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The "handoff" phase of patient care is frequently associated with the genesis of adverse events. Patient handoffs in anesthesia care remain poorly studied. By reviewing archived video of anesthesia handoffs taking place in a simulated environment, we aimed to identify latent conditions and their impact on the quality and nature of handoffs occurring during surgical anesthesia care. Four trained coders assessed 58 handoffs occurring in 58 different simulated cases, for the presence or absence of 4 latent conditions: distractions, production pressure, noninteractive communication, and inappropriately timed handoff. Latent hazards frequently jeopardized handoff quality. Distractions and interruptions were conditions observed in 82% of cases; independently these did not appear to degrade handoff quality. The latent condition noninteractive communication was the greatest predictor of poor handoff scores (P < .001). Handoffs were often good or excellent with 0, 1, or 2 latent conditions present, but with 3 or more latent conditions, the quality invariably degraded. When handoff scores were high, the handoffs were always interactive. This is the first study to relate specific latent conditions to handoff quality, providing a foundation for future research, as well as for the education and training of anesthesia providers. [ABSTRACT FROM AUTHOR]

Context: As evidence-based practice (EBP) becomes a necessity in athletic training, Web-based modules have been developed and made available to the National Athletic Trainers' Association membership as a mechanism to educate athletic trainers (ATs) on concepts of EBP. Objective: To assess the effect of an educational intervention on enhancing knowledge of EBP among ATs. Design: Randomized controlled trial. Setting: Web-based modules and knowledge assessment. Patients or Other Participants: A total of 164 of 473 ATs (34.7% response rate), including professional athletic training students, graduate students, clinical preceptors, educators, and clinicians, were randomized into a control group (40 men, 42 women) or experimental group (33 men, 49 women). Intervention(s): Ten Web-based modules were developed that covered concepts involved in the EBP process. Both groups completed the Evidence-Based Practice Knowledge Assessment before and after the intervention phase. During the intervention phase, the experimental group had access to the Web-based modules for 4 weeks, whereas the control group had no direct responsibilities for the investigation. The knowledge assessment consisted of 60 multiple choice questions pertaining to concepts presented in the 10 modules. Test-retest reliability was determined to be good (intraclass correlation coefficient [2,1] = 0.726, 95% confidence interval = 0.605, 0.814). Main Outcome Measure(s): Independent variables consisted of group (control, experimental) and time (preassessment, postassessment). Knowledge scores were tabulated by awarding 1 point for each correct answer (maximum = 60). Between-group and within-group differences were calculated using a 2 3 2 repeated-measures analysis of variance (P ≤ .05), post hoc t tests, and Hedges g effect size with 95% confidence intervals. Results: We found a group 3 time interaction (F1,162 = 26.29, P < .001). No differences were identified between the control (30.12 ± 5.73) and experimental (30.65 ± 5.93) groups during the preassessment (t162 = 0.58, P = .84). The experimental group (36.35 6 8.58) obtained higher scores on the postassessment than the control group (30.99 ± 6.33; t162 = 4.55, P = .01). No differences were identified among time instances within the control group (t81 =1.77, P=.08); however, the experimental group obtained higher scores on the postassessment than the preassessment (t81 = 7.07, P < .001). Conclusions: An educational intervention consisting of 10 Web-based modules was an effective mechanism to increase knowledge of foundational EBP concepts among ATs. However, it is not known whether ATs are integrating EBP into daily clinical practice. Researchers should determine whether increased knowledge of EBP affects the daily clinical decision making of ATs. [ABSTRACT FROM AUTHOR]

Context: Quadriceps-activation deficits have been reported after meniscectomy. Transcranial magnetic stimulation (TMS) in conjunction with maximal contractions affects quadriceps activation in patients after meniscectomy. Objective: To determine the effect of single-pulsed TMS on quadriceps central activation ratio (CAR) in patients after meniscectomy. Design: Randomized controlled clinical trial. Setting: University laboratory. Patients or Other Participants: Twenty participants who had partial meniscectomy and who had a CAR less than 85% were assigned randomly to the TMS group (7 men, 4 women; age = 38.1 ± 16.2 years, height = 176.8 ± 11.5 cm, mass = 91.8 ± 27.5 kg, postoperative time = 36.7 ± 34.9 weeks) or the control group (7 men, 2 women; age = 38.2 ± 17.5 years, height = 176.5 ± 7.9 cm, mass = 86.2 ± 15.3 kg, postoperative time = 36.6 ± 37.4 weeks). Intervention(s): Participants in the experimental group received TMS over the motor cortex that was contralateral to the involved leg and performed 3 maximal quadriceps contractions with the involved leg. The control group performed 3 maximal quadriceps contractions without the TMS. Main Outcome Measure(s): Quadriceps activation was assessed using the CAR, which was measured in 70° of knee flexion at baseline and at 0, 10, 30, and 60 minutes posttest. The CAR was expressed as a percentage of full activation. Results: Differences in CAR were detected over time (F4,72 = 3.025, P =.02). No interaction (F4,72 = 1.457, P = .22) or between-groups differences (F1,18 = 0.096, P = .76) were found for CAR. Moderate CAR effect sizes were found at 10 (Cohen d = 0.54, 95% confidence interval [CI] = −0.33, 1.37) and 60 (Cohen d = 0.50, 95% CI = −0.37, 1.33) minutes in the TMS group compared with CAR at baseline. Strong effect sizes were found for CAR at 10 (Cohen d = 0.82, 95% CI = −0.13, 1.7) and 60 (Cohen d = 1.06, 95% CI = 0.08, 1.95) minutes in the TMS group when comparing percentage change scores between groups. Conclusions: No differences in CAR were found between groups at selected points within a 60-minute time frame, yet moderate to strong effect sizes for CAR were found at 10 and 60 minutes in the TMS group, indicating increased activation after TMS. [ABSTRACT FROM AUTHOR]