospective cohort study was conducted from November 2011 to November 2012 in a pediatric ED at a regional Level 1 trauma center, serving 35,000 pediatric patients per year. Subjects were aged 8 years to 17 years and were discharged from the ED with a diagnosis of concussion. Exclusion criteria included recent (past 3 months) diagnosis of head injury, hospital admission, intracranial injury, skull fracture, suspected nonaccidental trauma, or preexisting neurologic condition. Subjects were administered a baseline survey in the ED and were given standardized discharge instructions for concussion by the treating physician. Telephone follow-up surveys were conducted at 2 weeks and 4 weeks after ED visit.A total of 150 patients were enrolled. The majority (67%) of concussions were sports related. Among sports-related concussions, soccer (30%), football (11%), lacrosse (8%), and basketball (8%) injuries were most common. More than one third (39%) reported return to play (RTP) on the day of the injury. Physician follow-up was equivalent for sport and nonsport concussions (2 weeks, 58%; 4 weeks, 64%). Sports-related concussion patients were more likely to follow up with a trainer (2 weeks, 25% vs. 10%, p = 0.06; 4 weeks, 29% vs. 8%, p < 0.01). Of the patients who did RTP or normal activities at 2 weeks (44%), more than one third (35%) were symptomatic, and most (58%) did not receive medical clearance. Of the patients who had returned to activities at 4 weeks (64%), less than one quarter (23%) were symptomatic, and most (54%) received medical clearance.Pediatric patients discharged from the ED are mostly compliant with concussion instructions. However, a significant number of patients RTP on the day of injury, while experiencing symptoms or without medical clearance.Care management, level IV. Epidemiologic study, level III.

    View details for DOI 10.1097/TA.0000000000000275

    View details for Web of Science ID 000338389600031

    View details for PubMedID 24977765

  • Colectomy without mechanical bowel preparation in the private practice setting TECHNIQUES IN COLOPROCTOLOGY Otchy, D. P., Crosby, M. E., Trickey, A. W. 2014; 18 (1): 45–51

    Abstract

    Despite randomized trials and meta-analyses demonstrating the safety of omitting mechanical bowel preparation (MBP) before colorectal surgery, private practice surgeons may hesitate to eliminate MBP for fear of being outside community standards. This study evaluated the safety of eliminating MBP before colectomy in a private practice setting.This prospective observational study included elective abdominal colorectal operations from one surgeon's practice from October 2008 to June 2011. MBP was not routinely utilized after November 2009. Postoperative 30-day complication rates and length of hospital stay were compared in patients with and without MBP. Multivariable regression models were developed to compare outcomes among study groups, adjusting for demographics, diagnoses, procedures, and year.A total of 165 patients were analyzed. Demographics were similar between groups. Laparoscopic procedures were more common in patients without MBP due to increased laparoscopy over time (43 vs. 61 %, p = 0.03). As regards complications, infection rates were similar between groups (MBP 10.5 % vs. no MBP(NMBP) 11.4 %, adj p = 0.57). Patients without MBP had a shorter length of hospital stay (median: 6 vs. 5 days, p = 0.01), but those differences were not statistically significant after adjustment (p = 0.14).Private practice surgeons should embrace evidence-based practice changes and make efforts to quantitatively evaluate the safety of those changes. Omission of MBP for most elective colectomy procedures appears to be safe with no significant increase in complications or length of hospital stay. Because MBP has substantial drawbacks, there is little justification for its routine use in the majority of elective abdominal colorectal procedures.

    View details for DOI 10.1007/s10151-013-0990-2

    View details for Web of Science ID 000329710100008

    View details for PubMedID 23467770

  • Transcranial Doppler Investigation of Hemodynamic Alterations Associated With Blunt Cervical Vascular Injuries in Trauma Patients JOURNAL OF ULTRASOUND IN MEDICINE Purvis, D. L., Crutchfield, K., Trickey, A. W., Aldaghlas, T., Rizzo, A., Sikdar, S. 2013; 32 (10): 1759-1768

    Abstract

    Blunt cervical vascular injuries, often missed with current screening methods, have substantial morbidity and mortality, and there is a need for improved screening. Elucidation of cerebral hemodynamic alterations may facilitate serial bedside monitoring and improved management. Thus, the objective of this study was to define cerebral flow alterations associated with single blunt cervical vascular injuries using transcranial Doppler sonography and subsequent Doppler waveform analyses in a trauma population.In this prospective pilot study, patients with suspected blunt cervical vascular injuries had diagnoses by computed tomographic angiography and were examined using transcranial Doppler sonography to define cerebral hemodynamics. Multiple vessel injuries were excluded for this analysis, as the focus was to identify hemodynamic alterations from isolated injuries. The inverse damping factor characterized altered extracranial flow patterns; middle cerebral artery flow velocities, the pulsatility index, and their asymmetries characterized altered intracranial flow patterns.Twenty-three trauma patients were evaluated: 4 with single internal carotid artery injuries, 5 with single vertebral artery injuries, and 14 without blunt cervical vascular injuries. All internal carotid artery injuries showed a reduced inverse damping factor in the internal carotid artery and dampened ipsilateral mean flow and peak systolic velocities in the middle cerebral artery. Vertebral artery injuries produced asymmetry of a similar magnitude in the middle cerebral artery mean flow velocity with end-diastolic velocity alterations.These data indicate that extracranial and intracranial hemodynamic alterations occur with internal carotid artery and vertebral artery blunt cervical vascular injuries and can be quantified in the acute injury phase by transcranial Doppler indices. Further study is required to elucidate cerebral flow changes resulting from a single blunt cervical vascular injury, which may guide future management to preserve cerebral perfusion after trauma.

    View details for DOI 10.7863/ultra.32.10.1759

    View details for Web of Science ID 000326357000010

    View details for PubMedID 24065257

  • The impact of missing trauma data on predicting massive transfusion Trickey, A. W., Fox, E. E., del Junco, D. J., Ning, J., Holcomb, J. B., Brasel, K. J., Cohen, M. J., Schreiber, M. A., Bulger, E. M., Phelan, H. A., Alarcon, L. H., Myers, J. G., Muskat, P., Cotton, B. A., Wade, C. E., Rahbar, M. H., PROMMTT Study Grp LIPPINCOTT WILLIAMS & WILKINS. 2013: S68–S74

    Abstract

    Missing data are inherent in clinical research and may be especially problematic for trauma studies. This study describes a sensitivity analysis to evaluate the impact of missing data on clinical risk prediction algorithms. Three blood transfusion prediction models were evaluated using an observational trauma data set with valid missing data.The PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study included patients requiring one or more unit of red blood cells at 10 participating US Level I trauma centers from July 2009 to October 2010. Physiologic, laboratory, and treatment data were collected prospectively up to 24 hours after hospital admission. Subjects who received 10 or more units of red blood cells within 24 hours of admission were classified as massive transfusion (MT) patients. Correct classification percentages for three MT prediction models were evaluated using complete case analysis and multiple imputation. A sensitivity analysis for missing data was conducted to determine the upper and lower bounds for correct classification percentages.PROMMTT study enrolled 1,245 subjects. MT was received by 297 patients (24%). Missing percentage ranged from 2.2% (heart rate) to 45% (respiratory rate). Proportions of complete cases used in the MT prediction models ranged from 41% to 88%. All models demonstrated similar correct classification percentages using complete case analysis and multiple imputation. In the sensitivity analysis, correct classification upper-lower bound ranges per model were 4%, 10%, and 12%. Predictive accuracy for all models using PROMMTT data was lower than reported in the original data sets.Evaluating the accuracy clinical prediction models with missing data can be misleading, especially with many predictor variables and moderate levels of missingness per variable. The proposed sensitivity analysis describes the influence of missing data on risk prediction algorithms. Reporting upper-lower bounds for percent correct classification may be more informative than multiple imputation, which provided similar results to complete case analysis in this study.

    View details for DOI 10.1097/TA.0b013e3182914530

    View details for Web of Science ID 000330458600011

    View details for PubMedID 23778514

    View details for PubMedCentralID PMC3736742

  • Implications of Medicare procedure volumes on resident education AMERICAN JOURNAL OF SURGERY Broughan, T. A., Crosby, M. E., Trickey, A. W., Ma, A., Bratzler, D. W. 2013; 205 (6): 737–44

    Abstract

    Preparation of future general surgeons requires the ongoing assessment of projected case experience.Surgical procedures (2005-2008) were abstracted from the Centers for Medicare and Medicaid Services inpatient National Claims History Part A 100% Nearline File for all general surgeons. The most frequent Medicare surgical procedures and physician caseloads were compared by practice population.Over 5 million procedures were evaluated, with procedures decreasing over time in urban and large rural areas. A total of 15 procedures comprised the top 10 for all population/year categories. The most frequent surgical procedures were similar in rural and urban areas. Rural surgeons' caseloads consisted of a higher proportion of endoscopic procedures.The most common Medicare general surgery procedures are similar across population areas and are required experience for residents. Separate surgical educational programs for urban and rural general surgeons may not be necessary to provide adequate care to rural patients.

    View details for DOI 10.1016/j.amjsurg.2012.11.006

    View details for Web of Science ID 000319802500018

    View details for PubMedID 23540717

  • A Novel Decision Tree Approach Based on Transcranial Doppler Sonography to Screen for Blunt Cervical Vascular Injuries JOURNAL OF ULTRASOUND IN MEDICINE Purvis, D., Aldaghlas, T., Trickey, A. W., Rizzo, A., Sikdar, S. 2013; 32 (6): 1023-1031

    Abstract

    Early detection and treatment of blunt cervical vascular injuries prevent adverse neurologic sequelae. Current screening criteria can miss up to 22% of these injuries. The study objective was to investigate bedside transcranial Doppler sonography for detecting blunt cervical vascular injuries in trauma patients using a novel decision tree approach.This prospective pilot study was conducted at a level I trauma center. Patients undergoing computed tomographic angiography for suspected blunt cervical vascular injuries were studied with transcranial Doppler sonography. Extracranial and intracranial vasculatures were examined with a portable power M-mode transcranial Doppler unit. The middle cerebral artery mean flow velocity, pulsatility index, and their asymmetries were used to quantify flow patterns and develop an injury decision tree screening protocol. Student t tests validated associations between injuries and transcranial Doppler predictive measures.We evaluated 27 trauma patients with 13 injuries. Single vertebral artery injuries were most common (38.5%), followed by single internal carotid artery injuries (30%). Compared to patients without injuries, mean flow velocity asymmetry was higher for single internal carotid artery (P = .003) and single vertebral artery (P = .004) injuries. Similarly, pulsatility index asymmetry was higher in single internal carotid artery (P = .015) and single vertebral artery (P = .042) injuries, whereas the lowest pulsatility index was elevated for bilateral vertebral artery injuries (P = .006). The decision tree yielded 92% specificity, 93% sensitivity, and 93% correct classifications.In this pilot feasibility study, transcranial Doppler measures were significantly associated with the blunt cervical vascular injury status, suggesting that transcranial Doppler sonography might be a viable bedside screening tool for trauma. Patient-specific hemodynamic information from transcranial Doppler assessment has the potential to alter patient care pathways to improve outcomes.

    View details for DOI 10.7863/ultra.32.6.1023

    View details for Web of Science ID 000319895500016

    View details for PubMedID 23716524

  • Website Usage and Weight Loss in a Free Commercial Online Weight Loss Program: Retrospective Cohort Study JOURNAL OF MEDICAL INTERNET RESEARCH Hwang, K. O., Ning, J., Trickey, A. W., Sciamanna, C. N. 2013; 15 (1): e11

    Abstract

    Online weight loss programs are increasingly popular. However, little is known about outcomes and associations with website usage among members of free online weight loss programs.This retrospective cohort study examined the association between website usage and weight loss among members of a free commercial online weight loss program (SparkPeople).We conducted a retrospective analysis of a systematic random sample of members who joined the program during February 1 to April 30, 2008, and included follow-up data through May 10, 2010. The main outcome was net weight change based on self-reported weight. Measures of website usage included log-ins, self-monitoring entries (weight, food, exercise), and use of social support tools (discussion forums, friendships).The main sample included 1258 members with at least 2 weight entries. They were 90.7% female, with mean (SD) age 33.6 (11.0) and mean (SD) BMI 31.6 (7.7). Members with at least one forum post lost an additional 1.55 kg (95% CI 0.55 kg to 2.55 kg) relative to those with no forum posts. Having at least 4 log-in days, weight entry days, or food entry days per 30 days was significantly associated with weight loss. In the multiple regression analysis, members with at least 4 weight entry days per 30 days reported 5.09 kg (95% CI 3.29 kg to 6.88 kg) more weight loss per 30 days than those with fewer weight entry days. After controlling for weight entry days, the other website usage variables were not associated with weight change.Weekly or more frequent self-monitoring of weight is associated with greater weight loss among members of this free online weight loss program.

    View details for DOI 10.2196/jmir.2195

    View details for Web of Science ID 000315113200018

    View details for PubMedID 23322819

    View details for PubMedCentralID PMC3636231

  • Speaking Up and Sharing Information Improves Trainee Neonatal Resuscitations JOURNAL OF PATIENT SAFETY Katakam, L. I., Trickey, A. W., Thomas, E. J. 2012; 8 (4): 202–9

    Abstract

    To identify teamwork behaviors associated with improving efficiency and quality of simulated resuscitation training.Secondary analysis of a randomized controlled trial of trainees undergoing neonatal resuscitation training was performed. Trainees at a large academic center (n = 100) were randomized to receive standard curriculum (n = 36) versus supplemental team training curriculum (n = 62). A 2-hour team training session focused on communication skills, and team behaviors served as the intervention. Outcomes of interest included resuscitation duration, time required to complete a simulated newborn resuscitation, and performance score, determined by evaluation of each of the team's steps during simulated resuscitation scenarios.The teamwork behaviors assertion and sharing information were associated with shorter resuscitation duration and higher performance scores. Each additional use of assertion (per minute) was associated with a duration reduction of 41 s (95% confidence interval [CI], -71.5 to -10.2) and an increase in performance score of 1.6% (95% CI, 0.4-2.7). Each additional use of sharing information (per minute) was associated with a 14-second reduction in duration (95% CI, -30.4 to 2.9) and a 0.8% increase in performance score (95% CI, 0.05-1.5).Teamwork behaviors of assertion and sharing information are 2 important mediators of efficiency and quality of resuscitations.

    View details for DOI 10.1097/PTS.0b013e3182699b4f

    View details for Web of Science ID 000313586500009

    View details for PubMedID 23007245

    View details for PubMedCentralID PMC3504644

  • General Surgery vs Fellowship: The Role of the Independent Academic Medical Center JOURNAL OF SURGICAL EDUCATION Adra, S. W., Trickey, A. W., Crosby, M. E., Kurtzman, S. H., Friedell, M. L., Reines, H. D. 2012; 69 (6): 740-745

    Abstract

    To compare career choices of residency graduates from Independent Academic Medical Center (IAMC) and University Academic Medical Center (UAMC) programs and evaluate program directors' perceptions of residents' motivations for pursuing general surgery or fellowships.From May to August 2011, an electronic survey collected information on program characteristics, graduates' career pursuits, and career motivations. Fisher's exact tests were calculated to compare responses by program type. Multivariate logistic regression was used to identify independent program characteristics associated with graduates pursuing general surgery.Data were collected on graduates over 3 years (2009-2011).Surgery residency program directors.Seventy-four program directors completed the survey; 42% represented IAMCs. IAMCs reported more graduates choosing general surgery. Over one-quarter of graduates pursued general surgery from 52% of IAMC vs 37% of UAMC programs (p = 0.243). Career choices varied significantly by region: over one-quarter of graduates pursue general surgery from 78% of Western, 60% of Midwestern, 40% of Southern, and 24% of Northeastern programs (p = 0.018). On multivariate analysis, IAMC programs were independently associated with more graduates choosing general surgery (p = 0.017), after adjustment for other program characteristics. Seventy-five percent of UAMC programs reported over three-fourths of graduates receive first choice fellowship, compared with only 52% of IAMC programs (p = 0.067). Fellowships were comparable among IAMC and UAMC programs, most commonly MIS/Bariatric (16%), Critical Care/Trauma (16%), and Vascular (14%). IAMC and UAMC program directors cite similar reasons for graduate career choices.Most general surgery residents undergo fellowship training. Graduates from IAMC and UAMC programs pursue similar specialties, but UAMC programs report more first choice acceptance. IAMC programs may graduate proportionately more general surgeons. Further studies directly evaluating surgical residents' career choices are warranted to understand the influence of independent and university programs in shaping these choices and to develop strategies for reducing the general surgeon shortage.

    View details for DOI 10.1016/j.jsurg.2012.05.006

    View details for Web of Science ID 000311024100012

    View details for PubMedID 23111040

  • Sound Levels, Staff Perceptions, and Patient Outcomes During Renovation Near the Neonatal Intensive Care Unit HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL Trickey, A. W., Arnold, C. C., Parmar, A., Lasky, R. E. 2012; 5 (4): 76–87

    Abstract

    Sound levels, staff perceptions, and patient outcomes were evaluated during a year-long hospital renovation project on the floor above a neonatal intensive care unit (NICU).Construction noise may be detrimental to NICU patients and healthcare professionals. There are no comprehensive studies evaluating the impact of hospital construction on sound levels, staff, and patients.Prospective observational study comparing sound measures and patient outcomes before, during, and after construction. Staff were surveyed about the construction noise, and hospital employee satisfaction scores are reported.Equivalent sound levels were not significantly higher during construction. Most staff members (89%) perceived the renovation period as louder, and 83% reported interruptions of their work. Patient outcomes were the same or more positive during construction. Very low birth weight (VLBW) infants were less likely to require 24+ hours' mechanical ventilation during construction: 54% vs. 59% before (OR = 1.6, p = 0.018) and 62% after (OR = 1.48, p = 0.065); and they required a shorter total period of mechanical ventilation: 3.6 days vs. 8.0 before (p = 0.011) and 9.5 after (p = 0.001). VLBW newborns' differences in ventilation days were mostly in the upper extremes; medians were similar in all periods: 0.6 days vs. 1 day preconstruction and 2 days postconstruction.Construction above the NICU did not cause substantially louder sound levels, but staff perceived important changes in noise and work routines. No evidence suggested that patients were negatively affected by the renovation period. Meticulous construction planning remains necessary to avoid interference with patient care and caregiver work environments.

    View details for DOI 10.1177/193758671200500407

    View details for Web of Science ID 000309436900007

    View details for PubMedID 23224808

  • Acceptability of narratives to promote colorectal cancer screening in an online community PREVENTIVE MEDICINE Hwang, K. O., Trickey, A. W., Graham, A. L., Thomas, E. J., Street, R. L., Kraschnewski, J. L., Vernon, S. W. 2012; 54 (6): 405–7

    Abstract

    To assess the acceptability of narratives to promote colorectal cancer (CRC) screening among members of an online weight loss community.Members of online weight loss community completed an Internet survey in 2010. Multiple logistic regression models examined demographic and attitudinal correlates of interest in sharing and receiving CRC screening narratives.Participants (n=2386) were 92% female with mean (SD) age 58 (6) years; 68% were up-to-date with CRC screening. Among those who were up-to-date, 39% were interested in sharing their narratives with other members. African-Americans were more likely than other racial groups to be interested in sharing narratives (adjusted OR 2.02, 95% CI 1.14-3.57). Older, married members and those with greater CRC screening worries were less likely to be interested in sharing narratives. Among those not up-to-date, 63% were interested in receiving narratives from online community members, and those with higher perceived salience of CRC screening were more likely to be interested in receiving narratives (adjusted OR 1.86, 95% CI 1.31-2.65).Members of this online weight loss community expressed interest in sharing and receiving narratives for CRC screening promotion. Attitudes and demographic characteristics may predict successful recruitment of those who would share and receive narratives.

    View details for DOI 10.1016/j.ypmed.2012.03.018

    View details for Web of Science ID 000305378900007

    View details for PubMedID 22498021

    View details for PubMedCentralID PMC4154343

  • Team Training in the Neonatal Resuscitation Program for Interns: Teamwork and Quality of Resuscitations PEDIATRICS Thomas, E. J., Williams, A. L., Reichman, E. F., Lasky, R. E., Crandell, S., Taggart, W. R. 2010; 125 (3): 539–46

    Abstract

    Poor communication and teamwork may contribute to errors during neonatal resuscitation. Our objective was to evaluate whether interns who received a 2-hour teamwork training intervention with the Neonatal Resuscitation Program (NRP) demonstrated more teamwork and higher quality resuscitations than control subjects.Participants were noncertified 2007 and 2008 incoming interns for pediatrics, combined pediatrics and internal medicine, family medicine, emergency medicine, and obstetrics and gynecology (n = 98). Pediatrics and combined pediatrics/internal medicine interns were eligible for 6-month follow-up (n = 34). A randomized trial was conducted in which half of the participants in the team training arm practiced NRP skills by using high-fidelity simulators; the remaining practiced with low-fidelity simulators, as did control subjects. Blinded, trained observers viewed video recordings of high-fidelity-simulated resuscitations for teamwork and resuscitation quality.High-fidelity training (HFT) group had higher teamwork frequency than did control subjects (12.8 vs 9.0 behaviors per minute; P < .001). Intervention groups maintained more workload management (control subjects: 89.3%; low-fidelity training [LFT] group: 98.0% [P < .001]; HFT group: 98.8%; HFT group versus control subjects [P < .001]) and completed resuscitations faster (control subjects: 10.6 minutes; LFT group: 8.6 minutes [P = .040]; HFT group: 7.4 minutes; HFT group versus control subjects [P < .001]). Overall, intervention teams completed the resuscitation an average of 2.6 minutes faster than did control subjects, a time reduction of 24% (95% confidence interval: 12%-37%). Intervention groups demonstrated more frequent teamwork during 6-month follow-up resuscitations (11.8 vs 10.0 behaviors per minute; P = .030).Trained participants exhibited more frequent teamwork behaviors (especially the HFT group) and better workload management and completed the resuscitation more quickly than did control subjects. The impact on team behaviors persisted for at least 6 months. Incorporating team training into the NRP curriculum is a feasible and effective way to teach interns teamwork skills. It also improves simulated resuscitation quality by shortening the duration.

    View details for DOI 10.1542/peds.2009-1635

    View details for Web of Science ID 000275945700018

    View details for PubMedID 20156896

  • Teamwork behaviours and errors during neonatal resuscitation QUALITY & SAFETY IN HEALTH CARE Williams, A. L., Lasky, R. E., Dannemiller, J. L., Andrei, A. M., Thomas, E. J. 2010; 19 (1): 60-64

    Abstract

    To describe relationships between teamwork behaviours and errors during neonatal resuscitation.Trained observers viewed video recordings of neonatal resuscitations (n = 12) for the occurrence of teamwork behaviours and errors. Teamwork state behaviours (such as vigilance and workload management, which extend for some duration) were assessed as the percentage of each resuscitation that the behaviour was observed and correlated with the percentage of observed errors. Teamwork event behaviours (such as information sharing, inquiry and assertion, which occur at specific times) were counted in 20-s intervals before and after resuscitation steps, and a generalised linear mixed model was calculated to evaluate relationships between these behaviours and errors.Resuscitation teams who were more vigilant committed fewer errors (Spearman's rho for vigilance and errors = -0.62, 95% CI -0.07 to -0.87, p = 0.031). Assertions were more likely to occur before errors than correct steps (OR = 1.44, 95% CI 1.10 to 1.89, p = 0.008) and teaching/advising occurred less frequently after errors (OR = 0.59, 95% CI 0.37 to 0.94, p = 0.028). Though not statistically significant, there was less information sharing before errors (OR = 0.90, 95% CI 0.77 to 1.05, p = 0.172).Vigilance is an important behaviour for error management. Assertion may have caused errors, or perhaps was an indicator for some other factor that caused errors. Teams may have preferred to resolve errors directly, rather than using errors as opportunities to teach their teammates. These observations raise important questions about the appropriate use of some teamwork behaviours and how to include them in team training programmes.

    View details for DOI 10.1136/qshc.2007.025320

    View details for Web of Science ID 000274641500012

    View details for PubMedID 20172885

  • Heart Rate Variability in Response to Pain Stimulus in VLBW Infants Followed Longitudinally During NICU Stay DEVELOPMENTAL PSYCHOBIOLOGY Padhye, N. S., Williams, A. L., Khattak, A. Z., Lasky, R. E. 2009; 51 (8): 638–49

    Abstract

    The objective of this longitudinal study, conducted in a neonatal intensive care unit, was to characterize the response to pain of high-risk very low birth weight infants (<1,500 g) from 23 to 38 weeks post-menstrual age (PMA) by measuring heart rate variability (HRV). Heart period data were recorded before, during, and after a heel lanced or wrist venipunctured blood draw for routine clinical evaluation. Pain response to the blood draw procedure and age-related changes of HRV in low-frequency and high-frequency bands were modeled with linear mixed-effects models. HRV in both bands decreased during pain, followed by a recovery to near-baseline levels. Venipuncture and mechanical ventilation were factors that attenuated the HRV response to pain. HRV at the baseline increased with post-menstrual age but the growth rate of high-frequency power was reduced in mechanically ventilated infants. There was some evidence that low-frequency HRV response to pain improved with advancing PMA.

    View details for DOI 10.1002/dev.20399

    View details for Web of Science ID 000272671000004

    View details for PubMedID 19739134

    View details for PubMedCentralID PMC2936240

  • The behavioral pain response to heelstick in preterm neonates studied longitudinally: Description, development, determinants, and components EARLY HUMAN DEVELOPMENT Williams, A. L., Khattak, A. Z., Garza, C. N., Lasky, R. E. 2009; 85 (6): 369–74

    Abstract

    Preterm infants often experience multiple painful procedures during their stay in neonatal intensive care units (NICUs). The objectives of this study were to evaluate behavioral responses to heelstick in preterm newborns, characterize developmental changes and the effects of other demographic and clinical variables on the pain response, and estimate the contributions of individual Neonatal Infant Pain Scale (NIPS) behaviors to the summary pain score.A longitudinal study was conducted to evaluate the behavioral responses of 35 preterm newborns to multiple heelstick procedures during their stay in the NICU. Sixty-one video recordings of blood collection by heel lance were evaluated for behavioral pain response using the NIPS. Generalized linear mixed models were calculated to address the study objectives.The increases in NIPS scores from the baseline to the blood draw were highly significant (mean baseline score=3.34, mean blood draw score=5.45, p<0.001). The newborns' pain responses increased an average of 0.23 points on the NIPS scale each week (p=0.002). Lower NIPS scores during the heelstick procedure were associated with four clinical variables: younger post-menstrual age at birth, lower birthweight, mechanical ventilation, and longer length of stay in the NICU. Crying, arousal state, and facial grimace contributed more than 85% of the increase in NIPS scores during the heelstick procedure.While behavioral responses to pain are attenuated in young, severely ill preterm newborns, they can be reliably detected. The most robust pain behaviors are crying, changes in arousal state, and facial grimacing.

    View details for DOI 10.1016/j.earlhumdev.2009.01.001

    View details for Web of Science ID 000266851700005

    View details for PubMedID 19167172

  • Intensive Care Noise and Mean Arterial Blood Pressure in Extremely Low-Birth-Weight Neonates AMERICAN JOURNAL OF PERINATOLOGY Williams, A. L., Sanderson, M., Lai, D., Selwyn, B. J., Lasky, R. E. 2009; 26 (5): 323-329

    Abstract

    Noise in neonatal intensive care units (NICUs) may impede growth and development for extremely low-birth-weight (ELBW, < 1000 g) newborns. We calculated correlations between NICU sound levels and ELBW neonates' heart rate and arterial blood pressure to evaluate whether this population experiences noise-induced stress. Sound levels inside the incubator, heart rate (HR), and arterial blood pressure recordings were simultaneously collected for eight ELBW neonates for 15 minutes during the first week of life. Cross-correlation functions were calculated for NICU noise, HR, and mean arterial blood pressure (MABP) recordings for each subject. ELBW neonates' HR and MABP were significantly correlated ( R = 0.16 at 2-second lag time), with stronger correlation apparent for higher-birth-weight ELBW newborns (0.22 versus 0.10). Lower-birth-weight newborns responded to increased noise with HR acceleration from 45 to 130 seconds after noise events, and higher-birth-weight infants initially responded with an HR deceleration at 25 to 60 seconds, then HR acceleration ~175 seconds after noise increased. MABP was not as strongly correlated with NICU sound levels, although some correlation coefficients were slightly outside the 95% confidence interval. Higher-birth-weight newborns' more mature neurological systems may be responsible for stronger correlations between HR and MABP. NICU noise influenced newborns' HR, indicating that these infants hear and respond to NICU sounds. ELBW newborns in the first week of life seem to maintain a relatively stable blood pressure in response to moderate NICU sound levels (50 to 60 dBA).

    View details for DOI 10.1055/s-0028-1104741

    View details for Web of Science ID 000265577700001

    View details for PubMedID 19085678

  • A randomized clinical trial evaluating silicone earplugs for very low birth weight newborns in intensive care JOURNAL OF PERINATOLOGY Abou Turk, C., Williams, A. L., Lasky, R. E. 2009; 29 (5): 358–63

    Abstract

    To determine whether very low birth weight (VLBW) newborns (<1500 g) wearing silicone earplugs grow larger and perform better on developmental exams than controls.VLBW newborns (n=34) were randomized to wearing earplugs or not. Hospital outcomes were abstracted from medical charts by research staff masked to intervention status. Fourteen extremely low birth weight (ELBW) newborns (<1000 g) were also evaluated at 18 to 22 months.After adjusting for birth weight, 11 surviving newborns in the earplug group were 225 g (95% CI: 45, 405) heavier at 34 weeks post menstrual age than the 13 controls. Six ELBW earplug infants scored 15.53 points (95% CI: 3.03, 28.02) higher than six controls on the Bayley Mental Development Index. Their head circumferences were 2.59 cm (95% CI: 0.97, 4.21) larger.Earplugs may facilitate weight gain in VLBW newborns. Better outcomes may persist at 18 to 22 months at least in ELBW infants.

    View details for DOI 10.1038/jp.2008.236

    View details for Web of Science ID 000265853300005

    View details for PubMedID 19194455

    View details for PubMedCentralID PMC2674530

  • Noise and Light Exposures for Extremely Low Birth Weight Newborns During Their Stay in the Neonatal Intensive Care Unit PEDIATRICS Lasky, R. E., Williams, A. L. 2009; 123 (2): 540-546

    Abstract

    The objectives of this study were to characterize noise and light levels for extremely low birth weight newborns throughout their stay in the NICU, evaluate factors influencing noise and light levels, and determine whether exposures meet recommendations from the American Academy of Pediatrics.Sound and light were measured inside the beds of extremely low birth weight newborns (n = 22) from birth to discharge. Measurements were recorded for 20 consecutive hours weekly from birth until 36 weeks' postmenstrual age, biweekly until 40 weeks, and every 4 weeks thereafter. Clinical variables including bed type and method of respiratory support were recorded at each session.Age-related changes in respiratory support and bed type explained the weekly increase of 0.22 dB in sound level and 3.67 lux in light level. Old incubators were the noisiest bed types, and new incubators were the quietest. Light levels were significantly higher in open beds than in incubators. The variations in noise and light levels over time were greatest for open beds. Noise and light levels were much less affected by respiratory support in incubators compared with open beds. A typical extremely low birth weight neonate was exposed to noise levels averaging 56.44 dB(A) and light levels averaging 70.56 lux during their stay from 26 to 42 weeks' postmenstrual age in the NICU. Noise levels were rarely within American Academy of Pediatrics recommendations (5.51% of the time), whereas light levels almost always met recommendations (99.37% of the time).Bed type and respiratory support explained differences in noise and light levels that extremely low birth weight newborns experience during their hospital stay. Noise levels exceeded recommendations, although evidence supporting those recommendations is lacking. Well-designed intervention studies are needed to determine the effects of noise reduction on the development of extremely low birth weight newborns.

    View details for DOI 10.1542/peds.2007-3418

    View details for Web of Science ID 000262678700017

    View details for PubMedID 19171620

  • Changes in the PQRST Intervals and Heart Rate Variability Associated with Rewarming in Two Newborns Undergoing Hypothermia Therapy NEONATOLOGY Lasky, R. E., Parikh, N. A., Williams, A. L., Padhye, N. S., Shankaran, S. 2009; 96 (2): 93-95

    Abstract

    Little is known about the effects of hypothermia therapy and subsequent rewarming on the PQRST intervals and heart rate variability (HRV) in term newborns with hypoxic-ischemic encephalopathy (HIE).This study describes the changes in the PQRST intervals and HRV during rewarming to normal core body temperature of 2 newborns with HIE after hypothermia therapy.Within 6 h after birth, 2 newborns with HIE were cooled to a core body temperature of 33.5 degrees C for 72 h using a cooling blanket, followed by gradual rewarming (0.5 degrees C per hour) until the body temperature reached 36.5 degrees C. Custom instrumentation recorded the electrocardiogram from the leads used for clinical monitoring of vital signs. Generalized linear mixed models were calculated to estimate temperature-related changes in PQRST intervals and HRV.For every 1 degrees C increase in body temperature, the heart rate increased by 9.2 bpm (95% CI 6.8-11.6), the QTc interval decreased by 21.6 ms (95% CI 17.3-25.9), and low and high frequency HRV decreased by 0.480 dB (95% CI 0.052-0.907) and 0.938 dB (95% CI 0.460-1.416), respectively.Hypothermia-induced changes in the electrocardiogram should be monitored carefully in future studies.

    View details for DOI 10.1159/000205385

    View details for Web of Science ID 000266881900004

    View details for PubMedID 19252411

    View details for PubMedCentralID PMC2957844

  • Spectral analysis of time series of events: effect of respiration on heart rate in neonates PHYSIOLOGICAL MEASUREMENT van Drongelen, W., Williams, A. L., Lasky, R. E. 2009; 30 (1): 43–61

    Abstract

    Certain types of biomedical processes such as the heart rate generator can be considered as signals that are sampled by the occurring events, i.e. QRS complexes. This sampling property generates problems for the evaluation of spectral parameters of such signals. First, the irregular occurrence of heart beats creates an unevenly sampled data set which must either be pre-processed (e.g. by using trace binning or interpolation) prior to spectral analysis, or analyzed with specialized methods (e.g. Lomb's algorithm). Second, the average occurrence of events determines the Nyquist limit for the sampled time series. Here we evaluate different types of spectral analysis of recordings of neonatal heart rate. Coupling between respiration and heart rate and the detection of heart rate itself are emphasized. We examine both standard and data adaptive frequency bands of heart rate signals generated by models of coupled oscillators and recorded data sets from neonates. We find that an important spectral artifact occurs due to a mirror effect around the Nyquist limit of half the average heart rate. Further we conclude that the presence of respiratory coupling can only be detected under low noise conditions and if a data-adaptive respiratory band is used.

    View details for DOI 10.1088/0967-3334/30/1/004

    View details for Web of Science ID 000263031300004

    View details for PubMedID 19075368

  • Effects of hypoxic-ischemic encephalopathy and whole-body hypothermia on neonatal auditory function: A pilot study AMERICAN JOURNAL OF PERINATOLOGY Mietzsch, U., Parikh, N. A., Williams, A. L., Shankaran, S., Lasky, R. E. 2008; 25 (7): 435–41

    Abstract

    We assessed the effects of hypoxic-ischemic encephalopathy (HIE) and whole-body hypothermia therapy on auditory brain stem evoked responses (ABRs) and distortion product otoacoustic emissions (DPOAEs). We performed serial assessments of ABRs and DPOAEs in newborns with moderate or severe HIE, randomized to hypothermia ( N = 4) or usual care ( N = 5). Participants were five boys and four girls with mean gestational age (standard deviation) of 38.9 (1.8) weeks. During the first week of life, peripheral auditory function, as measured by the DPOAEs, was disrupted in all nine subjects. ABRs were delayed but central transmission was intact, suggesting a peripheral rather than a central neural insult. By 3 weeks of age, peripheral auditory function normalized. Hypothermia temporarily prolonged the ABR, more so for waves generated higher in the brain stem but the effects reversed quickly on rewarming. Neonatal audiometric testing is feasible, noninvasive, and capable of enhancing our understanding of the effects of HIE and hypothermia on auditory function.

    View details for DOI 10.1055/s-0028-1083842

    View details for Web of Science ID 000259542200008

    View details for PubMedID 18720323

    View details for PubMedCentralID PMC2586420

  • Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial JOURNAL OF PERINATOLOGY Thomas, E. J., Taggart, B., Crandell, S., Lasky, R. E., Williams, A. L., Love, L. J., Sexton, J. B., Tyson, J. E., Helmreich, R. L. 2007; 27 (7): 409–14

    Abstract

    To add a team training and human error curriculum to the Neonatal Resuscitation Program (NRP) and measure its effect on teamwork. We hypothesized that teams that received the new course would exhibit more teamwork behaviors than those in the standard NRP course.Interns were randomized to receive NRP with team training or standard NRP, then video recorded when they performed simulated resuscitations at the end of the day-long course. Outcomes were assessed by observers blinded to study arm allocation and included the frequency or duration of six team behaviors: inquiry, information sharing, assertion, evaluation of plans, workload management and vigilance.The interns in the NRP with team training group exhibited more frequent team behaviors (number of episodes per minute (95% CI)) than interns in the control group: information sharing 1.06 (0.24, 1.17) vs 0.13 (0.00, 0.43); inquiry 0.35 (0.11, 0.42) vs 0.09 (0.00, 0.10); assertion 1.80 (1.21, 2.25) vs 0.64 (0.26, 0.91); and any team behavior 3.34 (2.26, 4.11) vs 1.03 (0.48, 1.30) (P-values <0.008 for all comparisons). Vigilance and workload management were practiced throughout the entire simulated code by nearly all the teams in the NRP with team training group (100% for vigilance and 88% for workload management) vs only 53 and 20% of the teams in the standard NRP. No difference was detected in the frequency of evaluation of plans.Compared with the standard NRP, NRP with a teamwork and human error curriculum led interns to exhibit more team behaviors during simulated resuscitations.

    View details for DOI 10.1038/sj.jp.7211771

    View details for Web of Science ID 000247533200003

    View details for PubMedID 17538634

  • Longitudinal assessment of heart rate variability in very low birth weight infants during their NICU stay EARLY HUMAN DEVELOPMENT Khattak, A. Z., Padhye, N. S., Williams, A. L., Lasky, R. E., Moya, F. R., Verklan, M. 2007; 83 (6): 361–66

    Abstract

    Maturation of the autonomic nervous system has not been studied in high-risk very low birth weight (VLBW) infants in the first few weeks of life.To characterize developmental changes in autonomic nervous system activity of high-risk VLBW infants from 23 to 38 weeks post-menstrual age by measuring heart rate variability (HRV).In this prospective cohort study 38 infants admitted to Children's Memorial Hermann Hospital NICU were longitudinally followed weekly or biweekly. Heart period data were recorded while infants were resting in active sleep.Growth of spectral power of HRV in low-frequency (0.05-0.25 Hz) and high-frequency (0.25-1.00 Hz) bands was modeled with linear mixed-effects models. The high-frequency power provides a measure of respiratory sinus arrhythmia (RSA).Low-frequency power increases with post-menstrual age, and intubated infants have lower HRV. The increase in low-frequency power is faster (0.50+/-0.12 dB/week) than the increase in RSA (0.17+/-0.09 dB/week).This longitudinal data exhibits developmental maturation of the RSA and of the low-frequency power of HRV in high-risk VLBW infants.

    View details for DOI 10.1016/j.earlhumdev.2006.07.007

    View details for Web of Science ID 000246654700003

    View details for PubMedID 16978804

  • Noise in contemporary neonatal intensive care Williams, A. L., van Drongelen, W., Lasky, R. E. ACOUSTICAL SOC AMER AMER INST PHYSICS. 2007: 2681–90

    Abstract

    Weekly sound surveys (n = 63) were collected, using 5 s sampling intervals, for two modern neonatal intensive care units (NICUs). Median weekly equivalent sound pressure levels (LEQ) for NICU A ranged from 61 to 63 dB (A weighted), depending on the level of care. NICU B L(EQ) measurements ranged from 55 to 60 dB (A weighted). NICU B was recently built with a focus on sound abatement, explaining much of the difference between the two NICUs. Sound levels exceeded 45 dB (A weighted), recommended by the American Academy of Pediatrics, more than 70% of the time for all levels of care. Hourly L(EQ)s below 50 dB (A weighted) and hourly L10s below 55 dB (A weighted), recommended by the Sound Study Group (SSG) of the National Resource Center, were also exceeded in more than 70% of recorded samples. A third SSG recommendation, that the 1 s L(MAX), should not exceed 70 dB (A weighted), was exceeded relatively infrequently (< 11% of the time). Peak impulse measurements exceeded 90 dB for 6.3% of 5 s samples recorded from NICU A and 2.8% of NICU B samples. Twenty-four h periodicities in sound levels as a function of regular staff activities were apparent, but short-term variability was considerable.

    View details for DOI 10.1121/1.27175001

    View details for Web of Science ID 000246378200022

    View details for PubMedID 17550168