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Lollapalooza is an annual music festival that brings hundreds of thousands of concert-goers to Chicago, many of whom are adolescents. Emergency departments (EDs) see a surge of adolescent patients during seasonal events such as this, which places a strain on resources and provides unique challenges. The variation in care that Lollapalooza patients receive has served as a source of data for quality improvement initiatives within our ED. [ABSTRACT FROM AUTHOR]

The Promoting Excellence and Reflective Learning in Simulation (PEARLS) blended approach to debriefing encourages educators to purposefully merge various debriefing strategies to tailor discussion to learner needs and learning context. While debriefing is a key component to simulation-based education, few resources exist to promote implementation of specific debriefing approaches. In response to growing demands from simulation programs and facilitators wishing to teach the PEARLS approach to debriefing, we offer a collection of resources to serve as a faculty development guide for implementation of PEARLS. In this article, we discuss common pitfalls and associated solutions when using PEARLS to facilitate debriefings and offer a PEARLS debriefing checklist that can serve as a tool for providing peer feedback on debriefing performance. [ABSTRACT FROM AUTHOR]

The pediatric emergency medicine (PEM) environment is well suited for simulation-based activities, be they educational interventions for PEM learners, evaluations of the interface between health providers and the environment that they work in, or research investigations using simulation as a tool to answer specific clinical questions. As such, PEM has been among the leaders in the integration of this modality for clinical training. Traditionally, simulation has been used extensively for the dissemination of clinical training in the areas of clinical knowledge and its application, and the clinical, technical, and teamwork skills involved in PEM care. Increasingly, simulation is being used in novel applications, including breaking bad news, disclosure of error, family-centered care, quality and patient safety education, and system-level integration. The future will look to further identify, measure, and inform the integration of simulation with new and innovative adjuncts in the clinical environment, as well as to determine the optimal timing and use of simulation-based education to enhance the quality of care delivered to patients by the interprofessional and multidisciplinary team. [ABSTRACT FROM AUTHOR]

Successful transition from the intrauterine to extrauterine environment is dependent on several significant physiologic changes that must occur within minutes of birth. Most infants effectively transition at delivery without requiring any special assistance. However, about 10% of infants will require some level of intervention, and 1% will require extensive resuscitative measures at birth. The focus of this article is on the preparation for and management of an unexpected delivery in the emergency department. We will highlight the unique aspects of newborn resuscitation, as well as recent changes to the Neonatal Resuscitation Program from the 2015 American Heart Association Guidelines. [ABSTRACT FROM AUTHOR]

Objective Transport professionals must routinely engage in complex decision making. One challenging decision is the determination of mode of transport. This study explores the decisional factors involved in the determination of mobilizing ground ambulance versus helicopter for pediatric-neonatal interfacility transport. The aim was to gather initial qualitative data to aid in the development of an objective scoring tool that would be used to guide the mode of transport decision for pediatric and neonatal interfacility transport. The focus of the study was to elicit the factors that influence the mode of transport decision among professionals who are involved in this decision. Methods This study was conducted in an urban, freestanding children's hospital with a dedicated pediatric/neonatal transport team. Subjects were given written scenarios that represented a phone call requesting transport from a referring hospital. Subjects were asked to choose between 2 modes of transport: ambulance or helicopter. Weather was assumed to be clear. Decision-making factors were gathered and tallied. For group comparison, the Fisher exact, Pearson chi-square, Student t , or Wilcoxon rank sum tests for scale data was used. A multivariate logistic regression was performed to assess factors associated with the mode of transport decision. Results Responses were received from a total of 19 subjects. Nurses represented 58% (11) of the respondents, and physicians represented 42% (8). The nurses were all either currently employed on the transport team or had left the team within the past 2 years. The physicians were all critical care or emergency medicine fellows and attending physicians who serve in the medical control role for the transport team. All subjects reported a minimum of five years in their respective professions. The decision to mobilize a helicopter for interfacility transport was significantly associated with the provider's level of clinical concern in conjunction with the perceived distance and if neurovascular or respiratory status was in question in both univariate tests and the multivariate logistic regression. The decision to mobilize a helicopter did not differ significantly between professional roles (nurse vs. physician) or concerns about hemodynamic status such as blood pressure and heart rate. Physicians were significantly more likely to overestimate perceived ground travel time to the outside facility. Conclusions Health care providers responsible for directing and conducting the interfacility transport of critically ill children are more likely to mobilize a helicopter for transport in the face of neurovascular or respiratory clinical concerns in conjunction with a prolonged transport distance. When the provider's level of concern is lower, then a ground ambulance is consistently chosen even if out of hospital time is prolonged. [ABSTRACT FROM AUTHOR]

Reports on the development of potential nutritional prophylactic for the reduction of feline hairball symptoms by researchers from Australia. Role of the routine activity of grooming on the formation of hairball in cats; Incapability of the gastric mucosa to move the strands of ingested hair by peristalsis; Advantages of nutritional prophylactics over surgery to treat severe cases of hairball intestinal obstruction.

Aim Many healthcare providers rely on visual perception to guide cardiopulmonary resuscitation (CPR), but little is known about the accuracy of provider perceptions of CPR quality. We aimed to describe the difference between perceived versus measured CPR quality, and to determine the impact of provider role, real-time visual CPR feedback and Just-in-Time (JIT) CPR training on provider perceptions. Methods We conducted secondary analyses of data collected from a prospective, multicenter, randomized trial of 324 healthcare providers who participated in a simulated cardiac arrest scenario between July 2012 and April 2014. Participants were randomized to one of four permutations of: JIT CPR training and real-time visual CPR feedback. We calculated the difference between perceived and measured quality of CPR and reported the proportion of subjects accurately estimating the quality of CPR within each study arm. Results Participants overestimated achieving adequate chest compression depth (mean difference range: 16.1–60.6%) and rate (range: 0.2–51%), and underestimated chest compression fraction (0.2–2.9%) across all arms. Compared to no intervention, the use of real-time feedback and JIT CPR training (alone or in combination) improved perception of depth ( p < 0.001). Accurate estimation of CPR quality was poor for chest compression depth (0–13%), rate (5–46%) and chest compression fraction (60–63%). Perception of depth is more accurate in CPR providers versus team leaders (27.8% vs. 7.4%; p = 0.043) when using real-time feedback. Conclusion Healthcare providers’ visual perception of CPR quality is poor. Perceptions of CPR depth are improved by using real-time visual feedback and with prior JIT CPR training. [ABSTRACT FROM AUTHOR]