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Biomedical subjects

Robert L Wears

Publications and source records attributed to Robert L Wears.

18 recordsLinked to original sources
PubMed2003

Effect of an intervention standardization system on pediatric dosing and equipment size determination: a crossover trial involving simulated resuscitation events.

BACKGROUND: Pediatric medication dosing has been recognized as a high-error activity with the potential to cause serious harm. Few studies assess systems approaches to error reduction in pediatrics. OBJECTIVE: To estimate the decrease in deviation from recommended medication doses associated with use of a pediatric intervention standardization system in the acute setting. DESIGN: Two-period, 2-treatment crossover trial with data collected between December 1, 1999, and February 29, 2000. SETTING: Tertiary, academic medical center. PARTICIPANTS: Convenience sample of 28 resident physicians, representing 69% of pediatrics and 50% of medicine-pediatrics residents. INTERVENTION: Each resident participated in 4 simulated pediatric resuscitations. The Broselow Pediatric Emergency Tape and color-coded materials were available in either the first or second 2 scenarios. Traditional dosing references were available in all scenarios. MAIN OUTCOME MEASURE: Median difference between deviation from recommended dose range (DRDR) in scenarios where color coding was used (intervention) and DRDR in scenarios where color coding was not available (control). RESULTS: Median DRDR in intervention scenarios was 25.4% lower than in control scenarios (95% confidence interval [CI], 19.1%-32.5%; P<.001). In 4 medication prescriptions in intervention scenarios and in 54 prescriptions in control scenarios, DRDRs exceeded 100%. Median deviation from recommended equipment sizes in intervention scenarios was 0.12 size lower than in control scenarios (95% CI, 0.03-0.22 size; P<.001). Deviations in equipment size of 2 or more sizes were noted in 1 size determination in intervention scenarios and in 21 size determinations in control scenarios. CONCLUSIONS: Color coding was associated with a significant reduction in deviation from recommended doses in simulated pediatric emergencies. Numerous potentially clinically significant deviations from recommended doses and equipment sizes were avoided. Future studies should measure impact in the real clinical setting.

Academic Medical Centers↗
PubMed2002

Journal prestige, publication bias, and other characteristics associated with citation of published studies in peer-reviewed journals.

CONTEXT: Citation by other authors is important in the dissemination of published science, but factors predicting it are little studied. METHODS: To identify characteristics of published research predicting citation in other journals, we searched the Science Citations Index database for a standardized 3.5 years for all citations of published articles originally submitted to a 1991 emergency medicine specialty meeting. Analysis was conducted by classification and regression trees, a nonparametric modeling technique of regression trees, to determine the impact of previously determined characteristics of the full articles on the outcome measures. We calculated the the number of times an article was cited each year and calculated the mean impact factor (citations per manuscript per year) in other citing journals. RESULTS: Of the 493 submitted manuscripts, 204 published articles met entry criteria. The mean citations per year was 2.04 (95% confidence interval, 1.6-2.4; range, 0-20.9) in 440 different journals. Nineteen articles (9.3%) were never cited. The ability to predict the citations per year was weak (pseudo R(2) = 0.14.). The strongest predictor of citations per year was the impact factor of the original publishing journal. The presence of a control group, the subjective newsworthiness score, and sample size predicted citation frequency (24.3%, 26.0%, and 26.5% as strongly, respectively). The ability to predict mean impact factor of the citing journals was even weaker (pseudo R(2) = 0.09). The impact factor of the publishing journal was the strongest predictor, followed by the newsworthiness score (89.9% as strongly) and a subjective quality score (61.5%). Positive outcome bias was not evident for either outcome measure. CONCLUSION: In this cohort of published research, commonly used measures of study methodology and design did not predict the frequency of citations or the importance of citing journals. Positive outcome bias was not evident. The impact factor of the original publishing journal was more important than any other variable, suggesting that the journal in which a study is published may be as important as traditional measures of study quality in ensuring dissemination.

Bibliometrics↗
PubMed2002

The prosecution of sexual assault cases: correlation with forensic evidence.

STUDY OBJECTIVE: We sought to determine the association between historical and physical evidence with judicial outcome in sexual assault cases. METHODS: A population-based, retrospective review of forensic evidence was conducted for all sexual assault cases reported in Duval County, FL, during a 2-year period. Variables examined included age, race of victim, evidence of trauma (body, genital, or both), presence of spermatozoa at the time of the forensic examination, weapon use, and whether the victim knew the assailant. In cases in which an arrest was made, logistic regression was used to estimate the strength of association with the outcome of conviction in sexual assault cases. RESULTS: During the study period, 821 sexual assaults were reported, and 801 forensic examinations were performed. The victims were predominantly female (776; 97%), with 409 (51%) being black, 376 (47%) white, and 16 (2%) other minorities. A suspect was identified in 355 (44%) of the 801 cases for which a sexual assault forensic examination was conducted. No suspect was identified in 446 (56%) of these cases. There were 271 arrests made. The police did not have enough evidence to arrest a suspect after detention in 84 cases. For those cases in which a suspect was arrested, 153 had charges dropped, 89 were found guilty, 2 were found not guilty, and 27 cases were still pending or the files were sealed and unavailable for review. There was evidence of trauma in 202 (57%) of the examinations, and spermatozoa were found at the time of the forensic examination in 110 (31%) of the cases in which a suspect was identified. Logistic regression found that victims aged younger than 18 years, the presence of trauma, and the use of a weapon by the assailant were significantly associated with successful prosecution. There was a trend toward conviction if the victim was white. CONCLUSION: Emergency physicians have an obligation to provide care for victims of sexual assault cases. This care includes a possible legal defense. To that end, emergency physicians should be vigilant in the documentation of the history of the event (eg, weapon use) and in the documentation of traumatic injuries because these factors can assist in a successful prosecution.

Adolescent↗
PubMed2002

Human factors and ergonomics in the emergency department.

Although health care rapidly adopts technologic advances from other fields, it has been slow to incorporate well-established principles from human factors engineering into the health care workplace. This article demonstrates some of those principles by analyzing an all too routine clinical event from a human factors point of view. Review of this case and ergonomic principles leads us to conclude that the routine application of human factors engineering principles could improve patient safety and would likely improve system efficiency as well.

Blood Pressure Monitors↗
PubMed2002

The use of dedicated methodology and statistical reviewers for peer review: a content analysis of comments to authors made by methodology and regular reviewers.

STUDY OBJECTIVES: In 1997, Annals of Emergency Medicine initiated a protocol by which every original research article, in addition to each regular review, was concurrently evaluated by 1 of 2 methodology and statistical reviewers. We characterized and contrasted comments made by the methodology and regular peer reviewers. METHODS: After pilot testing, interrater reliability assessment, and revision, we finalized a 99-item taxonomy of reviewer comments organized in 8 categories. Two authors, uninvolved in the writing of reviews, classified each comment from a random sample of methodology reviews from 1999. For 30 of these reviews (15 for each methodology reviewer), the 2 authors also scored all (range 2 to 5) regular reviews. RESULTS: Sixty-five reviews by methodologist A, 60 by methodologist B, and 68 by regular reviewers were analyzed. Comments by methodologist A most frequently concerned the presentation of results (33% of all comments) and methods (17%). Methodologist B commented most frequently on presentation of results (28%) and statistical methods (16%). Regular reviewers most frequently made non-methodology/statistical comments (45%) and comments on presentation of results (18%). Of note, comments made by methodology and regular reviewers about methods issues were often contradictory. CONCLUSION: The distributions of comments made by the 2 methodology and statistical reviewers were similar, although reviewer A emphasized presentation and reviewer B stressed statistical issues. The regular reviewers (most of whom were unaware that a dedicated methodology and statistical reviewer would be reviewing the article) paid much less attention to methodology issues. The 2 dedicated methodology and statistical reviewers created reviews that were similarly focused and emphasized methodology issues that were distinct from the issues raised by regular reviewers.

Peer Review, Research↗
PubMed2002

The effect of dedicated methodology and statistical review on published manuscript quality.

STUDY OBJECTIVE: We examine how dedicated methodology and statistical review affects the quality of manuscripts published in Annals of Emergency Medicine. DESIGN: The dedicated reviewers developed a manuscript scoring form based on previously used instruments. The form contained 84 unique elements. Eight items sought the presence of state-of-the-art features (eg, formal exploration of the sensitivity of results to assumptions); the others sought substandard quality. Two raters independently scored each original research publication appearing in 4 consecutive issues of Annals for the presence or absence of each relevant item. We then reviewed the formal methodology and statistical review and all subsequent correspondence between authors and editors to determine whether the methodology and statistical review provided guidance regarding each of the 84 items and whether the advice was incorporated into the final manuscript. RESULTS: There were 32 original research articles. One was never subjected to methodology and statistical review. Reviewers agreed on 94% of all items; single-item agreement ranged from 77% to 100%. State-of-the-art features were present in 31 (14%) of 217 ratings; the methodology and statistical review had commented on 13 (42%) of these. State-of-the-art features were absent in 186 (86%) ratings; the methodology and statistical review had commented on 33 (18%) of these. Substandard features were deemed present in 166 (12%) of 1,519 ratings; the methodology and statistical review had commented on 82 (44%) of these. Substandard features were absent in 1,333 (88%) ratings; the methodology and statistical review had commented on 132 (10%) of these. We found no fatal flaws in the published manuscripts. CONCLUSION: Methodology reviewers often failed to comment on deficiencies that they had classified as substandard when designing this study. Reviews also did not encourage inclusion of state-of-the-art abstract, article, and references features. When reviews identified areas in need of improvement, only half of the comments led to improved manuscripts. In the other half, authors either rebuked the suggestions or the editors did not act when suggestions were ignored.

Peer Review, Research↗
PubMed2002

Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.

OBJECTIVE: To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. STUDY SETTING: Nine teaching and community hospital EDs. STUDY DESIGN: A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. DATA COLLECTION: Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. PRINCIPAL FINDINGS: A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040). CONCLUSION: Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.

Attitude of Health Personnel↗
PubMed2002

Advanced statistics: statistical methods for analyzing cluster and cluster-randomized data.

Sometimes interventions in randomized clinical trials are not allocated to individual patients, but rather to patients in groups. This is called cluster allocation, or cluster randomization, and is particularly common in health services research. Similarly, in some types of observational studies, patients (or observations) are found in naturally occurring groups, such as neighborhoods. In either situation, observations within a cluster tend to be more alike than observations selected entirely at random. This violates the assumption of independence that is at the heart of common methods of statistical estimation and hypothesis testing. Failure to account for the dependence between individual observations and the cluster to which they belong can have profound implications on the design and analysis of such studies. Their p-values will be too small, confidence intervals too narrow, and sample size estimates too small, sometimes to a dramatic degree. This problem is similar to that caused by the more familiar "unit of analysis error" seen when observations are repeated on the same subjects, but are treated as independent. The purpose of this paper is to provide an introduction to the problem of clustered data in clinical research. It provides guidance and examples of methods for analyzing clustered data and calculating sample sizes when planning studies. The article concludes with some general comments on statistical software for cluster data and principles for planning, analyzing, and presenting such studies.

Cluster Analysis↗
PubMed2002

Managing the unique size-related issues of pediatric resuscitation: reducing cognitive load with resuscitation aids.

A resuscitation is a complicated event that requires for its optimal outcome the effective completion of a distinct series of actions, some simple, some complex, most occurring simultaneously or in close proximity. In children, these actions are determined not only by the clinical situation, but also by a series of age and size factors particular to each child. Different tasks require different levels of cognitive load, or mental effort. Cognitive load describes the mental burden experienced by the decision maker and will be higher when the task is less familiar or more demanding. In the setting of resuscitation, it refers to the cumulative demands of patient assessment, the ongoing decisions for each of the various steps, and decisions around procedural intervention (e.g., intubation). In children, the level of task complexity and, hence, cognitive load is increased by the unique component of variability of pediatric age and size, introducing logistical factors, many of which involve computations. The purpose of this paper is to examine the effects of age/size-related variables on the pediatric resuscitative process and to explore how these effects can be mitigated using resuscitation aids. The concept of cognitive load and its relation to performance in resuscitation is introduced and is used to demonstrate the effect of the various aids in the pediatric resuscitative process.

Age Factors↗