The influence of standardisation and task load on team coordination patterns during anaesthesia inductions

BACKGROUND: The use of different forms of coordination according to situational demands plays a crucial role in teams working in complex environments. This study aimed to describe patterns of coordinative actions (CAs) as they occur during anaesthesia induction and to analyse the influence of two crucial situational factors on these patterns, namely the amount of existing standards and the level of task load. METHODS: 23 anaesthesia inductions were videotaped, and CAs of the anaesthesia teams were coded. The coding system distinguished between implicit and explicit coordination, coordination via leadership and heedful inter-relating as the individual effort to reach smooth coordination. Five phases within anaesthesia inductions were determined according to their level of standardisation and task load. RESULTS: Overall, 67.7% of all CAs were rated as explicit CA and 32.3% as implicit CAs. When we considered the duration of those CAs, we found the reverse tendency (coordination was explicit 40% of the time and implicit 60% of the time). In highly standardised phases, we observed less explicit coordination, less leadership behaviour and less heedful interrelating compared with less standardised phases. In high-task-load phases, we observed more heedful interrelating than in low-task-load phases. CONCLUSIONS: The anaesthesia teams relied greatly on implicit coordination, which contrasts with findings indicating a performance benefit through explicit coordination in other work settings. Standardisation in the form of written departmental directives may have a supportive effect on coordination by partially substituting for other forms of coordination. The effect of high task load should be tested further in a simulator setting, where high task load can be induced in a more controlled fashion

In VitroCytotoxicity, Chemotactic Effect, and Cellular Uptake of Branched Polypeptides with Poly[l-Lys] Backbone by J774 Murine Macrophage Cell Line

Branched polypeptides with polylysine backbone are promising candidates for selective delivery of drugs, epitopes. or reporter molecules. We reported earlier that polylysine-based polypeptides with polyanionic character were internalized by murine bone marrow derived macrophages via class A scavenger receptor. In the present studies, our investigations were extended to seven polypeptides with different amino acid composition and charge properties. We report on our findings on the concentration-dependent influence of these compounds on survival and chemotaxis of the murine macrophage-like cell line J774 and internalization properties of the polypeptides by J774 cells. Our observations indicate that the polypeptides regardless of their charge properties were essentially nontoxic and did not alter significantly the chemotaxis of J774 cells; therefore, the polypeptides suit the requirements for nontoxic and "neutral" carrier molecules. We also demonstrated that the polypeptides were internalized efficiently by J774 cells, depending on their chemical structure and charge properties. Using the scavenger receptor-ligand fucoidan as inhibitor, we established that the scavenger receptor played a role-in accordance with findings on murine bone marrow derived macrophages in the internalization only of the polyanionic polypeptides

Leadership in anaesthesia teams: the most effective leadership is shared

BACKGROUND: Leadership plays a crucial role in teams working in complex environments, and research has shown that shared leadership where all team members perform leadership functions is an effective strategy. The authors aimed to describe shared leadership patterns during anaesthesia induction and show how they are linked to team performance. METHODS: 12 anaesthesia teams consisting of one resident and one nurse during a simulated anaesthesia induction including a non-routine event (asystole) were videotaped, and two kinds of leadership behaviour (content-oriented and structuring) were coded. Team performance was operationalised as the reaction time to the non-routine event. The amount of leadership sharedness was compared between low- and high-performing teams by performing a univariate analysis of variance. Wilcoxon signed-rank tests were used to analyse the distribution of the two kinds of leadership behaviour among team members. RESULTS: Statistical analysis revealed that in high-performing teams, residents and nurses shared their leadership, while in low-performing teams, residents showed significantly higher levels of leadership behaviour than nurses. Further analyses revealed different distributions of leadership functions among team members. While residents of low-performing teams assumed both kinds of leadership behaviour, members of high-performing teams seemed to have distinct leadership roles: nurses mainly used content-oriented leadership behaviour, and residents tended to show structuring leadership behaviour. CONCLUSIONS: The study documents the effectiveness of shared leadership in situations with high task complexity and indicates that a clear distribution of content-oriented and structuring leadership among team members is an effective strategy. The findings have implications for training in shared leadership and also give rise to a number of recommendations for further research. ClinicalTrials (http://www.clinicaltrials.gov) registration number is NCT00706108

Analysis of the interaction with biomembrane models of the HAV-VP3(101-121) sequence conjugated to synthetic branched chain polypeptide carriers with a poly[L-lysine] backbone

The conjugation of the [Abu105,109 ] VP3(101-121) peptide sequence from the VP3 capsid protein of hepatitis A virus to synthetic branched polypeptide carriers is described. The establishment of either a disulfide or an amide bond between the peptide and the carrier molecules is reported. The interaction of VP3 conjugates with dipalmitoylphosphatidylcholine (DPPC) mono- and bilayers was studied, and the influence of the different hydrophilicities and peptide orientations on the conjugates is discussed. Results showed an increased interaction with biomembrane models due to the conjugation of VP3 peptide to the described macromolecular structures.This work was supported by Grants BIO95-0061-CO3-02 and BIO95-0061-CO3-03 from CICYT, Spain and by Hungarian Research Fund (OTKA) No. T014964. A predoctoral CIRIT grant (FI/95-8109) awarded to M.G. is also acknowledged.Peer reviewe