Articles: cations.
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The operating room (OR) remains a challenging and hierarchical work environment within healthcare, where the attending surgeon functions as a team captain. Unprofessional behavior or disconnects in this environment can lead to breakdowns in teamwork and reports within the safety event reporting system (SERS). Interventions focused on remediating adverse behaviors and team interactions should optimize team function and potentially enhance patient outcomes. The aim of the present study focused on decreasing the SERS reports regarding behavior and communication disconnects from November 2019 to March 2023. ⋯ The multidisciplinary task force developed and adapted a process to address communication and behavioral concerns in an efficient and supportive manner, with the objective of restoring relationships among team members in the perioperative environment and deweaponizing the SERS.
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Anesthesia and analgesia · Feb 2025
Defining Postinduction Hemodynamic Instability With an Automated Classification Model.
Postinduction hypotension (PIH) may be associated with increased morbidity and mortality. In earlier studies, the definition of PIH is solely based on different absolute or relative thresholds. However, the time-course (eg, how fast blood pressure drops during induction) is rarely incorporated, whereas it might represent the hemodynamic instability of a patient. We propose a comprehensive model to distinguish hemodynamically unstable from stable patients by combining blood pressure thresholds with the magnitude and speed of decline. ⋯ Based on the high sensitivity and specificity, the developed model is able to differentiate between clinically relevant hemodynamic instability and hemodynamic stable patients. This classification model will pave the way for future research concerning hemodynamic instability and its prevention.
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Introduction: Unplanned intensive care unit (ICU) admissions are associated with increased morbidity and mortality. This study uses interpretable machine learning to predict unplanned ICU admissions for initial nonoperative trauma patients admitted to non-ICU locations. Methods: TQIP (2020-2021) was queried for initial nonoperative adult patients admitted to non-ICU locations. ⋯ Dependency plots showed greater SHAP values for greater ISS, age, and presence of comorbidities. Conclusions: Machine learning may outperform prior attempts at predicting the risk of unplanned ICU admissions in trauma patients while identifying unique predictors. Despite this progress, further research is needed to improve predictive performance by addressing class imbalance limitations.
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Existing research exploring predictors of success on American Board of Surgery (ABS) examinations focused on either resident or residency program characteristics, but limited studies focus on both. This study examines relationships between both resident and program characteristics and ABS qualifying (QE) and certifying examination (CE) outcomes. ⋯ This study highlights resident and program characteristics that predict success on ABS examinations. USMLE scores consistently and strongly related to ABS examination success, providing evidence that USMLE scores relate to future high-stakes consequences like board certification. After controlling for previous performance, gender, IMG, and program %IMG significantly related to ABS examination success, but effects were small.
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Anesthesia and analgesia · Feb 2025
Multicenter Study Comparative StudyBronchial Blocker Versus Endobronchial Intubation in Young Children Undergoing One-Lung Ventilation: A Multicenter Retrospective Cohort Study.
Thoracic surgery and one-lung ventilation in young children carry significant risks. Approaches to one-lung ventilation in young children include endobronchial intubation (mainstem intubation) and use of a bronchial blocker. We hypothesized that endobronchial intubation is associated with a greater prevalence of airway complications compared to use of a bronchial blocker. ⋯ Endobronchial intubation might be associated with a slightly increased risk of critical airway complications compared to use of a bronchial blocker in young children undergoing thoracic surgery and one-lung ventilation. Further, prospective studies are needed before a definitive change in practice is recommended.