Team Adherence Research Articles

Critical Event Checklists for Simulated In-Hospital Dysrhythmias in Children with Heart Disease.

Children with heart disease are at increased risk of unstable dysrhythmias and in-hospital cardiac arrest (IHCA). Clinician adherence to lifesaving processes of care is an important contributor to improving patient outcomes. This study evaluated whether critical event checklists improve adherence to lifesaving processes during simulated acute events secondary to unstable dysrhythmias. A randomized controlled trial was conducted in a cardiac ward in a tertiary care, academic children's hospital. Unannounced simulated emergencies involving dysrhythmias in pediatric patients with underlying cardiac disease were conducted weekly. Responders were pediatric and anesthesiology residents, respiratory therapists, and bedside registered nurses. Six teams were randomized into two groups-three received checklists (intervention) and three did not (control). Each team participated in four simulated scenarios over a 4-week pediatric cardiology rotation. Participants received a brief slideshow presentation, which included a checklist orientation, at the start of their rotation. Simulations were video and audio recorded and those with three or more participants were included for analysis. The primary outcome was team adherence to lifesaving processes, expressed as the percentage of completed critical management steps. Secondary outcomes included participant perceptions of the checklist usefulness in identifying and managing dysrhythmias. We used generalized estimating equations (GEE) models, which accounted for clustering within groups, to evaluate the effects of the intervention. A total of 24 simulations were conducted; one of the 24 simulations was excluded due to an insufficient number of participants. In our GEE analysis, 81.21% (78.96%, 83.47%) of critical steps were completed with checklists available versus 68.06% (59.38%, 76.74%) without checklists (p = 0.004). Ninety-three percent of study participants reported that they would use the checklists during an unstable dysrhythmia of a child with underlying cardiac disease. Checklists were associated with improved adherence to lifesaving processes during simulated resuscitations for unstable pediatric dysrhythmias. These findings support the use of scenario specific checklists for the management of unstable dysrhythmias in simulations involving pediatric patients with underlying cardiac disease. Future studies should investigate whether checklists are as effective in actual pediatric in-hospital emergencies.

Effect of coaches’ interpersonal style on young athletes’ individual resilience and team adherence intention: a season-long investigation

BackgroundIn the sports context, coaches must be able to improve their players physically, psychologically, and socially. Hence, a fundamental part of this process is the athlete’s individual resilience (IR).MethodsThree hundred and fifteen youth team-sport players (boys: n = 283; Mage = 16.02, SD = 0.56; and girls: n = 32; Mage = 15.92, SD = 0.62) completed the measures of coach’s interpersonal style, individual resilience, perceived performance, and team adherence intention (intention to remain on the same team the following year) twice (Time 1: mid-season; Time 2: end-season). Structural equation modeling was used to test the relationships between variables.ResultsThe results showed that coach support was positively related to IR (p < 0.001) and, in turn, IR to individual (p < 0.01) and team performance (p < 0.05) at Time 1, and to individual performance (p < 0.001) and team adherence intention at Time 2 (p < 0.01). In addition, team performance at Time 2 was positively related to team adherence intention (p < 0.001). Finally, a mediating effect of IR was observed between interpersonal coaching style, individual and team performance, and team adherence intention.ConclusionsThese results show the importance of a supportive interpersonal coaching style to foster athletes’ levels of resilience, which could have positive consequences in performance (individual and team) and team adherence intention.

Medics, Mercenaries and Miscreants — A review of Canadian Medical Assistance Teams' EMT Type 1 response to the conflict in Ukraine

Introduction:On February 24, 2022, Russia invaded Ukraine, resulting in Europe’s largest refugee crisis since World War II. More than six million Ukrainians fled the country—half of these to Poland—and one-third of the population was internally displaced.Border points became bottlenecks where fatalities were reported—people risked their lives in long queues and subzero temperatures.Method:This presentation focuses on experiential information obtained during a 17-week deployment of EMT Type 1 both at border points (fixed) and in northwestern Ukraine (mobile). Quantitative and qualitative data were obtained after deployment by online survey with 75 medical, logistical and interpreter volunteers.Results:Initial teams experienced extremely fluid demands and numerous challenges with security, team adherence to COVID-19 protocols, behavioral issues with less experienced volunteers, and collaboration with novel governmental and non-governmental partners to achieve objectives.Conclusion:1. Deployment to a conflict setting requires adherence to the Incident Command System, with daily security briefings and structured handover between teams at the beginning of each deployment.2. Strict adherence to well-defined protocols for the prevention and management of emerging infectious risks such as COVID-19 is necessary, along with contingency plans to isolate infected team members.3. There is a need for standardized pre-deployment vetting, training and orientation of all volunteers—particularly team leaders.4. Identification of international partners should start pre-deployment and remain a continuous process during deployment.

Factors contributing to non-adherence of the peri-operative surgical team to WHO surgical safety checklist in the Kingdom of Saudi Arabia

IntroductionThe World Health Organization Surgical Safety Checklist addresses acceptable practices for patient safety. This paper aimed to explore and describe the factors that contribute to non-adherence of peri‑operative surgical team to WHO surgical safety checklist at the selected hospital in the Kingdom of Saudi Arabia. MethodsThe study adopted a qualitative design. The population consisted of a 12 peri‑operative surgical team with an average of 12 years’ experience in their respective medical fields. This population was purposely selected from a selected hospital operating theatres in Saudi Arabia. Non-probability purposive sampling was used to select the participants. Data was collected by means of semi-structured individual interviews. Content analysis was used to analyze data. ResultsThe findings revealed that peri‑operative surgical team experience challenges when implementing WHO SSC (2008). The challenges affect their adherence, which depends on a convergence of intertwined factors, such as the use of WHO SSC related to issues in the checklist steps and uncertainties regarding the safe use of WHO SSC, team factors, checklist items factors and procedural factors. ConclusionThe study clearly identified factors that contributed to suboptimal WHO SSC execution by peri‑operative surgical team in the Kingdom of Saudi Arabia, addressed at the institutional level. It is therefore important for the managerial teams to be supportive to the surgical perioperative team to improve adherence to WHO SSC. Support can be provided through continuous supervision, in-service training, mentoring, evaluation and awarding merits for the good adherence to patient safety. Furthermore, these findings can be used to develop strategies to promote perioperative surgical team adherence to WHO SSC and can be used for further research.

Adherence to an Injury Prevention Warm-Up Program in Children's Soccer-A Secondary Analysis of a Randomized Controlled Trial.

This study examined the impact of high adherence to a neuromuscular training (NMT) warm-up on the risk of lower extremity (LE) injuries in children’s soccer. Twenty U11–U14 youth clubs (n = 92 teams, 1409 players) were randomized into intervention (n = 44 teams) and control (n = 48 teams) groups. The intervention group was advised to perform an NMT warm-up 2 to 3 times a week for 20 weeks. Team adherence, injuries, and exposure were registered throughout the follow-up. Primary outcomes were the incidence of soccer-related acute LE injuries and the prevalence of overuse LE injuries. Intervention teams conducted mean 1.7 (SD 1.0) NMT warm-ups weekly through follow-up. The seasonal trend for adherence declined significantly by −1.9% (95% CI −0.8% to −3.1%) a week. There was no difference in the incidence of acute injuries nor the prevalence of overuse LE injuries in high team adherence group (n = 17 teams) compared to controls. However, the risk for acute noncontact LE injuries was 31% lower in the high team adherence group compared to controls (IRR 0.69, 95% CI 0.49 to 0.97). In an efficacy analysis (n = 7 teams), there was a significant reduction of 47% in the rate of noncontact LE injuries (IRR 0.53, 95% CI 0.29 to 0.97). In conclusion, teams conducted NMT warm-up sessions regularly, but with a declining trend. A greater protective effect was seen in teams with the highest adherence to the NMT warm-up.

Evaluation of Technology-Enabled Monitoring of Patient-Reported Outcomes to Detect and Treat Toxic Effects Linked to Immune Checkpoint Inhibitors

Immune checkpoint inhibitors can produce distinct toxic effects that require prompt recognition and timely management. To develop a technology-enabled, dynamically adaptive protocol that can provide the accurate information needed to inform specific remedies for immune toxic effects in patients treated with immune checkpoint inhibitors. An open-label cohort study was conducted at a single tertiary referral center from September 6, 2019, to September 3, 2020. The median follow-up duration was 63 (interquartile range, 35.5-122) days. Fifty patients with genitourinary cancers treated with immune checkpoint inhibitors were enrolled. A fit-for-purpose electronic platform was developed to enable active patient and care team participation. A smartphone application downloaded onto patients' personal mobile devices prompted them to report their symptoms at least 3 times per week. The set of symptoms and associated queries were paired with alert thresholds for symptoms requiring clinical action. The primary end point of this interim analysis was feasibility, as measured by patient and care team adherence, and lack of increase in care team staffing. Operating characteristics were estimated for each symptom alert and used to dynamically adapt the alert thresholds to ensure sensitivity while reducing unnecessary alerts. Of the 50 patients enrolled, 47 had at least 1 follow-up visit and were included in the analysis. Median age was 65 years (range, 37-86), 39 patients (83%) were men, and 39 patients (83%) had metastatic cancer, with the most common being urothelial cell carcinoma and renal cell carcinoma (22 [47%] patients each). After initial onboarding, no further care team training or additional care team staffing was required. Patients had a median study adherence rate of 74% (interquartile range, 60%-86%) and 73% of automated alerts were reviewed within 3 days by the clinic team. Symptoms with the highest positive predictive value for adverse events requiring acute intervention included dizziness (21%), nausea/vomiting (26%), and shortness of breath (14%). The symptoms most likely to result in unnecessary alerts were arthralgia and myalgia, fatigue, and cough. The findings of this cohort study suggest an acceptable and fiscally sound method can be developed to create a dynamic learning system to detect and manage immune-related toxic effects.

How much, how often, how well? Adherence to a neuromuscular training warm-up injury prevention program in youth basketball

ABSTRACT Adherence is a key implementation outcome that determines the effectiveness of an intervention. This study, an observational design involving coaches and players from 33 high school basketball teams, evaluated the dimensions of adherence to a basketball-specific neuromuscular training (NMT) warm-up program in youth basketball. Coach adherence (daily report of team adherence) was collected prospectively. Adherence measures: cumulative utilization (proportion of total sessions possible), utilization fidelity (average # of exercises completed per NMT session), utilization frequency (average # of NMT sessions completed per week) were calculated and further evaluated for optimal adherence (≥80%, ≥10.4 exercises/session and ≥2 sessions/week, respectively) per coach. Additionally, exercise fidelity (proportion of players performing individual exercises correctly) was assessed. Coach (n = 31; 27–59 years) median cumulative utilization was 80%, utilization fidelity was 12 (of a possible 13 exercises per session) and utilization frequency was 2.3 sessions per week. Optimal adherence ranged from 52% to 71% across measures of adherence. Player exercise fidelity was 48%. Time constraint (47%) was the most frequently reported adherence barrier. While coach adherence to the NMT warm-up program was reasonably high across measures of adherence, a considerable proportion of coaches did not attain optimal adherence levels and player exercise fidelity was low.

Team adherence to rapid prenatal testing and administration of benzathine penicillin in primary healthcare.

To identify the factors related to the work process regarding the adherence of Primary Healthcare teams to the rapid test for HIV, syphilis, hepatitis B and C during prenatal care and administration of benzathine penicillin in primary healthcare. A descriptive, exploratory and quantitative study conducted between the months of July and November 2018, with professionals from the Family Health Strategy teams of the Seridó Norte-Rio-Grandense region in Rio Grande do Norte State, Brazil. There were 18 municipalities, 94 Basic Health Units and 100 Family Health Strategy teams which participated in the study. The nurse was the main person involved in the testing service, and 93% of the interviewed teams offered the test in the service routine. Of these teams, 97.8% underwent prenatal testing, 51.6% offered the test to the pregnant woman at the beginning of the third trimester, and 57% offered the rapid test to sexual partners. Benzantine penicillin was available in 87.1% of the teams; however, 49.5% did not administer the medication in primary healthcare. The testing process proved to be fragile because even if the test was available in prenatal care, the other activities linked to the work process did not occur properly.

Implementation of a virtual patient-centered weight loss maintenance behavior competency assessment in adults with obesity.

Evidence shows that 95%-98% of individuals who undergo a diet for weight loss purposes will gain back their weight within 5 years. No standardized method exists to assess weight loss maintenance (WLM) behavior competencies in patients who lose weight within a telehealth nutritional counseling private practice. Incorporating this assessment can be used to increase patient self-efficacy and predict a patient's likelihood of long-term weight success. A quality improvement project, implementing four rapid plan-do-study-act cycles, was conducted. Each cycle included tests of change related to team and patient engagement, implementation of a WLM assessment, and an audit adherence. Data were analyzed using run charts to evaluate the impact of interventions on outcomes. The clinical team submitted a weekly WLM competency survey. A patient intake form was completed to identify behavior risks, followed by implementation of a WLM assessment in weekly follow-ups. A team adherence audit was completed and submitted every week. Team WLM competency levels increased 32%, averaging 82% at study conclusion. Completion of the patient intake form reached and held at 100% for the entire duration. Team usage of the WLM assessment peaked at 97%, correlating to increased patient behavior competence by 27.5% as the patient advanced. Team adherence gradually increased, peaking at 100%. Patient screening forms and audit logs created a standardized process to collect, deliver, and better coordinate care. The findings suggest that patients who embodied higher behavioral competence will have a greater likelihood of sustaining their weight results and become the successful 2%-5% of weight maintainers.

Adherence to the neonatal resuscitation algorithm for preterm infants in a tertiary hospital in Spain

BackgroundThere is evidence that delivery room resuscitation of very preterm infants often deviates from internationally recommended guidelines. There were no published data in Spain regarding the quality of neonatal resuscitation. Therefore, we decided to evaluate resuscitation team adherence to neonatal resuscitation guidelines after birth in very preterm infants.MethodsWe conducted an observational study. We video recorded resuscitations of preterm infants < 32 weeks’ gestational age and evaluated every step during resuscitation according to a score-sheet specifically designed for this purpose, following Carbine’s method, where higher scores indicated that more intense resuscitation maneuvers were required. We divided the score achieved by the total possible points per patient to obtain the percentage of adherence to the algorithm. We also compared resuscitations performed by staff neonatologists to those performed by pediatricians on-call. We compared percentages of adherence to the algorithm with the Chi-square test for large groups and Fisher’s exact test for smaller groups. We compared assigned Apgar scores with those given after analyzing the recordings and described them by their median and interquartile range. We measured the interrater agreement between Apgar scores with Cohen’s kappa coefficient. Linear and logarithmic regressions were drawn to characterize the pattern of algorithm adherence. Statistical analysis was performed using SPSS V.20. A p-value < 0.05 was considered significant. Our Hospital Ethics Committee approved this project, and we obtained parental written consent beforehand.ResultsSixteen percent of our resuscitations followed the algorithm. The number of mistakes per resuscitation was low. Global adherence to the algorithm was 80.9%. Ventilation and surfactant administration were performed best, whereas preparation and initial steps were done with worse adherence to the algorithm. Intubation required, on average, 2.2 attempts; success on the first attempt happened in 33.3% of cases. Only 12.5% of intubations were achieved within the allotted 30 s. Many errors were attributable to timing. Resuscitations led by pediatricians on-call were performed as correctly as those by staff neonatologists.ConclusionsResuscitation often deviates from the internationally recognized algorithm. Perfectly performed resuscitations are infrequent, although global adherence to the algorithm is high. Neonatologists and pediatricians need intubation training.

Adherence to Measuring What Matters: Description of an Inpatient Palliative Care Service of an Urban Teaching Hospital.

Benefits of palliative care have been extensively described; however, reports on adherence to national quality indicators are limited. This study focuses on describing the characteristics of patients who were seen at an urban academic hospital and their care team's adherence to 5 out of 10 Measuring What Matters (MWM) quality indicators. Retrospective chart review Setting/Subjects: Patients seen by inpatient palliative care service from January 2014 to December 2015 in an urban academic hospital. Patient age, gender, ethnicity, disease category, discharge end point, life-sustaining preferences, surrogate decision-maker documentation, and initial palliative assessment were analyzed using descriptive, parametric, and nonparametric statistics. During two years, 1272 patients were seen by the inpatient palliative care service. Fifty-one percent of patients were male, with an average age of 68 years. The majority were Caucasian (57%) and African American (41%). Life-limiting illnesses included were cancer, complex chronic illnesses, and gastrointestinal illness. Adherence to comprehensive palliative care assessment was measured at 64%; initial visit assessment for physical symptoms was 38%; code status preference was 99%; care consistent with preference in vulnerable elders was 99%; and surrogate documentation was noted at 33%. Compared to hospital patients discharged without hospice, patients discharged with hospice care had consults with higher adherence to comprehensive assessment and surrogate documentation quality standards (p < 0.05). Adherence to MWM measures was variable. Subjects discharged with hospice services were more likely to receive comprehensive assessment within 5 days of admission and surrogate documentation compared to those subjects without hospice care.

Gestion des erreurs médicamenteuses en médecine générale : étude en maison de santé pluridisciplinaire

Medication errors are the most frequent medical care adverse events in France. Their management process used in hospital remains poorly applied in primary ambulatory care. The main objective of our study was to assess medication error management in general ambulatory practice. The secondary objectives were the characterization of the errors and the analysis of their root causes in order to implement corrective measures. The study was performed in a pluriprofessionnal health care house, applying the stages and tools validated by the French high health authority, that we previously adapted to ambulatory medical cares. During the 3months study 4712medical consultations were performed and we collected 64medication errors. Most of affected patients were at the extreme ages of life (9,4% before 9years and 64% after 70years). Medication errors occurred at home in 39,1% of cases, at pluriprofessionnal health care house (25,0%) or at drugstore (17,2%). They led to serious clinical consequences (classified as major, critical or catastrophic) in 17,2% of cases. Drug induced adverse effects occurred in 5patients, 3of them needing hospitalization (1patient recovered, 1displayed sequelae and 1died). In more than half of cases, the errors occurred at prescribing stage. The most frequent type of errors was the use of a wrong drug, different from that indicated for the patient (37,5%) and poor treatment adherence (18,75%). The systemic reported causes were a care process dysfunction (in coordination or procedure), the health care action context (patient home, not planned act, professional overwork), human factors such as patient and professional condition. The professional team adherence to the study was excellent. Our study demonstrates, for the first time in France, that medication errors management in ambulatory general medical care can be implemented in a pluriprofessionnal health care house with two conditions: the presence of a trained team coordinator, and the use of validated adapted and simple processes and tools. This study also shows that medications errors in general practice are specific of the care process organization. We identified vulnerable points, as transferring and communication between home and care facilities or conversely, medical coordination and involvement of the patient himself in his care.

Implementation of a Standardized Patient Safety Checklist in Ophthalmic Surgery

Objective To develop and institute a standardized ophthalmology-specific operating room checklist, and to test adherence to the surgical checklist components after implementation. Design An ophthalmology-specific operative room checklist was developed using recommendations from surgical preoperative checklists from other subspecialties and checklists specific to cataract surgery. This standardized checklist was then implemented into the operating rooms. Operative room staff was trained on its use. Adherence to the checklist was measured prospectively. Setting Surgical centers at Kellogg Eye Center in Ann Arbor and Livonia, Michigan. Participants Patients undergoing ophthalmic surgery at the Livonia and Ann Arbor surgical centers. Main Outcome(s) and Measure(s) The primary outcome measures were surgical team adherence to each category of the operative checklist (preop, prebrief, preanesthesia verification, time-out, intraocular lens measurement/confirmation for cataract cases, debrief). Adherence to the subsections of the operative checklist was measured during three periods over the course of 1 year: baseline, postintervention (after introduction of the checklist in all operating rooms), and postadjustment (after additional training was provided to operating room staff and incentives to collect data were provided to personnel responsible for collecting it). Results A total of 2,532 surgical cases were included in the analysis. Baseline adherence ranged from 87 to 90% across preop, prebrief, preanesthesia, and time-out verification sections of the operative checklist. After the institution of the intervention and adjustments, adherence to the surgical checklist improved significantly across all areas of the checklist to 97–98% (p &lt; 0.01). Conclusions and Relevance The development and implementation of an ophthalmology-specific operative room checklist increase adherence to recommended safety checks prior to the start of surgery. To maximize patient safety, the same or similar checklist is recommended for use in all ophthalmology operating rooms.

Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre.

Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits.

Improving Code Team Performance and Survival Outcomes

To determine whether implementation of Composite Resuscitation Team Training is associated with improvement in survival to discharge and code team performance after pediatric in-hospital cardiopulmonary arrest. We conducted a prospective observational study with historical controls at a 302-bed, quaternary care, academic children's hospital. Inpatients who experienced cardiopulmonary arrest between January 1, 2006, and December 31, 2009, were included in the control group (123 patients experienced 183 cardiopulmonary arrests) and between July 1, 2010, and June 30, 2011, were included in the intervention group (46 patients experienced 65 cardiopulmonary arrests). Code team members were introduced to Composite Resuscitation Team Training and continued training throughout the intervention period (January 1, 2010-June 30, 2011). Training was integrated via in situ code blue simulations (n = 16). Simulations were videotaped and participants were debriefed for education and process improvement. Primary outcome was survival to discharge after cardiopulmonary arrest. Secondary outcome measures were 1) change in neurologic morbidity from admission to discharge, measured by Pediatric Cerebral Performance Category, and 2) code team adherence to resuscitation Standard Operating Performance variables. The intervention group was more likely to survive than the control group (60.9% vs 40.3%) (unadjusted odds ratio, 2.3 [95% CI, 1.15-4.60]) and had no significant change in neurologic morbidity (mean change in Pediatric Cerebral Performance Category 0.11 vs 0.27; p = 0.37). Code teams exposed to Composite Resuscitation Team Training were more likely than control group to adhere to resuscitation Standard Operating Performance (35.9% vs 20.8%) (unadjusted odds ratio, 2.14 [95% CI, 1.15-3.99]). After adjusting for adherence to Standard Operating Performance, survival remained improved in the intervention period (odds ratio, 2.13 [95% CI, 1.06-4.36]). With implementation of Composite Resuscitation Team Training, survival to discharge after pediatric cardiopulmonary arrest improved, as did code team performance. Demonstration of improved survival after adjusting for code team adherence to resuscitation standards suggests that this may be a valuable resuscitation training program. Further studies are needed to determine causality and generalizability.

Evaluation of how different implementation strategies of an injury prevention programme (FIFA 11+) impact team adherence and injury risk in Canadian female youth football players: a cluster-randomised trial

BackgroundInjury prevention programme delivery on adherence and injury risk, specifically involving regular supervisions with coaches and players on programme execution on field, has not been examined.AimThe objective of this cluster-randomised...

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Introduction: A Rapid Response Team can be associated with a significant reduction in cardiopulmonary arrest (CPA) outside of pediatric intensive care unit settings, and the resultant decrease in CPA events provides less resuscitation experience. Subsequently attractive, is the implementation of resuscitation training, that includes in-situ simulation, which has been shown to improve code team performance; however, little evidence associates simulation with improved patient outcomes. Hypothesis: We hypothesize that Resuscitation Team Training, including in-situ simulation, is associated with improved post-CPA survival to discharge, decreased accrual of neurological morbidity, and improved code team adherence to American Heart Association (AHA) gold standards of resuscitation. Methods: A prospective observational study with historical controls at a 328-bed academic children’s hospital was conducted. Included in the analysis were all CPA events to which the code team responded during the control and post intervention periods. A total of 183 CPA events in 123 patients were evaluated pre-intervention and 65 CPA events in 46 patients were evaluated post intervention. Code responders were introduced to a Composite Resuscitation Team Training and these educational endeavors were integrated via in-situ mock codes (n=16), designed to generate a realistic code team response. All simulations were videotaped and immediatly debriefed. Results: Patients in the post -intervention group were significantly more likely to survive than in the control group. The post intervention group had less, but not significantly, accrual of neurologic morbidity. The post intervention code team was significantly more likely than the control group to adhere to SOP (OR 2.14; CI 1.15-3.99). The odds of survival in the post- intervention period was significantly improved following events during which the SOP was adhered to (OR=6.00; 95% CI 1.15-31.23). Conclusions: This Composite Resuscitation Team Training that includes in-situ simulations, can be associated with a significant increase in post -CPA event survival to discharge, without an increase in neurologic morbidity in pediatrics and significantly improve code team performance.

Concepts and Methods for Strategy Building and Tactical Adherence: A Case Study in Football

This investigation looked at the on-field strategic planning of a professional German soccer club, how the strategic plans were adhered to in competition and how they were adjusted following matches. The methods presented in this article combine qualitative and quantitative techniques and are central to being able to assess objectively strategic plans and playing tactics. The coaching philosophy is a main contributor to the strategic plans, aspects of the match which were directly related to the coaching philosophy were less susceptible to change throughout the season. Additionally, adherence to strategic plans increased as the season progressed and was higher for home matches compared to away. The methods presented in this article have led to a new model of strategic planning, assessment of the quality of strategic plans put in place and the team's adherence to those strategies so that plans for upcoming matches can be optimised. The methods presented and the model for strategic planning and assessment can be used for other sports.

The Effect of Conformist and Attentive-To-Detail Members on Team Innovation: Reconciling the Innovation Paradox

To resolve “the innovation paradox,” we examined whether cognitive styles associated with idea implementation (i.e., conformity and attention to detail) have an influence on team radical innovation that goes above and beyond the contribution of creative members. We also examined mediating team processes. Using data on 41 teams in an R&D company, we found that including creative and conformist members on a team enhanced team radical innovation, whereas including attentive-to-detail members hindered it. Creative members enhanced task conflict and hindered team adherence to standards. In contrast, conformists reduced task conflict, and conformists and attentive-to-detail members enhanced team adherence to standards. Team potency mediated the effect of the cognitive styles on innovation.

Measuring fidelity to extreme programming: a psychometric approach

This study assesses the Shodan survey as an instrument for measuring an individual's or a team's adherence to the extreme programming (XP) methodology. Specifically, we hypothesize that the adherence to the XP methodology is not a uni-dimensional construct as presented by the Shodan survey but a multidimensional one reflecting dimensions that are theoretically grounded in the XP literature. Using data from software engineers in the University of Sheffield's Software Engineering Observatory, two different models were thus tested and compared using confirmatory factor analysis: a uni-dimensional model and a four-dimensional model. We also present an exploratory analysis of how these four dimensions affect students' grades. The results indicate that the four-dimensional model fits the data better than the uni-dimensional one. Nevertheless, the analysis also uncovered flaws with the Shodan survey in terms of the reliability of the different dimensions. The exploratory analysis revealed that some of the XP dimensions had linear or curvilinear relationship with grades. Through validating the four-dimensional model of the Shodan survey this study highlights how psychometric techniques can be used to develop software engineering metrics of fidelity to agile or other software engineering methods.