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 TM (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 5 .012). Subjective workload was not affected by the intervention ( p 5 .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group ( p 5 .039). In the experimental group, the ED staffs' attitudes toward teamwork increased ( p 5 .047) and staff assessments of institutional support showed a significant increase ( p 5 .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.

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Objective: Family-centered care is becoming a standard of care in neonatal intensive care units (NICUs). The purpose of this study was to evaluate the impact of a national program designed to promote family-centered care in NICUs and to provide information and comfort to families during the NICU hospitalization of their newborn.Study Design: A quasi-experimental, post-only design was utilized, examining eight March of Dimes NICU Family Support s (NFS) sites.Data were gathered via telephone interviews with NICU administrators and surveys of both NICU staff and NICU families.Result: NICU administrators interviewed identified benefits of NFS, including culture change and additional support to families. Surveys of NICU staff showed that NFS enhances the overall quality of NICU care resulting in less stressed, more informed and confident parents. Surveys of NICU families showed that NFS both reduced their stress and made them feel more confident as their baby's parent. Conclusion:March of Dimes NFS has had a positive impact on the stress level, comfort level and parenting confidence of NICU families. In addition, it has enhanced the receptivity of staff to the presence and benefits of family-centered care.

Our analysis shows evidence of a newly identified abnormal growth pattern for children with Hutchinson-Gilford progeria syndrome. The skeletal and dental findings are suggestive of a developmental dysplasia rather than a classical aging process. The presence of decreased and linear weight gain, maintained in all of the patients after the age of 2 years, provides the ideal parameter on which altered disease status can be assessed in clinical trials.

We developed a sensitive clinical decision rule with a high NPV for detection of intracranial injury in minor pediatric head trauma. If validated, this rule could provide a useful adjunct to the physician's clinical assessment by reducing variations in practice and unnecessary cranial CT.

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III.