Vasovagal syncope may be due to a transient cerebral hypoperfusion that accompanies frequency entrainment between arterial pressure (AP) and cerebral blood flow velocity (CBFV). We hypothesized that cerebral autoregulation fails during fainting; a phase synchronization index (PhSI) between AP and CBFV was used as a nonlinear, nonstationary, time-dependent measurement of cerebral autoregulation. Twelve healthy control subjects and twelve subjects with a history of vasovagal syncope underwent 10-min tilt table testing with the continuous measurement of AP, CBFV, heart rate (HR), end-tidal CO2 (ETCO2), and respiratory frequency. Time intervals were defined to compare physiologically equivalent periods in fainters and control subjects. A PhSI value of 0 corresponds to an absence of phase synchronization and efficient cerebral autoregulation, whereas a PhSI value of 1 corresponds to complete phase synchronization and inefficient cerebral autoregulation. During supine baseline conditions, both control and syncope groups demonstrated similar oscillatory changes in phase, with mean PhSI values of 0.58+/-0.04 and 0.54+/-0.02, respectively. Throughout tilt, control subjects demonstrated similar PhSI values compared with supine conditions. Approximately 2 min before fainting, syncopal subjects demonstrated a sharp decrease in PhSI (0.23+/-0.06), representing efficient cerebral autoregulation. Immediately after this period, PhSI increased sharply, suggesting inefficient cerebral autoregulation, and remained elevated at the time of faint (0.92+/-0.02) and during the early recovery period (0.79+/-0.04) immediately after the return to the supine position. Our data demonstrate rapid, biphasic changes in cerebral autoregulation, which are temporally related to vasovagal syncope. Thus, a sudden period of highly efficient cerebral autoregulation precedes the virtual loss of autoregulation, which continued during and after the faint.

Global health partnerships between high-income countries and low/middle-income countries can mirror colonial relationships. The growing call to advance global health equity therefore involves decolonising global health partnerships and outreach. Through decolonisation, local and international global health partners recognise non-western forms of knowledge and authority, acknowledge discrimination and disrupt colonial structures and legacies that influence access to healthcare.Despite these well-described aims, the ideal implementation process for decolonising global health remains ill-defined. This ambiguity exists, in part, because partners face barriers to adopting a decolonised perspective. Such barriers include overemphasis on intercountry relationships, implicit hierarchies perpetuated by educational interventions and ethical dilemmas in global health work.In this article, we explore the historical entanglement of education, health and colonialism. We then use this history as context to identify barriers that arise when decolonising contemporary educational global health partnerships. Finally, we offer global health partners strategies to address these challenges.

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Background: Patient transitions create vulnerability for care teams. Failures in the handoff process result in communication errors and knowledge gaps, mainly when the handoff occurs between resident and expert-level subspecialty clinicians. The authors set out to develop a standardized handoff using resident comfort as a proxy for implementation. The primary measurable aim of this study was to increase the percentage of pediatric residents who self-reported comfort in assuming care of patients transitioned from the cardiac intensive care unit to the cardiology acute care unit. Methods: Investigators surveyed residents at a 323-bed pediatric hospital on their handoff experiences. The study team performed a Failure Mode Effect Analysis and created a key driver diagram. Interventions included a transfer checklist and algorithm, a huddle between care teams, and education surrounding the transfer process. Results: Residents completed a survey before (n = 74) or after (n = 23) intervention. The percentage of residents who reported feeling “always” or “very often” prepared to care for patients at the time of transfer increased from 15% to 83%. The percentage of residents who reported that they “always” or “very often” had concerns about floor appropriateness decreased from 23% to 4%. Conclusions: The authors designed a transfer process to improve communication, resident-level education, and psychological safety among team members to ensure safe, thorough handoffs between providers with different levels of training. Although we cannot definitively conclude that resident comfort improved due to a small “n” postintervention, we offer a description outlining process changes, barriers to implementation, and lessons learned.

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BackgroundFirst‐year residents frequently encounter conflict during their training. Residents' conflict management strategies can influence patient safety, quality of care and perceptions of performance on competency evaluations. Existing literature inadequately describes how first‐year resident conflict management styles evolve over time.ObjectiveThe objective of this study is to assess if and how conflict management styles change during first year of paediatric residency in the United States.MethodsIn 2021–2022, we conducted a non‐experimental, longitudinal, survey study of first‐year residents from 16 US‐based paediatric residency programmes. Using the Thomas–Kilmann Conflict Mode Instrument, we scored first‐year residents' use of five conflict management modes twice, 6 months apart. We calculated the percentage of first‐year residents who experienced a change in predominant conflict management mode and assessed for changes in score and variance for each conflict management mode.ResultsFifty‐seven (18%) first‐year residents participated in the first survey. Of those, 45 (14%) also completed the follow‐up survey. Nonresponse bias analysis showed no significant difference in scores for early and late respondents or for second‐survey respondents and non‐respondents. Half of respondents experienced a change in predominant conflict management mode, but the distribution of predominant modes remained largely unchanged. When residents changed modes, they typically moved from one low‐assertiveness mode, such as avoiding or accommodating, to the other. Only the use of the compromising conflict management mode significantly decreased. Variance did not significantly change.ConclusionsThe overall lack of change in conflict management style may suggest the need for specific and focused educational interventions to help residents adjust their conflict handling strategies.