Cross-sectional survey of Australian and New Zealand clinical staff to explore attitudes regarding medication prescription and administration during neonatal emergencies.

AIM: To survey Australasian neonatal medical and nursing staff to determine confidence regarding medication use, prior experience with medication errors and common resources utilised in neonatal emergencies. METHODS: Data were collected through a cross-sectional online survey distributed to clinical staff affiliated with the Australian and New Zealand Neonatal Network. Information collected included: demographics, confidence in medication use, medication errors and resources used to assist with medication administration. Outcomes were compared between medical staff and nursing staff, and between clinical staff with differing levels of clinical experience (<5 years, 5-10 years and >10 years). RESULTS: Respondents (n = 133) were most confident in calculating medication doses (89%, n = 119), but least confident in prescribing medication (50%, n = 67). Nurses were more likely to be confident than doctors with respect to appropriately diluting and drawing up medication (88% nurses vs. 28% doctors, P < 0.0001), and administering intravenous medications to critically ill neonates (97% nurses vs. 82% doctors, P < 0.01). Over half of respondents reported being personally involved in a medication error in the last 12 months: 33% had been involved in an error related to delayed administration, 18% related to incorrect documentation and 17% related to an incorrect dose. Free-text responses highlighted issues relating to adrenaline (epinephrine) administration and difficulties with equipment (syringe drivers and/or infusion pumps). CONCLUSIONS: Medication errors in neonatal emergencies are common. Strategies to reduce such errors should be implemented in settings where neonates may require emergency care or resuscitation.

Interaction of task-related learning and transcranial direct current stimulation of the prefrontal cortex in modulating executive functions.

The effects of transcranial direct-current stimulation (tDCS) on cognitive functions, such as response inhibition, might be mediated through plastic changes within the prefrontal cortex. Previous studies have also confirmed learning-related plasticity in prefrontal neurocircuitry. The susceptibility of prefrontal neurocircuitry for tDCS-induced plastic changes and consequent behavioural modulations might depend on the level of learning in a particular task. Variabilities in the cognitive outcome of tDCS might be related to the interaction of tDCS and task-relevant learning. 73 participants completed the Stop Task before and after tDCS over the dorsolateral prefrontal cortex. Participants had to deliver a speeded response upon the onset of a visual go-cue and inhibit the response when the go-cue was replaced by a stop signal. We measured response time (RT) in Go trials, and stop signal reaction time (SSRT) as an index of inhibition ability. A shorter SSRT indicates a better inhibition ability. Participants received either anodal or sham stimulation in two separate sessions (one week apart). RT was increased and SSRT became shorter from pre-stimulation to post-stimulation testing, indicating within-session learning. Furthermore, compared to the first week of testing, RT was increased and SSRT became shorter in the second week, indicating across-session learning. Within-session learning was significantly higher if anodal stimulation was given in the first week rather than the second week indicating that the behavioural effects of tDCS were dependent on the level of learning. Our findings indicate that tDCS effects on executive functions are dependent on the level of experience (learning) in the cognitive task.

Interactive effects of music and prefrontal cortex stimulation in modulating response inhibition.

Influential hypotheses propose that alterations in emotional state influence decision processes and executive control of behavior. Both music and transcranial direct current stimulation (tDCS) of prefrontal cortex affect emotional state, however interactive effects of music and tDCS on executive functions remain unknown. Learning to inhibit inappropriate responses is an important aspect of executive control which is guided by assessing the decision outcomes such as errors. We found that high-tempo music, but not low-tempo music or low-level noise, significantly influenced learning and implementation of inhibitory control. In addition, a brief period of tDCS over prefrontal cortex specifically interacted with high-tempo music and altered its effects on executive functions. Measuring event-related autonomic and arousal response of participants indicated that exposure to task demands and practice led to a decline in arousal response to the decision outcome and high-tempo music enhanced such practice-related processes. However, tDCS specifically moderated the high-tempo music effect on the arousal response to errors and concomitantly restored learning and improvement in executive functions. Here, we show that tDCS and music interactively influence the learning and implementation of inhibitory control. Our findings indicate that alterations in the arousal-emotional response to the decision outcome might underlie these interactive effects.