Ruth Everett-Thomas | University of Miami (original) (raw)

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Background: We developed a course to introduce incoming third-year medical students to the subjec... more Background: We developed a course to introduce incoming third-year medical students to the subject of patient safety, to focus their attention on teamwork and communication, and to create an awareness of patient-safe practices that will positively impact their performance as clinicians. Methods: The course, held prior to the start of clinical rotations, consisted of lectures, web-based didactic materials, small group activities and simulation exercises, with an emphasis on experiential learning. First, students inspected a 'room of horrors',

Objective: This study assessed the impact of a blended, standardized curriculum for invasive beds... more Objective: This study assessed the impact of a blended, standardized curriculum for invasive bedside procedural training on medical knowledge and technical skills for Internal Medicine residents. Methods: The investigators developed a curriculum in procedural instruction and performance for Internal Medicine house staff, and implemented the program at a tertiary care academic medical center with a primary affiliation with a US medical school. The investigators chose procedures recommended for technical competence by the American Board of Internal Medicine: lumbar puncture, thoracentesis, paracentesis, central venous catheter insertion, and knee arthrocentesis. The program included:

Background: Reports regarding hand hygiene compliance (HHC) among hospital visitors are limited. ... more Background: Reports regarding hand hygiene compliance (HHC) among hospital visitors are limited. Although there is an implicit assumption that the availability of alcohol-based hand sanitizer (AHS) promotes visitor HHC, the degree of AHS use by visitors remains unclear. To assess AHS use, we observed visitor HHC and how it is affected by visual cues in a private university hospital. Methods: Using an observational controlled study, we tested 3 interventions: a desk sign mandating all visitors to use AHS, a free-standing AHS dispenser directly in front of a security desk, and a combination of a freestanding AHS dispenser and a sign. Results: HHC was 0.52% at baseline and did not improve significantly when the desk sign was provided as a cue 0.67% (P ¼ .753). However, HHC did improve significantly with use of the freestanding AHS dispenser (9.33%) and the sign and dispenser combination (11.67%) (P < .001 for all comparisons of dispenser alone and sign and dispenser with baseline and sign alone). The degree of improvement with the sign and dispenser combination over the dispenser was not statistically significant. Conclusions: Hospital visitors represent an important factor in infection prevention. A coordinated effort is needed to increase visitor HHC, including an evaluation of the AHS placement, education of visitors on the importance of HHC, and evaluation of corresponding changes in hand hygiene behavior.

Introduction: The purpose of this study was to identify the impact of high-fidelity simulation on... more Introduction: The purpose of this study was to identify the impact of high-fidelity simulation on the retention of basic life support cardiopulmonary resuscitation (CPR) knowledge among a group of healthcare providers (HCPs). Methods: A twenty-five question exam was completed by nurses and nurse technicians over a two-year period before and after mandatory CPR training with high-fidelity simulation. Results: Most HCPs scored near 50% or below the passing score (80%) with a mean range of scores between 28% and 84%. HCPs missed questions on the exam that requested specific details related to technique or human physiology during CPR. Conclusion: The current teaching method for basic life support may be enhanced by using high-fidelity simulation, but this modality alone is not enough to support HCPs retention of CPR knowledge. Additional studies are needed to identify strategies that will help HCPs remember specific and detailed information in the CPR algorithm.

0.13) vs. 0.34 (0.14)) and pulse oximetry readings were not significantly different. The incidenc... more 0.13) vs. 0.34 (0.14)) and pulse oximetry readings were not significantly different. The incidence of arterial oxygen desaturations was not different (3.48 (3.2) vs. 3.34 (3.0) episodes/h) but desaturations lasted longer during PAV (2.60 (2.8) vs. 1.85 (2.2) min of desaturation/h, p = 0.049). PaCO 2 measured transcutaneously in a subgroup of 12 infants was similar. One infant met prespecified PAV failure criteria. No adverse events occurred during the 164 cumulative hours of PAV application. Conclusions: PAV safely maintains gas exchange at lower mean airway pressures compared with PTV without adverse effects in this population. Backup conventional ventilation breaths must be provided to prevent apnea-related desaturations.

To compare the physiologic efficacy and safety aspects of proportional assist (PA), assist/contro... more To compare the physiologic efficacy and safety aspects of proportional assist (PA), assist/control (A/C), and intermittent mandatory ventilation (IMV) in very low birth weight infants with acute respiratory illness and to test the hypothesis that ventilatory pressure requirements are lower and arterial oxygenation is improved during PA when compared with IMV or A/C at an equivalent inspired oxygen fraction.

Objective: To ascertain possible mechanisms implicated in the development of transient episodes o... more Objective: To ascertain possible mechanisms implicated in the development of transient episodes of hypoxemia (oxygen saturation <85%) frequently observed in preterm infants undergoing mechanical ventilation, even after the acute phase of respiratory failure has passed.

A reflex resulting in a deep, sigh-like inspiratory effort (augmented breath) is frequently trigg... more A reflex resulting in a deep, sigh-like inspiratory effort (augmented breath) is frequently triggered during synchronized mechanical ventilation in preterm infants. We studied the incidence of augmented inspiratory efforts and their effect on ventilation and lung compliance during conventional IMV and synchronized IMV (SIMV) in 15 preterm neonates (GA 26.7 ± 1.5 wks (mean ± SD), BW 925 ± 222 g, age 1-8 days). Augmentation of spontaneous inspiratory effort was defined as an esophageal pressure deflection occurring coincident with a synchronized mechanical breath and exceeding the previous unassisted spontaneous effort by more than 50%.

Background. Mechanically ventilated very low birth weight infants often present with frequent epi... more Background. Mechanically ventilated very low birth weight infants often present with frequent episodes of hypoxemia, and maintaining arterial oxygen saturation by pulse oximetry (SpO 2 ) within a normal range by manual fraction of inspired oxygen (FIO 2 ) adjustments is difficult and time consuming.

The American Heart Association's (AHA) recommendation for biyearly recertification and annual man... more The American Heart Association's (AHA) recommendation for biyearly recertification and annual mandatory CPR training may be suboptimal for first responders (nurses and technicians) working in outpatient clinics (American Heart Association, 2013). To determine the efficacy of the AHA guidelines, 40 simulated sudden cardiac arrest (SCA) encounters were conducted followed by debriefing and a subsequent SCA to determine a basic level of CPR proficiency. First responders' CPR skills were evaluated using a 19-item assessment form to quantify the event. A comparison of scores using two different viewing modalities was performed to provide an assessment of the training program. Of the 40 sessions, group mean performance scores for the first encounter were just above the organization's minimum required score of 24. Performance scores increased slightly (27-28) after the second encounter. Proficiency of skills was poor and frequent basic life support training may be indicated to help first responders provide high-quality CPR.

Effective hand hygiene is the single most important procedure in preventing hospitalacquired infe... more Effective hand hygiene is the single most important procedure in preventing hospitalacquired infections. Traditional information/education-based interventions have shown only modest benefits on compliance. This study set out to investigate whether priming via olfactory and visual cues influences hand hygiene compliance. Method: Randomized controlled trial set in a surgical intensive care unit (SICU) at a teaching hospital in Miami, Florida. The primary outcome data involved observations-a mix of health professionals and service users were observed entering the SICU by 2 trained observers and their hand hygiene compliance was independently verified. Interventions included either an olfactory prime (clean, citrus smell) or visual prime (male or female eyes). The primary outcome measure was hand hygiene compliance (HHC) measured by the visitor using the hand gel dispenser. Results: At a 5% level there was significant evidence that a clean, citrus smell significantly improves HHC (46.9% vs. 15.0%, p ϭ .0001). Compared to the control group, a significant improvement in HHC was seen when a picture of "male eyes" was placed over the hand gel dispenser (33.3% vs. 15.0%, p Ͻ .038). No significant improvement in HHC was seen when a picture of female eyes was placed over the same hand gel dispenser (10.0% vs. 15.0%, p ϭ .626). Conclusions: This is one of the first studies to demonstrate that priming can influence HHC in a clinical setting. The findings suggest that priming interventions could be used to change other behaviors relevant to public health.

Please cite this article in press as: Birnbach DJ, et al. A ubiquitous but ineffective interventi... more Please cite this article in press as: Birnbach DJ, et al. A ubiquitous but ineffective intervention: Signs do not increase hand hygiene compliance. J Infect Public Health (2016), http://dx. Summary Proper hand hygiene is critical for preventing healthcare-associated infection, but provider compliance remains suboptimal. While signs are commonly used to remind physicians and nurses to perform hand hygiene, the content of these signs is rarely based on specific, validated health behavior theories. This observational study assessed the efficacy of a hand hygiene sign disseminated by the Centers for Disease Control and Prevention in an intensive care unit compared to an optimized evidence-based sign designed by a team of patient safety experts. The optimized sign was developed by four patient safety experts to include known evidence-based components and was subsequently validated by surveying ten physicians and ten nurses using a 10 point Likert scale. Eighty-two physicians and 98 nurses (102 females; 78 males) were observed for hand hygiene (HH) compliance, and the total HH compliance rate was 16%. HH compliance was not significantly different among the signs (Baseline 10% vs. CDC 18% vs. OIS 20%; p = 0.280).