Irving, Sharon Y

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  • Publication
    Training Hospital Providers in Basic CPR Skills in Botswana: Acquisition, Retention and Impact of Novel Training Techniques
    (2012-12-01) Meaney, Peter A; Sutton, Robert M; Tsima, Billy M; Steenhoff, Andrew P; Niles, Dana E; Irving, Sharon Y; Shilkofski, Nicole; Boulet, John R; Nadkarni, Vinay; Davis, Amanda; Kestler, Andrew M; Church, Kasey K; Mazhani, Loeto
    Objective Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana. Methods HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6 months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation. Results Of 214 HCP trained, 40% resuscitate ≥1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p < 0.01; adult 28% vs. 48%, p < 0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p < 0.01) and 6 months (38% vs. 67%, p < 0.01), and adult CPR skills were retained to 3 months (34% vs. 51%, p = 0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance. Conclusions HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction.
  • Publication
    Patterns of Weight Change in infants With Congenital Heart Disease Following Neonatal Surgery: Potential Predictors of Growth Failure
    (2011-12-21) Irving, Sharon Y; Irving, Sharon Y; Irving, Sharon Y
    Abstract Patterns of Weight Change in Infants with Congenital Heart Disease Following Neonatal Surgery: Potential predictors of growth failure Sharon Y Irving DISSERTATION SUPERVISOR: BARBARA MEDOFF-COOPER, RN, PhD Congenital heart disease (CHD) is reported to have an incidence of 9 to 14 per 1000 live births with a prevalence estimated between 650,000 and 1.3 million persons in the United States (US). It is a structural malformation(s) of one or more heart chamber(s) and/or deformity of one or more of the major intrathoracic blood vessel(s) and the ensuing malady occurring during embryonic development. Up to one-third of infants with CHD, require surgical intervention. Improved surgical technique over the last several decades has seen an increased survival of neonates with CHD. Concomitantly there has been an emergence of co-morbidities. Growth failure is a common co-morbidity following neonatal surgery for CHD. More than 30% of these infants fall below the third percentile for weight early in their lives. Postsurgical physiology, disease severity, feeding dysfunction, and a hypermetabolic state may all contribute to growth failure, which has been associated with deficits in cognitive development, intellectual ability and neurodevelopment, effecting maturation and school performance. Early recognition and intervention of growth failure can improve health outcomes. The objective of this work is to identify patterns of growth and growth failure in infants with CHD and explore potential predictors that may be modifiable to mitigate growth failure and prevent the associated untoward consequences.