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Nakamura T, Kobayashi N, Kumazu Y, Fukata K, Murakami M, Kohno S, Hojo Y, Nakao E, Kurahashi Y, Ishida Y, Shinohara H. Precise highlighting of the pancreas by semantic segmentation during robot-assisted gastrectomy: visual assistance with artificial intelligence for surgeons. Gastric Cancer 2024; 27:869-875. [PMID: 38573374 DOI: 10.1007/s10120-024-01495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND A postoperative pancreatic fistula (POPF) is a critical complication of radical gastrectomy for gastric cancer, mainly because surgeons occasionally misrecognize the pancreas and fat during lymphadenectomy. Therefore, this study aimed to develop an artificial intelligence (AI) system capable of identifying and highlighting the pancreas during robot-assisted gastrectomy. METHODS A pancreas recognition algorithm was developed using HRNet, with 926 training images and 232 validation images extracted from 62 scenes of robot-assisted gastrectomy videos. During quantitative evaluation, the precision, recall, intersection over union (IoU), and Dice coefficients were calculated based on the surgeons' ground truth and the AI-inferred image from 80 test images. During the qualitative evaluation, 10 surgeons answered two questions related to sensitivity and similarity for assessing clinical usefulness. RESULTS The precision, recall, IoU, and Dice coefficients were 0.70, 0.59, 0.46, and 0.61, respectively. Regarding sensitivity, the average score for pancreas recognition by AI was 4.18 out of 5 points (1 = lowest recognition [less than 50%]; 5 = highest recognition [more than 90%]). Regarding similarity, only 54% of the AI-inferred images were correctly differentiated from the ground truth. CONCLUSIONS Our surgical AI system precisely highlighted the pancreas during robot-assisted gastrectomy at a level that was convincing to surgeons. This technology may prevent misrecognition of the pancreas by surgeons, thus leading to fewer POPFs.
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Affiliation(s)
- Tatsuro Nakamura
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Nao Kobayashi
- Anaut Inc, WeWork Hibiya Park Front 19F, 2-1-6 Uchisaiwai-cho, Chiyoda-ku, Tokyo, 100-0011, Japan
| | - Yuta Kumazu
- Anaut Inc, WeWork Hibiya Park Front 19F, 2-1-6 Uchisaiwai-cho, Chiyoda-ku, Tokyo, 100-0011, Japan
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawaku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kyohei Fukata
- Anaut Inc, WeWork Hibiya Park Front 19F, 2-1-6 Uchisaiwai-cho, Chiyoda-ku, Tokyo, 100-0011, Japan
| | - Motoki Murakami
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shugo Kohno
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yudai Hojo
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Eiichiro Nakao
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yasunori Kurahashi
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshinori Ishida
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hisashi Shinohara
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Holgaard R, Bruun B, Zingenberg F, Dieckmann P. An interview study about how nurses and physicians talk about the same concepts differently. BMC MEDICAL EDUCATION 2024; 24:698. [PMID: 38926761 PMCID: PMC11210097 DOI: 10.1186/s12909-024-05682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND How healthcare professionals understand and use concepts of social and cognitive capabilities will influence their behaviour and their understanding of others' behaviour. Differing understandings of concepts might lead to healthcare professionals not acting in accordance with other healthcare professionals' expectations. Therefore, part of the problem concerning errors and adverse incidents concerning social and cognitive capabilities might be due to varying understandings of concepts among different healthcare professionals. This study aimed to examine the variations in how educators at the Copenhagen Academy for Medical Education and Simulation talk about social and cognitive capabilities. METHODS The study was conducted using semi-structured interviews and directed content analysis. The codes for the analysis process were derived from existing non-technical skills models and used to show variations in how the participants talk about the same concepts. RESULTS Educators with a background as nurses and physicians, talked differently about leadership and decision-making, with the nurses paying greater attention to group dynamics and external factors when describing both leadership and decision-making, whereas physicians focus on their individual efforts. CONCLUSION We found patterned differences in how the participants described leadership and decision-making that may be related to participants' professional training/background. As it can create misunderstandings and unsafe situations if nurses and physicians disagree on the meaning of leadership and decision-making (without necessarily recognising this difference), it could be beneficial to educate healthcare professionals to be aware of the specificity of their own concepts, and to communicate what exactly they mean by using a particular concept, e.g. "I want you to coordinate tasks" instead of "I want better leadership".
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Affiliation(s)
- Ragnhild Holgaard
- Center for Human Resources, Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Herlev Hospital, 25th floor, Herlev Ringvej 75, Herlev, 2370, Denmark.
| | - Birgitte Bruun
- Center for Human Resources, Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Herlev Hospital, 25th floor, Herlev Ringvej 75, Herlev, 2370, Denmark
| | - Frederik Zingenberg
- Center for Human Resources, Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Herlev Hospital, 25th floor, Herlev Ringvej 75, Herlev, 2370, Denmark
| | - Peter Dieckmann
- Center for Human Resources, Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Herlev Hospital, 25th floor, Herlev Ringvej 75, Herlev, 2370, Denmark
- Department of Public Health, Copenhagen University, Øster Farimagsgade 5, Copenhagen, 1353, Denmark
- Department of Quality and Health Technology, University in Stavanger, Kjell Arholms Gate 43, Stavanger, 4021, Norway
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Chui J, Ng W, Yang V, Duggal N. The Impact of Neuroanesthesia Fellowship Training and Anesthesiologist-Surgeon Dyad Volume on Patient Outcomes in Adult Spine Surgery: A Population-Based Study. J Neurosurg Anesthesiol 2024:00008506-990000000-00115. [PMID: 38910335 DOI: 10.1097/ana.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/15/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Extensive research has explored the impact of surgeons' characteristics on patient outcomes; however, the influence of anesthesiologists remains understudied. We performed a population-based retrospective cohort study to investigate the impact of anesthesiologists' characteristics on in-hospital morbidity after spine surgery. METHODS Adult patients who underwent spine surgery at the London Health Science Centre, Ontario, Canada between January 1, 2010 and June 30, 2023 were included in this study. Data was extracted from the local administrative database. Five anesthesiologists' characteristics (neuroanesthesia fellowship and residency training backgrounds, surgeon familiarity, annual case volume, and sex) were examined as primary exposures. The primary outcome was composite in-hospital morbidity, encompassing 141 complications. Multivariable logistic regression was performed to assess the association between anesthesiologists' characteristics and postoperative morbidity with adjustment of patients' sex, Charlson Comorbidities Index, surgical complexity, and surgeon characteristics. RESULTS A total of 7692 spine surgeries were included in the analysis. Being a neuroanesthesia fellowship-trained anesthesiologist and high anesthesiologist-surgeon annual dyad volume were associated with reduction in in-hospital comorbidity; adjusted odds ratio (95% CI) of 0.58 (0.49-0.69; P<0.001) and 0.93 (0.91-0.95; P<0.001), respectively. Conversely, anesthesiologist annual case volume, characteristics of residency training and anesthesiologist sex showed only nuanced associations with outcomes. CONCLUSIONS Neuroanesthesia fellowship training and high surgeon-anesthesiologist dyad familiarity was associated with a reduction in in-hospital morbidity following spine surgery. These findings underscore the superiority of structured fellowship education over case exposure experience alone, advocate for dedicated neuroanesthesia teams with high surgeon-anesthesiologist dyad volume and recognize neuroanesthesia as a crucial subspecialty in spine surgery.
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Affiliation(s)
- Jason Chui
- Department of Anesthesia and Perioperative Medicine
- Clinical Neurological Science, University of Western Ontario and London Health Science Centre
| | - Wai Ng
- Clinical Neurological Science, University of Western Ontario and London Health Science Centre
- Department of Medical Biophysics, University of Western Ontario
| | - Victor Yang
- Clinical Neurological Science, University of Western Ontario and London Health Science Centre
- Department of Medical Biophysics, University of Western Ontario
- Lawson Research Institute, London, ON, Canada
| | - Neil Duggal
- Clinical Neurological Science, University of Western Ontario and London Health Science Centre
- Department of Medical Biophysics, University of Western Ontario
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Sengun B, Iscan Y, Yazici ZA, Sormaz IC, Aksakal N, Tunca F, Ekenel HK, Giles Senyurek Y. Utilization of artificial intelligence in minimally invasive right adrenalectomy: recognition of anatomical landmarks with deep learning. Acta Chir Belg 2024:1-7. [PMID: 38841838 DOI: 10.1080/00015458.2024.2363599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The primary surgical approach for removing adrenal masses is minimally invasive adrenalectomy. Recognition of anatomical landmarks during surgery is critical for minimizing complications. Artificial intelligence-based tools can be utilized to create real-time navigation systems during laparoscopic and robotic right adrenalectomy. In this study, we aimed to develop deep learning models that can identify critical anatomical structures during minimally invasive right adrenalectomy. METHODS In this experimental feasibility study, intraoperative videos of 20 patients who underwent minimally invasive right adrenalectomy in a tertiary care center between 2011 and 2023 were analyzed and used to develop an artificial intelligence-based anatomical landmark recognition system. Semantic segmentation of the liver, the inferior vena cava (IVC), and the right adrenal gland were performed. Fifty random images per patient during the dissection phase were extracted from videos. The experiments on the annotated images were performed on two state-of-the-art segmentation models named SwinUNETR and MedNeXt, which are transformer and convolutional neural network (CNN)-based segmentation architectures, respectively. Two loss function combinations, Dice-Cross Entropy and Dice-Focal Loss were experimented with for both of the models. The dataset was split into training and validation subsets with an 80:20 distribution on a patient basis in a 5-fold cross-validation approach. To introduce a sample variability to the dataset, strong-augmentation techniques were performed using intensity modifications and perspective transformations to represent different surgery environment scenarios. The models were evaluated by Dice Similarity Coefficient (DSC) and Intersection over Union (IoU) which are widely used segmentation metrics. For pixelwise classification performance, accuracy, sensitivity and specificity metrics were calculated on the validation subset. RESULTS Out of 20 videos, 1000 images were extracted, and the anatomical landmarks (liver, IVC, and right adrenal gland) were annotated. Randomly distributed 800 images and 200 images were selected for the training and validation subsets, respectively. Our benchmark results show that the utilization of Dice-Cross Entropy Loss with the transformer-based SwinUNETR model achieved 78.37%, whereas the CNN-based MedNeXt model reached a 77.09% mDSC score. Conversely, MedNeXt reaches a higher mIoU score of 63.71% than SwinUNETR by 62.10% on a three-region prediction task. CONCLUSION Artificial intelligence-based systems can predict anatomical landmarks with high performance in minimally invasive right adrenalectomy. Such tools can later be used to create real-time navigation systems during surgery in the near future.
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Affiliation(s)
- Berke Sengun
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Yalin Iscan
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Ziya Ata Yazici
- Faculty of Computer and Informatics Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Ismail Cem Sormaz
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Nihat Aksakal
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Fatih Tunca
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Hazim Kemal Ekenel
- Faculty of Computer and Informatics Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Yasemin Giles Senyurek
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
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Gomez-Cabello CA, Borna S, Pressman SM, Haider SA, Forte AJ. Large Language Models for Intraoperative Decision Support in Plastic Surgery: A Comparison between ChatGPT-4 and Gemini. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:957. [PMID: 38929573 PMCID: PMC11205293 DOI: 10.3390/medicina60060957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Large language models (LLMs) are emerging as valuable tools in plastic surgery, potentially reducing surgeons' cognitive loads and improving patients' outcomes. This study aimed to assess and compare the current state of the two most common and readily available LLMs, Open AI's ChatGPT-4 and Google's Gemini Pro (1.0 Pro), in providing intraoperative decision support in plastic and reconstructive surgery procedures. Materials and Methods: We presented each LLM with 32 independent intraoperative scenarios spanning 5 procedures. We utilized a 5-point and a 3-point Likert scale for medical accuracy and relevance, respectively. We determined the readability of the responses using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) score. Additionally, we measured the models' response time. We compared the performance using the Mann-Whitney U test and Student's t-test. Results: ChatGPT-4 significantly outperformed Gemini in providing accurate (3.59 ± 0.84 vs. 3.13 ± 0.83, p-value = 0.022) and relevant (2.28 ± 0.77 vs. 1.88 ± 0.83, p-value = 0.032) responses. Alternatively, Gemini provided more concise and readable responses, with an average FKGL (12.80 ± 1.56) significantly lower than ChatGPT-4's (15.00 ± 1.89) (p < 0.0001). However, there was no difference in the FRE scores (p = 0.174). Moreover, Gemini's average response time was significantly faster (8.15 ± 1.42 s) than ChatGPT'-4's (13.70 ± 2.87 s) (p < 0.0001). Conclusions: Although ChatGPT-4 provided more accurate and relevant responses, both models demonstrated potential as intraoperative tools. Nevertheless, their performance inconsistency across the different procedures underscores the need for further training and optimization to ensure their reliability as intraoperative decision-support tools.
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Affiliation(s)
- Cesar A. Gomez-Cabello
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Sophia M. Pressman
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Syed Ali Haider
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
- Center for Digital Health, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
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de Mattos LA, Rocha R, de Castro Moura Duarte FJ. Human error and violation of rules in industrial safety: A systematic literature review. Work 2024:WOR230186. [PMID: 38820041 DOI: 10.3233/wor-230186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Human error and violation of rules are perceived as deviations from some desired behavior, appearing variably in literature as either similar or opposing concepts. Behavioral deviations may be linked to accidents or considered a protective factor against them. OBJECTIVE This article aims to explore definitions, characteristics, classifications, and management approaches for behavioral deviations, specifically human error and violation of rules. METHODS A systematic literature review was conducted. RESULTS The authors differ in defining and classifying error and violation, associating them with generation of accidents or their prevention. The management proposals for deviations highlighted by the authors were emphasized. CONCLUSION The findings of this article reinforce the prominence of authors Jens Rasmussen and James Reason in the field. They assert that deviations are a natural aspect of the work process and even serve as a preventive factor against accidents, although their frequent association with accidents remains common in organizations. This study contributes to theoretical understanding by systematizing prevalent perspectives on deviation, human error, and violation of rules. It proposes a taxonomy and emphasizing the need for managing deviations, rather than combating them, especially in an organizational context.
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Affiliation(s)
| | - Raoni Rocha
- Ph.D. in Cognitive Sciences and Ergonomics, Professor at Federal University of Ouro Preto, Brazil
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Mejia OAV, Borgomoni GB, de Freitas FL, Furlán LS, Orlandi BMM, Tiveron MG, Silva PGMDBE, Nakazone MA, Oliveira MAPD, Campagnucci VP, Normand SL, Dias RD, Jatene FB. Data-driven coaching to improve statewide outcomes in CABG: before and after interventional study. Int J Surg 2024; 110:2535-2544. [PMID: 38349204 DOI: 10.1097/js9.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/25/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The impact of quality improvement initiatives program (QIP) on coronary artery bypass grafting surgery (CABG) remains scarce, despite improved outcomes in other surgical areas. This study aims to evaluate the impact of a package of QIP on mortality rates among patients undergoing CABG. MATERIALS AND METHODS This prospective cohort study utilized data from the multicenter database Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II), spanning from July 2017 to June 2019. Data from 4018 isolated CABG adult patients were collected and analyzed in three phases: before-implementation, implementation, and after-implementation of the intervention (which comprised QIP training for the hospital team). Propensity Score Matching was used to balance the groups of 2170 patients each for a comparative analysis of the following outcomes: reoperation, deep sternal wound infection/mediastinitis ≤30 days, cerebrovascular accident, acute kidney injury, ventilation time >24 h, length of stay <6 days, length of stay >14 days, morbidity and mortality, and operative mortality. A multiple regression model was constructed to predict mortality outcomes. RESULTS Following implementation, there was a significant reduction of operative mortality (61.7%, P =0.046), as well as deep sternal wound infection/mediastinitis ( P <0.001), sepsis ( P =0.002), ventilation time in hours ( P <0.001), prolonged ventilation time ( P =0.009), postoperative peak blood glucose ( P <0.001), total length of hospital stay ( P <0.001). Additionally, there was a greater use of arterial grafts, including internal thoracic ( P <0.001) and radial ( P =0.038), along with a higher rate of skeletonized dissection of the internal thoracic artery. CONCLUSIONS QIP was associated with a 61.7% reduction in operative mortality following CABG. Although not all complications exhibited a decline, the reduction in mortality suggests a possible decrease in failure to rescue during the after-implementation period.
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Affiliation(s)
- Omar A V Mejia
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo
- Hospital Samaritano Paulista
- Hospital Paulistano
| | - Gabrielle B Borgomoni
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo
- Hospital Samaritano Paulista
- Hospital Paulistano
| | - Fabiane Letícia de Freitas
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo
| | - Lucas S Furlán
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo
| | - Bianca Maria M Orlandi
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo
| | | | | | | | | | | | | | - Roger D Dias
- Harvard Medical School, Boston, Massachusetts, USA
| | - Fábio B Jatene
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo
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Mansoor Q, Qurashi N, Chen Y. A Modular Cataract Surgery Training Model Incorporating Human Factors and a Pedagogical Theory. Clin Ophthalmol 2024; 18:1171-1180. [PMID: 38711573 PMCID: PMC11073136 DOI: 10.2147/opth.s451594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
Synopsis High volume cataract lists are cost-effective, reduce waiting times, and facilitate surgical teaching. We propose a stepwise training model that incorporates human factor principles and a reflective pedagogical approach, which has not been documented previously. Background/Aims Surgical training in ophthalmology is effective when a modular approach is utilised. High volume lists further enhance training by increasing exposure to a newer way of learning and working. We evaluated the efficiency and safety of trainee-assisted cataract surgery across a single NHS eye unit and an independent sector (IS) provider. Methods We examined results from audits of surgical efficiency and safety in trainee-assisted high-volume lists, including a single-centre comparative evaluation of consultant-only and trainee lists. The quantitative and qualitative information gained from these projects helped us to implement a modular, structured training programme that utilises a reflective cycle of pedagogy, suitable for any grade of trainee. Results Our projects included an audit following cataract surgery performed by a surgical trainee over a 5-month period, which showed excellent post-op refractive results and no cases of intra-operative and post-operative complications. A single-centre observational study demonstrated comparable surgical throughput and safety results for trainee and solo consultant high volume lists. Systemic and ocular complication rates were reported to be similar for low and medium risk cataract surgery among trainee supervised IS and NHS lists. Conclusion Cataract surgery outcomes and patient feedback support the effectiveness of the surgical training model. Combining Gibbs' reflective cycle of critical reflection with the International Council of Ophthalmology's principles helped us to develop the QM Model of modular teaching for cataract surgery, which we believe is suitable for utilisation in all surgical centres in the NHS and IS settings, for both low volume and high-volume surgical lists regardless of trainee experience.
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Affiliation(s)
- Qasim Mansoor
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
- Teesside Newmedica Eye Health Clinic & Surgical Centre, Middlesbrough, UK
| | - Neda Qurashi
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - Yunzi Chen
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
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Tesfai FM, Nagi J, Morrison I, Boal M, Olaitan A, Chandrasekaran D, Stoyanov D, Lanceley A, Francis N. Objective assessment tools in laparoscopic or robotic-assisted gynecological surgery: A systematic review. Acta Obstet Gynecol Scand 2024. [PMID: 38610108 DOI: 10.1111/aogs.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION There is a growing emphasis on proficiency-based progression within surgical training. To enable this, clearly defined metrics for those newly acquired surgical skills are needed. These can be formulated in objective assessment tools. The aim of the present study was to systematically review the literature reporting on available tools for objective assessment of minimally invasive gynecological surgery (simulated) performance and evaluate their reliability and validity. MATERIAL AND METHODS A systematic search (1989-2022) was conducted in MEDLINE, Embase, PubMed, Web of Science in accordance with PRISMA. The trial was registered with the Prospective Register of Systematic Reviews (PROSPERO) ID: CRD42022376552. Randomized controlled trials, prospective comparative studies, prospective single-group (with pre- and post-training assessment) or consensus studies that reported on the development, validation or usage of assessment tools of surgical performance in minimally invasive gynecological surgery, were included. Three independent assessors assessed study setting and validity evidence according to a contemporary framework of validity, which was adapted from Messick's validity framework. Methodological quality of included studies was assessed using the modified medical education research study quality instrument (MERSQI) checklist. Heterogeneity in data reporting on types of tools, data collection, study design, definition of expertise (novice vs. experts) and statistical values prevented a meaningful meta-analysis. RESULTS A total of 19 746 titles and abstracts were screened of which 72 articles met the inclusion criteria. A total of 37 different assessment tools were identified of which 13 represented manual global assessment tools, 13 manual procedure-specific assessment tools and 11 automated performance metrices. Only two tools showed substantive evidence of validity. Reliability and validity per tool were provided. No assessment tools showed direct correlation between tool scores and patient related outcomes. CONCLUSIONS Existing objective assessment tools lack evidence on predicting patient outcomes and suffer from limitations in transferability outside of the research environment, particularly for automated performance metrics. Future research should prioritize filling these gaps while integrating advanced technologies like kinematic data and AI for robust, objective surgical skill assessment within gynecological advanced surgical training programs.
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Affiliation(s)
- Freweini Martha Tesfai
- The Griffin Institute, Northwick Park & St Marks' Hospital, London, UK
- EGA Institute for Women's Health, University College London, London, UK
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | | | - Iona Morrison
- Yeovil District Hospital, Somerset Foundation NHS Trust, Yeovil, UK
| | - Matt Boal
- The Griffin Institute, Northwick Park & St Marks' Hospital, London, UK
- EGA Institute for Women's Health, University College London, London, UK
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | | | - Dhivya Chandrasekaran
- EGA Institute for Women's Health, University College London, London, UK
- Department of Gynecological Oncology, University College of London Hospitals, London, UK
| | - Danail Stoyanov
- EGA Institute for Women's Health, University College London, London, UK
- Wellcome/EPSRC Center for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Anne Lanceley
- EGA Institute for Women's Health, University College London, London, UK
| | - Nader Francis
- The Griffin Institute, Northwick Park & St Marks' Hospital, London, UK
- EGA Institute for Women's Health, University College London, London, UK
- Yeovil District Hospital, Somerset Foundation NHS Trust, Yeovil, UK
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Soenens G, Gorden L, Doyen B, Wheatcroft M, de Mestral C, Palter V, Van Herzeele I. Development and Testing of Step, Error, and Event Frameworks to Evaluate Technical Performance in Peripheral Endovascular Interventions. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00252-1. [PMID: 38492630 DOI: 10.1016/j.ejvs.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/22/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Tools for endovascular performance assessment are necessary in competency based education. This study aimed to develop and test a detailed analysis tool to assess steps, errors, and events in peripheral endovascular interventions (PVI). METHODS A modified Delphi consensus was used to identify steps, errors, and events in iliac-femoral-popliteal endovascular interventions. International experts in vascular surgery, interventional radiology, cardiology, and angiology were identified, based on their scientific track record. In an initial open ended survey round, experts volunteered a comprehensive list of steps, errors, and events. The items were then rated on a five point Likert scale until consensus was reached with a pre-defined threshold (Cronbach's alpha > 0.7) and > 70% expert agreement. An experienced endovascular surgeon applied the finalised frameworks on 10 previously videorecorded elective PVI cases. RESULTS The expert consensus panel was formed by 28 of 98 invited proceduralists, consisting of three angiologists, seven interventional radiologists, five cardiologists, and 13 vascular surgeons, with 29% from North America and 71% from Europe. The Delphi process was completed after three rounds (Cronbach's alpha; αsteps = 0.79; αerrors = 0.90; αevents = 0.90), with 15, 26, and 18 items included in the final step (73 - 100% agreement), error (73 - 100% agreement), and event (73 - 100% agreement) frameworks, respectively. The median rating time per case was 4.3 hours (interquartile range [IQR] 3.2, 5 hours). A median of 55 steps (IQR 40, 67), 27 errors (IQR 21, 49), and two events (IQR 1, 6) were identified per case. CONCLUSION An evaluation tool for the procedural steps, errors, and events in iliac-femoral-popliteal endovascular procedures was developed through a modified Delphi consensus and applied to recorded intra-operative data to identify hazardous steps, common errors, and events. Procedural mastery may be promoted by using the frameworks to provide endovascular proceduralists with detailed technical performance feedback.
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Affiliation(s)
- Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. https://www.twitter.com/GillesSoenens
| | - Lauren Gorden
- Division of Vascular Surgery, University of Toronto, Canada; International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Biomedical Engineering (BME), University of Toronto, Canada
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Mark Wheatcroft
- Division of Vascular Surgery, University of Toronto, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, University of Toronto, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Vanessa Palter
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
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11
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Vikan M, Deilkås EC, Valeberg BT, Bjørnnes AK, Husby VS, Haugen AS, Danielsen SO. The anatomy of safe surgical teams: an interview-based qualitative study among members of surgical teams at tertiary referral hospitals in Norway. Patient Saf Surg 2024; 18:7. [PMID: 38374077 PMCID: PMC10877820 DOI: 10.1186/s13037-024-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams' perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department. METHODS This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke's method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes. RESULTS The analysis process resulted in three themes describing the participants' perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning. CONCLUSIONS This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals' competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.
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Affiliation(s)
- Magnhild Vikan
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway.
| | - Ellen Ct Deilkås
- Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Berit T Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Ann K Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Vigdis S Husby
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim, Norway
- Department of Health Sciences Aalesund, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Arvid S Haugen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Stein O Danielsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
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Stucky CH, Michael Hartmann J, Yauger YJ, Romito KJ, Bradley DF, Baza G, Lorenz ME, House SL, Dindinger RA, Wymer JA, Miller MJ, Knight AR. Surgical Safety Does Not Happen By Accident: Learning From Perioperative Near Miss Case Studies. J Perianesth Nurs 2024; 39:10-15. [PMID: 37855761 DOI: 10.1016/j.jopan.2023.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/30/2023] [Indexed: 10/20/2023]
Abstract
Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.
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Affiliation(s)
- Christopher H Stucky
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany.
| | - J Michael Hartmann
- Adult Gerontology-Clinical Nurse Specialist Program, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Young J Yauger
- TriService Nursing Research Program (TSNRP), Bethesda, MD
| | - Kenneth J Romito
- Adult Gerontology-Clinical Nurse Specialist Program, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - David F Bradley
- Adult Gerontology-Clinical Nurse Specialist Program, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Gaston Baza
- Adult Gerontology-Clinical Nurse Specialist Program, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Megan E Lorenz
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Sherita L House
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC
| | - Rebeccah A Dindinger
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Joshua A Wymer
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, CA
| | - Melissa J Miller
- Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Liberty, NC
| | - Albert R Knight
- Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
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Paterson C, Mckie A, Turner M, Kaak V. Barriers and facilitators associated with the implementation of surgical safety checklists: A qualitative systematic review. J Adv Nurs 2024; 80:465-483. [PMID: 37675871 DOI: 10.1111/jan.15841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
AIM Despite the documented benefits of the World Health Organisation Patient Safety Checklist compliance rates with implementation continue to cause risk to patient safety. This qualitative systematic review aimed to explore the reported factors that impact compliance and implementation processes related to surgical safety checklists in perioperative settings. DESIGN A qualitative systematic review. METHODS A systematic review using the Joanna Briggs Institute (JBI) approach to synthesize qualitative studies was conducted and reported according to PRISMA guidelines. Electronic databases were expansively searched using keywords and subject headings. Articles were assessed using a pre-selected eligibility criterion. Data extraction and quality appraisal was undertaken for all included studies and a meta-aggregation performed. DATA SOURCES The CINAHL, Medline and Scopus databases were searched in August 2022 and the search was repeated in June 2023. RESULTS 34 studies were included. Following the synthesis of the findings there were multiple interrelating barriers to checklist compliance that impacted implementation. There were more barriers than enablers reported in existing studies. Enablers included effective leadership, education and training, timely use of audit and feedback, local champions, and the option for local modifications to the surgical checklist. Further research should focus on targeted interventions that improve observed compliance rates to optimize patient safety. CONCLUSION This qualitative systematic review identified multiple key factors that influenced the uptake of the Surgical Safety Checklist in operating theatres. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Surgeon participation, hierarchical culture, complacency, and duplication of existing safety processes were identified which impacted the use and completion of the checklist.
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Affiliation(s)
- Catherine Paterson
- Faculty of Health, University of Canberra, Bruce ACT, Australia
- Caring Futures Institute, Flinders University, Australia
- Central Adelaide Local Health Network, Adelaide
- Robert Gordon University, Aberdeen, Scotland, UK
| | - A Mckie
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - V Kaak
- Faculty of Health, University of Canberra, Bruce ACT, Australia
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14
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Tashiro Y, Aoki T, Kobayashi N, Tomioka K, Kumazu Y, Akabane M, Shibata H, Hirai T, Matsuda K, Kusano T. Color-coded laparoscopic liver resection using artificial intelligence: A preliminary study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:67-68. [PMID: 37877501 DOI: 10.1002/jhbp.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023]
Abstract
Tashiro and colleagues demonstrated for the first time that an artificial intelligence system can precisely identify intrahepatic vascular structures during laparoscopic liver resection in real time through color coding under bleeding and indocyanine green fluorescent imaging. The system supports real-time navigation and offers potentially safer laparoscopic or robotic liver surgery.
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Affiliation(s)
- Yoshihiko Tashiro
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Takeshi Aoki
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | | | - Kodai Tomioka
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | | | - Miho Akabane
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Hideki Shibata
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Takahito Hirai
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Kazuhiro Matsuda
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Tomokazu Kusano
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
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15
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Totonchilar S, Aarabi A, Eftekhari N, Mohammadi M. Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study. Perioper Med (Lond) 2024; 13:1. [PMID: 38167373 PMCID: PMC10763043 DOI: 10.1186/s13741-023-00356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND A high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals. METHODS This cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale. RESULTS A total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons. CONCLUSIONS The results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members' workload.
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Affiliation(s)
| | - Akram Aarabi
- Ardabil University of Medical Science, Ardabil, Iran.
- Isfahan University of Medical Sciences, Isfahan, Iran.
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16
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Kwan JL, Calder LA, Bowman CL, MacIntyre A, Mimeault R, Honey L, Dunn C, Garber G, Singh H. Characteristics and contributing factors of diagnostic error in surgery: analysis of closed medico-legal cases and complaints in Canada. Can J Surg 2024; 67:E58-E65. [PMID: 38320779 PMCID: PMC10852193 DOI: 10.1503/cjs.003523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Diagnostic errors lead to patient harm; however, most research has been conducted in nonsurgical disciplines. We sought to characterize diagnostic error in the pre-, intra-, and postoperative surgical phases, describe their contributing factors, and quantify their impact related to patient harm. METHODS We performed a retrospective analysis of closed medico-legal cases and complaints using a database representing more than 95% of all Canadian physicians. We included cases if they involved a legal action or complaint that closed between 2014 and 2018 and involved a diagnostic error assigned by peer expert review to a surgeon. RESULTS We identified 387 surgical cases that involved a diagnostic error. The surgical specialties most often associated with diagnostic error were general surgery (n = 151, 39.0%), gynecology (n = 71, 18.3%), and orthopedic surgery (n = 48, 12.4%), but most surgical specialties were represented. Errors occurred more often in the postoperative phase (n = 171, 44.2%) than in the pre- (n = 127, 32.8%) or intra-operative (n = 120, 31.0%) phases of surgical care. More than 80% of the contributing factors for diagnostic errors were related to providers, with clinical decision-making being the principal contributing factor. Half of the contributing factors were related to the health care team (n = 194, 50.1%), the most common of which was communication breakdown. More than half of patients involved in a surgical diagnostic error experienced at least moderate harm, with 1 in 7 cases resulting in death. CONCLUSION In our cohort, diagnostic errors occurred in most surgical disciplines and across all surgical phases of care; contributing factors were commonly attributed to provider clinical decision-making and communication breakdown. Surgical patient safety efforts should include diagnostic errors with a focus on understanding and reducing errors in surgical clinical decision-making and improving communication.
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Affiliation(s)
- Janice L Kwan
- From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh).
| | - Lisa A Calder
- From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)
| | - Cara L Bowman
- From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)
| | - Anna MacIntyre
- From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)
| | - Richard Mimeault
- From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)
| | - Liisa Honey
- From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)
| | - Cynthia Dunn
- From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)
| | - Gary Garber
- From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)
| | - Hardeep Singh
- From the Department of Medicine, Sinai Health and University of Toronto, Toronto, Ont. (Kwan); Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ont. (Calder, Bowman, MacIntyre, Mimeault, Honey, Dunn, Garber); the Department of Emergency Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Calder); the Canadian Association of General Surgeons, Kanata, Ont. (Mimeault); the Department of Obstetrics and Gynecology, Queensway Carleton Hospital, Ottawa, Ont. (Honey); the Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ont. (Garber); Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (Singh); and Baylor College of Medicine, Houston, TX, USA (Singh)
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Mathis MR, Janda AM, Yule SJ, Dias RD, Likosky DS, Pagani FD, Stakich-Alpirez K, Kerray FM, Schultz ML, Fitzgerald D, Sturmer D, Manojlovich M, Krein SL, Caldwell MD. Nontechnical Skills for Intraoperative Team Members. Anesthesiol Clin 2023; 41:803-818. [PMID: 37838385 PMCID: PMC10703542 DOI: 10.1016/j.anclin.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Nontechnical skills, defined as the set of cognitive and social skills used by individuals and teams to reduce error and improve performance in complex systems, have become increasingly recognized as a key contributor to patient safety. Efforts to characterize, quantify, and teach nontechnical skills in the context of perioperative care continue to evolve. This review article summarizes the essential behaviors for safety, described in taxonomies for nontechnical skills assessments developed for intraoperative clinical team members (eg, surgeons, anesthesiologists, scrub practitioners, perfusionists). Furthermore, the authors describe emerging methods to advance understanding of the impact of nontechnical skills on perioperative outcomes.
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Affiliation(s)
- Michael R Mathis
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Allison M Janda
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Steven J Yule
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Roger D Dias
- Department of Emergency Medicine, Brigham & Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Korana Stakich-Alpirez
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Fiona M Kerray
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Megan L Schultz
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - David Fitzgerald
- Department of Clinical Sciences, Medical University of South Carolina College of Health Professions, A 151 Rutledge Avenue, Charleston, SC 29403, USA
| | - David Sturmer
- Department of Perfusion, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Milisa Manojlovich
- School of Nursing, University of Michigan, 426 N Ingalls Street, Ann Arbor, MI 48104, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Matthew D Caldwell
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Fahy R, Corbett M, Crotty T, Chadwick L, Keogh I. Totally endoscopic cartilage tympanoplasty: a hierarchical task analysis. J Laryngol Otol 2023; 137:1326-1333. [PMID: 36093951 DOI: 10.1017/s0022215122001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Totally endoscopic ear surgery is a novel method of conducting otological surgery. Hierarchical task analysis and the systematic human error reduction and prediction approach ('SHERPA') are valuable tools that can effectively deconstruct the technical and non-technical skills required to successfully complete a surgical procedure. METHODS Twenty-five endoscopic tragal cartilage tympanoplasties were observed, to identify the tasks and subtasks required for completion of totally endoscopic tragal cartilage tympanoplasty. The systematic human error reduction and prediction approach was used to identify the potential risks and methods, to reduce or remediate these risks. RESULTS A hierarchical task analysis was performed, identifying 8 tasks and 50 subtasks for a safe approach to completing totally endoscopic tragal cartilage tympanoplasty. A risk score for each subtask was calculated to produce a systematic human error reduction and prediction approach and to highlight potential errors. CONCLUSION This hierarchical task analysis allowed for quick reference to a correct method of endoscopic tympanoplasty. The systematic human error reduction and prediction approach was employed to reduce the risks associated with undergoing endoscopic tympanoplasty, to improve patient safety.
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Affiliation(s)
- R Fahy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - M Corbett
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - T Crotty
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - L Chadwick
- Department of Mechanical and Biomedical Engineering, National University of Ireland, Galway, Ireland
| | - I Keogh
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
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19
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Sengun B, Iscan Y, Tataroglu Ozbulak GA, Kumbasar N, Egriboz E, Sormaz IC, Aksakal N, Deniz SM, Haklidir M, Tunca F, Giles Senyurek Y. Artificial Intelligence in Minimally Invasive Adrenalectomy: Using Deep Learning to Identify the Left Adrenal Vein. Surg Laparosc Endosc Percutan Tech 2023; 33:327-331. [PMID: 37311027 DOI: 10.1097/sle.0000000000001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/18/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Minimally invasive adrenalectomy is the main surgical treatment option for the resection of adrenal masses. Recognition and ligation of adrenal veins are critical parts of adrenal surgery. The utilization of artificial intelligence and deep learning algorithms to identify anatomic structures during laparoscopic and robot-assisted surgery can be used to provide real-time guidance. METHODS In this experimental feasibility study, intraoperative videos of patients who underwent minimally invasive transabdominal left adrenalectomy procedures between 2011 and 2022 in a tertiary endocrine referral center were retrospectively analyzed and used to develop an artificial intelligence model. Semantic segmentation of the left adrenal vein with deep learning was performed. To train a model, 50 random images per patient were captured during the identification and dissection of the left adrenal vein. A randomly selected 70% of data was used to train models while 15% for testing and 15% for validation with 3 efficient stage-wise feature pyramid networks (ESFPNet). Dice similarity coefficient (DSC) and intersection over union scores were used to evaluate segmentation accuracy. RESULTS A total of 40 videos were analyzed. Annotation of the left adrenal vein was performed in 2000 images. The segmentation network training on 1400 images was used to identify the left adrenal vein in 300 test images. The mean DSC and sensitivity for the highest scoring efficient stage-wise feature pyramid network B-2 network were 0.77 (±0.16 SD) and 0.82 (±0.15 SD), respectively, while the maximum DSC was 0.93, suggesting a successful prediction of anatomy. CONCLUSIONS Deep learning algorithms can predict the left adrenal vein anatomy with high performance and can potentially be utilized to identify critical anatomy during adrenal surgery and provide real-time guidance in the near future.
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Affiliation(s)
- Berke Sengun
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yalin Iscan
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | | | | | - Ismail C Sormaz
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nihat Aksakal
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | | | - Fatih Tunca
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasemin Giles Senyurek
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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20
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Soenens G, Marchand B, Doyen B, Grantcharov T, Van Herzeele I, Vlerick P. Surgeons' Leadership Style and Team Behavior in the Hybrid Operating Room: Prospective Cohort Study. Ann Surg 2023; 278:e5-e12. [PMID: 35904023 DOI: 10.1097/sla.0000000000005645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the relationship between surgeons' leadership style and team behavior in the hybrid operating room through video coding. Secondly, possible fluctuations possible fluctuations in leadership styles and team behavior during operative phases were studied. BACKGROUND Leadership is recognized as a key component to successful team functioning in high-risk industries. The 'full range of leadership' theory is commonly used to evaluate leadership, marking transformational, transactional, and passive. Few studies have examined the effects of these leadership styles on team behavior in surgery and/or their fluctuations during surgery. METHODS A single-center study included patients planned for routine endovascular procedures. A medical data capture system was used to allow post hoc video coding through Behavior Anchored Rating Scales. Multilevel statistical analysis was performed to assess possible correlations between leadership style and 3 team behavior indicators (speaking up, knowledge sharing, and collaboration) on an operative phase level. RESULTS Twenty-two cases were analyzed (47 hours recording). Transformational leadership is positively related to the extent to which team members work together (γ=0.20, P <0.001), share knowledge (γ=0.45, P <0.001), and speak up (γ=0.64, P <0.001). Passive leadership is significantly positively correlated with speaking up (γ=0.29, P =0.004). Leadership style and team behavior clearly fluctuate during a procedure, with similar patterns across different types of endovascular procedures. CONCLUSIONS Consistent with other professional fields, surgeons' transformational leadership enhances team behavior, especially during the most complex operative phases. This suggests that encouraging surgeons to learn and actively implement a transformational leadership style is meaningful to enhance patient safety and team performance.
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Affiliation(s)
- Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Benoit Marchand
- Department of Work, Organization and Society, Ghent University, Ghent, Belgium
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Teodor Grantcharov
- Department of Surgery, Stanford University, Clinical Excellence Research Center, Stanford, CA
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Peter Vlerick
- Department of Work, Organization and Society, Ghent University, Ghent, Belgium
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21
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Flemming AFS, Carpini JA. Why multi-disciplinary team briefings work. ANZ J Surg 2023; 93:1754-1755. [PMID: 37565639 DOI: 10.1111/ans.18515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 08/12/2023]
Affiliation(s)
- A F Stewart Flemming
- Department of Plastic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Joseph Alexander Carpini
- Management & Organisations Department, University of Western Australia, Perth, Western Australia, Australia
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22
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Arney D, Zhang Y, Kennedy-Metz LR, Dias RD, Goldman JM, Zenati MA. An Open-Source, Interoperable Architecture for Generating Real-Time Surgical Team Cognitive Alerts from Heart-Rate Variability Monitoring. SENSORS (BASEL, SWITZERLAND) 2023; 23:3890. [PMID: 37112231 PMCID: PMC10145698 DOI: 10.3390/s23083890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/09/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
Clinical alarm and decision support systems that lack clinical context may create non-actionable nuisance alarms that are not clinically relevant and can cause distractions during the most difficult moments of a surgery. We present a novel, interoperable, real-time system for adding contextual awareness to clinical systems by monitoring the heart-rate variability (HRV) of clinical team members. We designed an architecture for real-time capture, analysis, and presentation of HRV data from multiple clinicians and implemented this architecture as an application and device interfaces on the open-source OpenICE interoperability platform. In this work, we extend OpenICE with new capabilities to support the needs of the context-aware OR including a modularized data pipeline for simultaneously processing real-time electrocardiographic (ECG) waveforms from multiple clinicians to create estimates of their individual cognitive load. The system is built with standardized interfaces that allow for free interchange of software and hardware components including sensor devices, ECG filtering and beat detection algorithms, HRV metric calculations, and individual and team alerts based on changes in metrics. By integrating contextual cues and team member state into a unified process model, we believe future clinical applications will be able to emulate some of these behaviors to provide context-aware information to improve the safety and quality of surgical interventions.
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Affiliation(s)
- David Arney
- Medical Device Plug-and-Play Interoperability and Cybersecurity Program, Massachusetts General Hospital, Boston, MA 02115, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA
| | - Yi Zhang
- Medical Device Plug-and-Play Interoperability and Cybersecurity Program, Massachusetts General Hospital, Boston, MA 02115, USA
| | | | - Roger D. Dias
- STRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Julian M. Goldman
- Medical Device Plug-and-Play Interoperability and Cybersecurity Program, Massachusetts General Hospital, Boston, MA 02115, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA
| | - Marco A. Zenati
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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23
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Gawria L, Jaber A, Ten Broek RPG, Bernasconi G, Rosenthal R, Van Goor H, Dell-Kuster S. Appraisal of Intraoperative Adverse Events to Improve Postoperative Care. J Clin Med 2023; 12:jcm12072546. [PMID: 37048631 PMCID: PMC10095268 DOI: 10.3390/jcm12072546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Intraoperative adverse events (iAEs) are associated with adverse postoperative outcomes and cause a significant healthcare burden. However, a critical appraisal of iAEs is lacking. Considering the details of iAEs could benefit postoperative care. We comprehensively analyzed iAEs in a large series including all types of operations and their relation to postoperative complications. Methods: All patients enrolled in the multicenter ClassIntra® validation study (NCT03009929) were included in this analysis. The surgical and anesthesia team prospectively recorded all iAEs. Two researchers, blinded to each other’s ratings, appraised all recorded iAEs according to their origin into four categories: surgery, anesthesia, organization, or other, including subcategories such as organ injury, arrhythmia, or instrument failure. They further descriptively analyzed subcategories of all iAEs. Postoperative complications were assessed using the Comprehensive Complication Index (CCI®), a weighted sum of all postoperative complications according to the Clavien–Dindo classification. The association of iAE origins in addition to the severity grade of ClassIntra® on CCI® was assessed with a multivariable mixed-effects generalized linear regression analysis. Results: Of 2520 included patients, 778 iAEs were recorded in 610 patients. The origin was surgical in 420 (54%), anesthesia in 283 (36%), organizational in 34 (4%), and other in 41 (5%) events. Bleeding (n = 217, 28%), hypotension (n = 118, 15%), and organ injury (n = 98, 13%) were the three most frequent subcategories in surgery and anesthesia, respectively. In the multivariable mixed-effect analysis, no significant association between the origin and CCI® was observed. Conclusion: Analyzing the type and origin of an iAE offers individualized and contextualized information. This detailed descriptive information can be used for targeted surveillance of intra- and postoperative care, even though the overall predictive value for postoperative events was not improved by adding the origin in addition to the severity grade.
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Affiliation(s)
- Larsa Gawria
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, 4051 Basel, Switzerland
- Correspondence: or
| | - Ahmed Jaber
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
- Department of Surgery, Yitzhak Shamir Medical Centre, Tel Aviv 7030083, Israel
| | | | - Gianmaria Bernasconi
- Clinic for Anesthesiology and Pain Therapy, Hospital of Fribourg, 1752 Fribourg, Switzerland
| | - Rachel Rosenthal
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| | - Harry Van Goor
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Salome Dell-Kuster
- Department of Surgery, Yitzhak Shamir Medical Centre, Tel Aviv 7030083, Israel
- Clinic for Anesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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24
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Nourrit V, Lamour JB, Abiven B, Fracasso B, de Bougrenet de la Tocnaye JL. Head-Mounted Miniature Motorized Camera and Laser Pointer Driven by Eye Movements. SENSORS (BASEL, SWITZERLAND) 2023; 23:3503. [PMID: 37050563 PMCID: PMC10098879 DOI: 10.3390/s23073503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
Recording a video scene as seen by an observer, materializing where is focused his visual attention and allowing an external person to point at a given object in this scene, could be beneficial for various applications such as medical education or remote training. Such a versatile device, although tested at the experimental laboratory demonstrator stage, has never been integrated in a compact and portable way in a real environment. In this context, we built a low-cost, light-weight, head-mounted device integrating a miniature camera and a laser pointer that can be remotely controlled or servo-controlled by an eye tracker. Two motorizations were implemented and tested (pan/tilt and Rilsey-prisms-based). The video was both recorded locally and transmitted wirelessly. Risley prisms allowed finer remote control of camera or laser pointer orientation (0.1° vs. 0.35°), but data processing and Wi-Fi transmission incur significant latency (~0.5 s) limiting the servo-controlling by eye movements. The laser beam was spatially shaped by a Diffractive Optical Element to facilitate object illumination or recognition. With this first proof-of-concept prototype, the data stream needs to be optimized to make full use of the eye tracker, but this versatile device can find various applications in education, healthcare or research.
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Affiliation(s)
- Vincent Nourrit
- Optics Department, IMT Atlantique, 29238 Brest CEDEX 03, France; (V.N.)
| | | | - Bernard Abiven
- Optics Department, IMT Atlantique, 29238 Brest CEDEX 03, France; (V.N.)
| | - Bruno Fracasso
- Optics Department, IMT Atlantique, 29238 Brest CEDEX 03, France; (V.N.)
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25
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den Boer RB, Jaspers TJM, de Jongh C, Pluim JPW, van der Sommen F, Boers T, van Hillegersberg R, Van Eijnatten MAJM, Ruurda JP. Deep learning-based recognition of key anatomical structures during robot-assisted minimally invasive esophagectomy. Surg Endosc 2023:10.1007/s00464-023-09990-z. [PMID: 36947221 DOI: 10.1007/s00464-023-09990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To develop a deep learning algorithm for anatomy recognition in thoracoscopic video frames from robot-assisted minimally invasive esophagectomy (RAMIE) procedures using deep learning. BACKGROUND RAMIE is a complex operation with substantial perioperative morbidity and a considerable learning curve. Automatic anatomy recognition may improve surgical orientation and recognition of anatomical structures and might contribute to reducing morbidity or learning curves. Studies regarding anatomy recognition in complex surgical procedures are currently lacking. METHODS Eighty-three videos of consecutive RAMIE procedures between 2018 and 2022 were retrospectively collected at University Medical Center Utrecht. A surgical PhD candidate and an expert surgeon annotated the azygos vein and vena cava, aorta, and right lung on 1050 thoracoscopic frames. 850 frames were used for training of a convolutional neural network (CNN) to segment the anatomical structures. The remaining 200 frames of the dataset were used for testing the CNN. The Dice and 95% Hausdorff distance (95HD) were calculated to assess algorithm accuracy. RESULTS The median Dice of the algorithm was 0.79 (IQR = 0.20) for segmentation of the azygos vein and/or vena cava. A median Dice coefficient of 0.74 (IQR = 0.86) and 0.89 (IQR = 0.30) were obtained for segmentation of the aorta and lung, respectively. Inference time was 0.026 s (39 Hz). The prediction of the deep learning algorithm was compared with the expert surgeon annotations, showing an accuracy measured in median Dice of 0.70 (IQR = 0.19), 0.88 (IQR = 0.07), and 0.90 (0.10) for the vena cava and/or azygos vein, aorta, and lung, respectively. CONCLUSION This study shows that deep learning-based semantic segmentation has potential for anatomy recognition in RAMIE video frames. The inference time of the algorithm facilitated real-time anatomy recognition. Clinical applicability should be assessed in prospective clinical studies.
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Affiliation(s)
- R B den Boer
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - T J M Jaspers
- Department of Biomedical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE, Eindhoven, The Netherlands
| | - C de Jongh
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J P W Pluim
- Department of Biomedical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE, Eindhoven, The Netherlands
| | - F van der Sommen
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 19, 5612 AP, Eindhoven, The Netherlands
| | - T Boers
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 19, 5612 AP, Eindhoven, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M A J M Van Eijnatten
- Department of Biomedical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE, Eindhoven, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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26
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Cheikh Youssef S, Haram K, Noël J, Patel V, Porter J, Dasgupta P, Hachach-Haram N. Evolution of the digital operating room: the place of video technology in surgery. Langenbecks Arch Surg 2023; 408:95. [PMID: 36807211 PMCID: PMC9939374 DOI: 10.1007/s00423-023-02830-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The aim of this review was to collate current evidence wherein digitalisation, through the incorporation of video technology and artificial intelligence (AI), is being applied to the practice of surgery. Applications are vast, and the literature investigating the utility of surgical video and its synergy with AI has steadily increased over the last 2 decades. This type of technology is widespread in other industries, such as autonomy in transportation and manufacturing. METHODS Articles were identified primarily using the PubMed and MEDLINE databases. The MeSH terms used were "surgical education", "surgical video", "video labelling", "surgery", "surgical workflow", "telementoring", "telemedicine", "machine learning", "deep learning" and "operating room". Given the breadth of the subject and the scarcity of high-level data in certain areas, a narrative synthesis was selected over a meta-analysis or systematic review to allow for a focussed discussion of the topic. RESULTS Three main themes were identified and analysed throughout this review, (1) the multifaceted utility of surgical video recording, (2) teleconferencing/telemedicine and (3) artificial intelligence in the operating room. CONCLUSIONS Evidence suggests the routine collection of intraoperative data will be beneficial in the advancement of surgery, by driving standardised, evidence-based surgical care and personalised training of future surgeons. However, many barriers stand in the way of widespread implementation, necessitating close collaboration between surgeons, data scientists, medicolegal personnel and hospital policy makers.
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Affiliation(s)
| | | | - Jonathan Noël
- Guy's and St. Thomas' NHS Foundation Trust, Urology Centre, King's Health Partners, London, UK
| | - Vipul Patel
- Adventhealth Global Robotics Institute, 400 Celebration Place, Celebration, FL, USA
| | - James Porter
- Department of Urology, Swedish Urology Group, Seattle, WA, USA
| | - Prokar Dasgupta
- Guy's and St. Thomas' NHS Foundation Trust, Urology Centre, King's Health Partners, London, UK
| | - Nadine Hachach-Haram
- Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
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Stadler C, Luger M, Schauer B, Stevoska S, Gotterbarm T, Klasan A. Failed Attempt to Recommend Noise Cancelling Headphones for Knee Arthroplasty Surgeons-Results of a Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020320. [PMID: 36837521 PMCID: PMC9965943 DOI: 10.3390/medicina59020320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Background and Objectives: Noise exposure during total knee arthroplasty (TKA) has been demonstrated to exceed thresholds that are deemed as over-exposure by industry noise level standards. With orthopedic surgeons being at risk of suffering from Noise Induced Hearing Loss, the purpose of this pilot study was to evaluate the viability of the use of industry grade active noise cancelling headphones (ANCH) during TKA. Material and Methods: In this prospective pilot study, 10 TKA were performed. In five of these cases, surgeon, assistant, scrub nurse and anesthetist wore ANCH with automatic noise level dependent noise attenuation above 82 dB. A validated 14-item questionnaire was used after each case to evaluate the quality of communication, performance, teamwork and mental load. In seven cases a calibrated sound level meter was used to measure the operating theatre noise. Peak sound level (LApeak), A-weighted continuous sound level (LAeq) and A-weighted noise exposure averaged for an 8-h time-period (LEPd) were calculated. Results: There was no perceived benefit of ANCH for the surgeons (p = 0.648), assistants (p = 0.908) and scrub nurses (p = 0.251). There was an overall improvement observed by anesthetists (p = 0.001). A worse communication while wearing ANCH was reported by surgeons but not by the rest of the team. Average LApeak was 90.6 ± 3.2 dB(C), LAeq was 61.9 ± 1.0 dB(A) and LEPd was 53.2 ± 1.2 dB(A). Conclusions: Industry grade ANCH seem to provide no benefit for surgeons, assistants and scrub nurses during TKA, while anesthesiologists seem to benefit from the use of ANCH during TKA. Due to the limitations of this pilot study, further studies with larger study populations are necessary to adequately investigate the use of ANCH during TKA.
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Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
- Correspondence:
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstr. 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
| | - Antonio Klasan
- Johannes Kepler University Linz, Altenberger Str. 96, 4040 Linz, Austria
- AUVA Trauma Hospital Styria Graz, Göstinger Str. 24, 8020 Graz, Austria
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How crises work: A model of error cause and effect in surgical practice. Int J Surg 2022; 104:106711. [PMID: 35717023 DOI: 10.1016/j.ijsu.2022.106711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Surgical crises have major consequences for patients, staff and healthcare institutions. Nevertheless, their aetiology and evolution are poorly understood outside the remit of root-cause analyses. AIMS To develop a crisis model in surgery in order to aid the reporting and management of safety critical events. METHODS A narrative review surveyed the safety literature on failure causes, mechanisms and effects in the context of surgical crises. Sources were identified using non-probability sampling, with selection and inclusion being determined by author panel consensus. The data underwent thematic analysis and reporting followed the recommendation of the SALSA framework. RESULTS Data from 133 sources derived five principal themes. Analysis suggested that surgical care processes become destabilized in a step-wise manner. This crisis chain is initiated by four categories of threat or risk: (i) the systems in which surgeons operate; (ii) surgeons' technical, cognitive and behavioural skills; (iii) surgeons' physiological and psychological state (operational condition); and (iv) professional culture. Once triggered, the crisis chain is driven by only three types of errors: Type I. Performance errors consist of failures to diagnose, plan or execute tasks; Type II. Awareness errors are failures to recognise, comprehend or extrapolate the impact of performance failures; Type III. Rescue errors represent failures to correct faulty performance. The co-occurrence of all three error types gives rise to harm, which can lead to a crisis in the absence of mitigating actions. CONCLUSION Surgical crises may be triggered by four categories of threat and driven by only three types of error. These may represent universal targets for safety interventions that create new opportunities for crisis management.
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Ghosh NK, Kumar A. Colorectal cancer: Artificial intelligence and its role in surgical decision making. Artif Intell Gastroenterol 2022; 3:36-45. [DOI: 10.35712/aig.v3.i2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/02/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Despite several advances in the oncological management of colorectal cancer (CRC), there still remains a lacuna in the treatment strategy, which differs from center to center and on the philosophy of the treating clinician that is not without bias. Personalized treatment is essential for the treatment of CRC to achieve better long-term outcomes and to reduce morbidity. Surgery has an important role to play in the treatment. Surgical treatment of CRC is decided based on clinical parameters and investigations and hence likely to have judgmental errors. Artificial intelligence has been reported to be useful in the surveillance, diagnosis, treatment, and follow-up with accuracy in several malignancies. However, it is still evolving and yet to be established in surgical decision making in CRC. It is not only useful preoperatively but also intraoperatively. Artificial intelligence helps to rectify the human surgical decision when clinical data and radiological and laboratory parameters are fed into the computer and may guide correct surgical treatment.
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Affiliation(s)
- Nalini Kanta Ghosh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
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Kennedy-Metz LR, Barbeito A, Dias RD, Zenati MA. Importance of high-performing teams in the cardiovascular intensive care unit. J Thorac Cardiovasc Surg 2022; 163:1096-1104. [PMID: 33931232 PMCID: PMC8481338 DOI: 10.1016/j.jtcvs.2021.02.098] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Lauren R. Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, Mass,Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Mass
| | - Atilio Barbeito
- Anesthesiology Service, Durham VA Health Care System, Durham, NC,Department of Anesthesiology, Duke University, Durham, NC
| | - Roger D. Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, Mass
| | - Marco A. Zenati
- Department of Surgery, Harvard Medical School, Boston, Mass,Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Mass
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Stahel PF, Cobianchi L, Dal Mas F, Paterson-Brown S, Sakakushev BE, Nguyen C, Fraga GP, Yule S, Damaskos D, Healey AJ, Biffl W, Ansaloni L, Catena F. The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective. Patient Saf Surg 2022; 16:8. [PMID: 35135584 PMCID: PMC8822725 DOI: 10.1186/s13037-022-00317-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
The assurance of patient safety in emergency general surgery remains challenging due to the patients’ high-risk underlying conditions and the wide variability in emergency surgical care provided around the globe. The authors of this article convened as an expert panel on patient safety in surgery at the 8th International Conference of the World Society of Emergency Surgery (WSES) in Edinburgh, Scotland, on September 7–10, 2021. This review article represents the proceedings from the expert panel discussions at the WSES congress and was designed to provide an international perspective on optimizing teamwork and non-technical skills in emergency general surgery.
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Meyer HS, Wagner A, Obermueller T, Negwer C, Wostrack M, Krieg S, Gempt J, Meyer B. Assessment of the incidence and nature of adverse events and their association with human error in neurosurgery. A prospective observation. BRAIN AND SPINE 2022; 2:100853. [PMID: 36248119 PMCID: PMC9560675 DOI: 10.1016/j.bas.2021.100853] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 12/25/2022]
Abstract
Introduction Adverse events in surgery are a relevant cause of costs, disability, or death, and their incidence is a key quality indicator that plays an important role in the future of health care. In neurosurgery, little is known about the frequency of adverse events and the contribution of human error. Research question To determine the incidence, nature and severity of adverse events in neurosurgery, and to investigate the contribution of human error. Material and methods Prospective observation of all adverse events occurring at an academic neurosurgery referral center focusing on neuro-oncology, cerebrovascular and spinal surgery. All 4176 inpatients treated between September 2019 and September 2020 were included. Adverse events were recorded daily and their nature, severity and a potential contribution of human error were evaluated weekly by all senior neurosurgeons of the department. Results 25.0% of patients had at least one adverse event. In 25.9% of these cases, the major adverse event was associated with human error, mostly with execution (18.3%) or planning (5.6%) deficiencies. 48.8% of cases with adverse events were severe (≥SAVES-v2 grade 3). Patients with multiple adverse events (8.6%) had more severe adverse events (67.6%). Adverse events were more severe in cranial than in spinal neurosurgery (57.6 vs. 39.4%). Discussion and conclusion Adverse events occur frequently in neurosurgery. These data can serve as benchmarks when discussing quality-based accreditation and reimbursement in upcoming health care reforms. The high frequency of human performance deficiencies contributing to adverse events shows that there is potential to further eliminate avoidable patient harm. Prospective observation of all patients treated at an academic neurosurgical center. Investigation of the incidence and severity of adverse events and their relation to human error. 25.0% of patients had at least one adverse event. Human error was involved in 25.9% of cases with adverse events. These data provide benchmarks for tertiary care neurosurgery and health care reform.
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Hashimoto M, Sawai S, Oshio M, Yoden M, Takeda K. The risk of footswitch misstep during robot-assisted thoracoscopic surgery: a case report. J Surg Case Rep 2021; 2021:rjab292. [PMID: 34925754 PMCID: PMC8673977 DOI: 10.1093/jscr/rjab292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
The Da Vinci Surgical System is an ergonomically devised and excellent surgical support device. However, surgeon skill is of paramount importance since human error cannot be completely eliminated. We report a case of bleeding from the pulmonary artery due to a footswitch misstep. A 72-year-old male with suspected right upper lobe lung cancer underwent robot-assisted thoracoscopic surgery (RATS). While avoiding the pulmonary artery with the right arm spatula and trying to cauterize V2t with the left arm bipolar-forceps, the footswitch was accidently activated and the spatula was energized, resulting in pulmonary artery trauma and blood loss. After this case, we changed the surgical procedure from a monopolar-bipolar combination use to a bipolar-only use and noted no significant difference in the console duration, and less intraoperative blood loss. Human errors can occur anytime. Especially for surgeons new to RATS, simplified foot management should be considered until RATS mastery is achieved.
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Affiliation(s)
- Masayuki Hashimoto
- Division of Thoracic Surgery, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Satoru Sawai
- Division of Thoracic Surgery, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mayumi Oshio
- Department of Thoracic Surgery, National Hospital Organization Minami Kyoto Hospital, Kyoto, Japan
| | - Makoto Yoden
- Division of Thoracic Surgery, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Keiko Takeda
- Division of Thoracic Surgery, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Kovach CP, Hebbe A, Barón AE, Strobel A, Plomondon ME, Valle JA, Waldo SW. Clinical Characteristics and Outcomes Among Patients Undergoing High-Risk Percutaneous Coronary Interventions by Single or Multiple Operators: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. J Am Heart Assoc 2021; 10:e022131. [PMID: 34775783 PMCID: PMC9075385 DOI: 10.1161/jaha.121.022131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background High-risk percutaneous coronary intervention (HR-PCI) is increasingly common among contemporary patients with coronary artery disease. Experts have advocated for a collaborative 2-operator approach to support intraprocedural decision-making for these complex interventions. The impact of a second operator on patient and procedural outcomes is unknown. Methods and Results Patients who underwent HR-PCI from 2015 to 2018 within the Veterans Affairs Healthcare System were identified. Propensity-matched cohorts were generated to compare the outcomes following HR-PCI performed by a single or multiple (≥2) operators. The primary end point was the 12-month rate of major adverse cardiovascular events. We identified 6672 patients who underwent HR-PCI during the study period; 6211 (93%) were treated by a single operator, and 461 (7%) were treated by multiple operators, with a nonsignificant trend toward increased multioperator procedures over time. A higher proportion of patients treated by multiple operators underwent left main (10% versus 7%, P=0.045) or chronic total occlusion intervention (11% versus 5%, P<0.001). Lead interventionalists participating in multioperator procedures practiced at centers with higher annual HR-PCI volumes (124±71.3 versus 111±69.2; standardized mean difference, 0.197; P<0.001) but otherwise performed a similar number of HR-PCI procedures per year (34.4±35.3 versus 34.7±30.7; standardized mean difference, 0.388; P=0.841) compared with their peers performing single-operator interventions. In a propensity-matched cohort, there was no significant difference in major adverse cardiovascular events (32% versus 30%, P=0.444) between patients who underwent single-operator versus multioperator HR-PCI. Adjusted analyses accounting for site-level variance showed no significant differences in outcomes. Conclusions Patients who underwent multioperator HR-PCI had similar outcomes compared with single-operator procedures. Further studies are needed to determine if the addition of a second operator offers clinical benefits to a subset of HR-PCI patients undergoing left main or chronic total occlusion intervention.
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Affiliation(s)
| | - Annika Hebbe
- Department of Biostatistics and Informatics University of Colorado Aurora CO.,CART Program Office of Quality and Patient Safety Veterans Health Administration Washington DC
| | - Anna E Barón
- Department of Biostatistics and Informatics University of Colorado Aurora CO
| | - Aaron Strobel
- Division of Cardiology Department of Medicine University of Colorado Aurora CO
| | - Mary E Plomondon
- CART Program Office of Quality and Patient Safety Veterans Health Administration Washington DC
| | - Javier A Valle
- Division of Cardiology Department of Medicine University of Colorado Aurora CO.,Department of Medicine, Michigan Heart and Vascular Institute Ann Arbor MI
| | - Stephen W Waldo
- Division of Cardiology Department of Medicine University of Colorado Aurora CO.,CART Program Office of Quality and Patient Safety Veterans Health Administration Washington DC
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Rosengart TK. Assessing clinical competency: The long and the short of it. J Thorac Cardiovasc Surg 2021; 164:1035-1037. [PMID: 34862047 DOI: 10.1016/j.jtcvs.2021.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Todd K Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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Swol J, Brodie D, Willers A, Zakhary B, Belezzo J, Shinar Z, Weingart SD, Haft JW, Lorusso R, Peek GJ. Human factors in ECLS - A keystone for safety and quality - A narrative review for ECLS providers. Artif Organs 2021; 46:40-49. [PMID: 34738639 PMCID: PMC9298045 DOI: 10.1111/aor.14095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/12/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Although the technology used for extracorporeal life support (ECLS) has improved greatly in recent years, the application of these devices to the patient is quite complex and requires extensive training of team members both individually and together. Human factors is an area that addresses the activities, contexts, environments, and tools which interact with human behavior in determining overall system performance. HYPOTHESIS Analyses of the cognitive behavior of ECLS teams and individual members of these teams with respect to the occurrence of human errors may identify additional opportunities to enhance safety in delivery of ECLS. RESULTS The aim of this article is to support health-care practitioners who perform ECLS, or who are starting an ECLS program, by establishing standards for the safe and efficient use of ECLS with a focus on human factor issues. Other key concepts include the importance of ECLS team leadership and management, as well as controlling the environment and the system to optimize patient care. CONCLUSION Expertise from other industries is extrapolated to improve patient safety through the application of simulation training to reduce error propagation and improve outcomes.
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Affiliation(s)
- Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Daniel Brodie
- Department of Medicine and Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York, USA
| | - Anne Willers
- ECLS Centrum, Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Bishoy Zakhary
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph Belezzo
- Emergency Room Sharp Memorial Hospital, San Diego, California, USA
| | - Zachary Shinar
- Emergency Room Sharp Memorial Hospital, San Diego, California, USA
| | - Scott D Weingart
- Department of Emergency Medicine, Division of Emergency Critical Care, Resuscitation and Acute Critical Care Unit, Stony Brook Hospital, Stony Brook, New York, USA
| | - Jonathan W Haft
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Roberto Lorusso
- ECLS Centrum, Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Giles J Peek
- UF Health Shands Children's Hospital, UF Health Congenital Heart Center, Gainesville, Florida, USA
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Kumazu Y, Kobayashi N, Kitamura N, Rayan E, Neculoiu P, Misumi T, Hojo Y, Nakamura T, Kumamoto T, Kurahashi Y, Ishida Y, Masuda M, Shinohara H. Automated segmentation by deep learning of loose connective tissue fibers to define safe dissection planes in robot-assisted gastrectomy. Sci Rep 2021; 11:21198. [PMID: 34707141 PMCID: PMC8551298 DOI: 10.1038/s41598-021-00557-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/13/2021] [Indexed: 02/06/2023] Open
Abstract
The prediction of anatomical structures within the surgical field by artificial intelligence (AI) is expected to support surgeons’ experience and cognitive skills. We aimed to develop a deep-learning model to automatically segment loose connective tissue fibers (LCTFs) that define a safe dissection plane. The annotation was performed on video frames capturing a robot-assisted gastrectomy performed by trained surgeons. A deep-learning model based on U-net was developed to output segmentation results. Twenty randomly sampled frames were provided to evaluate model performance by comparing Recall and F1/Dice scores with a ground truth and with a two-item questionnaire on sensitivity and misrecognition that was completed by 20 surgeons. The model produced high Recall scores (mean 0.606, maximum 0.861). Mean F1/Dice scores reached 0.549 (range 0.335–0.691), showing acceptable spatial overlap of the objects. Surgeon evaluators gave a mean sensitivity score of 3.52 (with 88.0% assigning the highest score of 4; range 2.45–3.95). The mean misrecognition score was a low 0.14 (range 0–0.7), indicating very few acknowledged over-detection failures. Thus, AI can be trained to predict fine, difficult-to-discern anatomical structures at a level convincing to expert surgeons. This technology may help reduce adverse events by determining safe dissection planes.
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Affiliation(s)
- Yuta Kumazu
- Department of Surgery, Yokohama City University, Kanagawa, Japan.,Anaut Inc., Tokyo, Japan
| | | | | | | | | | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Yudai Hojo
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tatsuro Nakamura
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tsutomu Kumamoto
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yasunori Kurahashi
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshinori Ishida
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Kanagawa, Japan
| | - Hisashi Shinohara
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Kennedy-Metz LR, Dias RD, Zenati MA. The Cognitive Relevance of a Formal Pre-incision Time-out in Surgery. ECCE ... : PROCEEDINGS OF THE ... EUROPEAN CONFERENCE ON COGNITIVE ERGONOMICS. EUROPEAN CONFERENCE ON COGNITIVE ERGONOMICS 2021; 2021. [PMID: 34676380 PMCID: PMC8528342 DOI: 10.1145/3452853.3452867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical time-outs are designed to promote situation awareness, teamwork, and error prevention. The pre-incision time-out in particular aims to facilitate shared mental models prior to incision. Objective, unbiased measures to confirm its effectiveness are lacking. We hypothesized that providers’ mental workload would reveal team psychophysiological mirroring during a formal, well-executed pre-incision time-out. Heart rate variability was collected during cardiac surgery cases from the surgeon, anesthesiologist, and perfusionist. Data were analyzed for six cases from patient arrival until sternal closure. Annotation of surgical phases was completed according to previously developed standardized process models of aortic valve replacement and coronary artery bypass graft procedures, producing thirteen total surgical phases. Statistical analysis revealed significant main effects. Tukey HSD post hoc tests revealed significant differences across provider roles within various phases, including Anesthesia Induction, Heparinization, Initiation of Bypass, Aortic Clamp and Cardioplegia, Anastomoses or Aortotomy, Separation from Bypass, and Sternal Closure. Despite these observed differences between providers over various surgical phases, the Pre-incision Time-out phase revealed almost negligible differences across roles. This preliminary work supports the utility of the pre-incision safety checklist to focus the attention of surgical team members and promote shared team mental models, measured via psychophysiological mirroring, using an objective mental workload measure. Future studies should investigate the relationship between psychophysiological mirroring among surgical team members and the effectiveness of the pre-incision time-out checklist.
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Affiliation(s)
- Lauren R Kennedy-Metz
- Medical Robotics and Computer-Assisted Surgery Lab, Harvard Medical School and VA Boston Healthcare System, Boston, MA, US
| | - Roger D Dias
- Human Factors and Cognitive Engineering Lab, STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US
| | - Marco A Zenati
- Medical Robotics and Computer-Assisted Surgery Lab, Harvard Medical School and VA Boston Healthcare System, Boston, MA, US
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Kobayashi N, Shinohara H, Haruta S, Udagawa H, Ueno M. Reducing the risk of postoperative pancreatic fistula in radical gastrectomy: pre-assessment with computed tomography for the diagnosis of pancreatic steatosis. Langenbecks Arch Surg 2021; 407:587-596. [PMID: 34559268 DOI: 10.1007/s00423-021-02337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine whether pancreatic steatosis (PS) is associated with the risk of postoperative pancreatic fistula (POPF) after radical gastrectomy, and if so, to investigate whether pre-assessment by diagnostic imaging can mitigate the risk. METHODS The clinical records of 276 patients with cStage I gastric cancer who underwent laparoscopic gastrectomy with D1 + lymphadenectomy between 2012 and 2015 were reviewed. In the first phase up to July 2013 (n = 138), PS was classified from computed tomography (CT) findings into type S (superficial fat deposition) or type D (diffuse fatty replacement) and examined for association with POPF. In the second phase (n = 138), the preoperative CT assessment of PS was routinized. Separate samples from pancreatoduodenectomy consistent with each type were histologically examined. RESULTS In the first phase, the incidence of POPF was significantly higher in group S, but not in group D, compared with normal pancreas (16.3% and 9.1% vs. 3.6%, respectively; P = 0.03). The drain amylase level was lowest in group D, reflecting exocrine insufficiency. Histologically, the loose connective-tissue space between the fat infiltrating the pancreas and the peripancreatic fat containing the lymph nodes was unclear in type D but conserved in type S. In the second phase, surgery was performed with more intention on accurately tracing the dissection plane and significantly lowered incidence of POPF in Group S (16.3% to 2.1%; P = 0.047). CONCLUSION Peripancreatic lymphadenectomy is more challenging and likely to cause POPF in patients with PS. However, the risk may be reduced using appropriate dissection techniques based on the CT pre-assessment findings.
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Affiliation(s)
- Nao Kobayashi
- Department of Surgery, Tsudanuma General Hospital, Narashino, Japan.,Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hisashi Shinohara
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan. .,Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Urban D, Burian BK, Patel K, Turley NW, Elam M, MacRobie AG, Merry AF, Kumar M, Hannenberg A, Haynes AB, Brindle ME. Surgical Teams' Attitudes About Surgical Safety and the Surgical Safety Checklist at 10 Years: A Multinational Survey. ANNALS OF SURGERY OPEN 2021; 2:e075. [PMID: 36590849 PMCID: PMC9770110 DOI: 10.1097/as9.0000000000000075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
To assess health care professionals' attitudes on the Surgical Safety Checklist ("the Checklist") in resource-rich health systems and provide insights on strategies for optimizing Checklist use. Background In use for over a decade, the Checklist is a safety instrument aimed at improving operating room communication, teamwork, and evidence-based safety practices. Methods An online survey was sent to surgeons, nurses, and anesthesiologists in 5 high-income countries (Canada, the United States, the United Kingdom, Australia, and New Zealand). Survey results were analyzed using SPSS. Results A total of 2032 health care professionals completed the survey. Of these respondents, 47.6% were nurses, 70.5% were women, 65.1% were from the United States, and 50.0% had 20 years of experience or more in their role. Most respondents felt the Checklist positively impacted patient safety (70.9%), team communication (73.1%), and teamwork (58.9%). Only 50.3% of respondents were satisfied their team's use of the Checklist, and only 47.5% reported team members stopping to fully participate in the process. More nurses lacked confidence regarding their role in the Checklist process than surgeons and anesthesiologists combined (8.9% vs 4.3%). Fewer surgeons and anesthesiologists than nurses felt they received adequate training on the Checklist's use (57.8% vs 76.7%). Conclusions While most respondents perceive the Checklist as enhancing patient safety, not all surgical team members are actively engaging with its use. To enhance buy-in and meaningful use of the Checklist, health systems should provide more training on the Checklist with respect to its purpose and strengthening teamwork.
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Affiliation(s)
- Denisa Urban
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | | | - Kripa Patel
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Nathan W. Turley
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Meagan Elam
- School of Public Health, Boston University, Boston, MA
| | - Ali G. MacRobie
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Alan F. Merry
- Department of Anesthesia, University of Auckland, Auckland, New Zealand
| | - Manoj Kumar
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland
| | - Alexander Hannenberg
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
| | | | - Mary E. Brindle
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
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Liu LQ, Mehigan S. A Systematic Review of Interventions Used to Enhance Implementation of and Compliance With the World Health Organization Surgical Safety Checklist in Adult Surgery. AORN J 2021; 114:159-170. [PMID: 34314014 DOI: 10.1002/aorn.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/16/2020] [Accepted: 01/23/2021] [Indexed: 11/10/2022]
Abstract
The focus of this systematic review is to identify and synthesize the evidence for effectiveness of interventions to increase compliance with the World Health Organization Surgical Safety Checklist (SSC) for adult surgery. We searched a variety of databases and identified 24 peer-reviewed articles of either a quantitative (n = 17), qualitative (n = 4), or mixed-methods design (n = 3) published in English from January 1, 2008, to July 8, 2020. Interventions included modifying the ways of delivering the SSC, integrating or tailoring the SSC to local context or existing practice, promoting clinician awareness and engagement, and managing policies. Despite a lack of common outcome measures, all quantitative and mixed-methods study results showed a significant positive effect on SSC compliance. A few researchers reported nonsignificant or negative changes in certain aspects with the interventions. Additional research is needed to address SSC compliance measures globally and outcomes in developing countries.
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Leonard LD, Shaw M, Moyer A, Tevis S, Schulick R, McIntyre R, Ballou M, Reiter K, Lace C, Weitzel N, Wiler J, Meacham R, Cumbler E, Steward L. The surgical debrief: Just another checklist or an instrument to drive cultural change? Am J Surg 2021; 223:120-125. [PMID: 34407917 DOI: 10.1016/j.amjsurg.2021.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Post-procedural debrief is recommended to improve patient safety. We examined operating room (OR) clinicians' perceptions of the impact of a multi-disciplinary debrief on OR culture. METHODS A survey was administered to 182 OR clinicians at a major academic medical center. Attitudes toward the surgical debrief and its effect on patient safety and OR culture were evaluated. RESULTS Majority of clinicians (58.2%) believed creating a culture of safety in the OR was a shared care team responsibility, however, surgical attendings and trainees were more likely to assign this responsibility to the surgical attending. Few circulating nurses and trainees felt comfortable initiating a surgical debrief. Overall clinicians agreed that a debrief would impact both patient safety outcomes and OR culture. CONCLUSIONS Clinicians felt implementation of a surgical debrief would positively affect the OR culture of safety by improving interdisciplinary communication and influencing the power hierarchy that exists in many ORs.
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Affiliation(s)
- Laura D Leonard
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA.
| | - Maxwell Shaw
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA
| | - Amber Moyer
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Sarah Tevis
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Robert McIntyre
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Michelle Ballou
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA
| | - Kaye Reiter
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA
| | - Christopher Lace
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, 12401 East 17th Ave. 7th Floor, Aurora, CO, 80045, USA
| | - Nathaen Weitzel
- Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, 12401 East 17th Ave. 7th Floor, Aurora, CO, 80045, USA
| | - Jennifer Wiler
- UCHealth at University of Colorado Anschutz Medical Campus, 1300 E. 17th Place, Aurora, CO, 80045, USA; Department of Emergency Medicine, University of Colorado, Anschutz Medical Campus, 12401 East 17th Ave. 7th Floor, Aurora, CO 80045, USA
| | - Randall Meacham
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
| | - Ethan Cumbler
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA; Department of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 8601, Aurora, CO, 80045, USA
| | - Lauren Steward
- Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17th Ave. Room 6000, Aurora, CO, 80045, USA
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Schutz A, LeMaire SA, Trautner BW, Rosengart TK. Commentary: Building an academic cardiothoracic surgical program: The Baylor experience. J Thorac Cardiovasc Surg 2021; 163:1435-1436. [PMID: 34024617 DOI: 10.1016/j.jtcvs.2021.04.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Alexander Schutz
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Division of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex
| | - Scott A LeMaire
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
| | - Barbara W Trautner
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex; Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex
| | - Todd K Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
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Kennedy-Metz LR, Dias RD, Stevens RH, Yule SJ, Zenati MA. Analysis of Mirrored Psychophysiological Change of Cardiac Surgery Team Members During Open Surgery. JOURNAL OF SURGICAL EDUCATION 2021; 78:622-629. [PMID: 32863172 PMCID: PMC7904574 DOI: 10.1016/j.jsurg.2020.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/20/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Mirrored psychophysiological change in cognitive workload indices may reflect shared mental models and effective healthcare team dynamics. In this exploratory analysis, we investigated the frequency of mirrored changes, defined as concurrent peaks in heart rate variability (HRV) across team members, during cardiac surgery. DESIGN Objective cognitive workload was evaluated via HRV collected from the primary surgical team during cardiac surgery cases (N = 15). Root mean square of the successive differences (RMSSD) was calculated as the primary HRV measure. Procedures were divided into consecutive nonoverlapping 5-minute segments, and RMSSD along with deviations from RMSSD were calculated for each segment. Segments with positive deflections represent above-average cognitive workload. Positive deflections and peaks across dyads within the same segment were counted. SETTING Data collection for this study took place in the cardiovascular operating room during live surgeries. PARTICIPANTS Physiological data were collected and analyzed from the attending surgeon, attending anesthesiologist, and primary perfusionist involved with the recorded cases. RESULTS Of the 641 five-minute segments analyzed, 325 (50.7%) were positive deflections above average, concurrently across at least 2 team members. Within the 325 positive deflections, 26 (8%) represented concurrent peaks in HRV across at least 2 active team members. Mirrored peaks across team members were observed most commonly during the coronary anastomoses or valve replacement phase (N = 12). CONCLUSIONS In this pilot study, mirrored physiological responses representing peaks in cognitive workload were observed uncommonly across dyads of cardiac surgery team members (1.73 peaks/case on average). Almost half of these occurred during the most technically demanding phases of cardiac surgery, which may underpin teamwork quality. Future work should investigate interactions between technical and nontechnical performance surrounding times of mirrored peaks and expand the sample size.
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Affiliation(s)
- Lauren R Kennedy-Metz
- Medical Robotics and Computer-Assisted Surgery Laboratory, Boston, Massachusetts; VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Roger D Dias
- Harvard Medical School, Boston, Massachusetts; STRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Steven J Yule
- Harvard Medical School, Boston, Massachusetts; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland; Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Marco A Zenati
- Medical Robotics and Computer-Assisted Surgery Laboratory, Boston, Massachusetts; VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Dubuisson A, Kaschten B, Steinmetz M, Gérardy F, Lombard A, Dewandre Q, Reuter G. Iatrogenic nerve injuries: a potentially serious medical and medicolegal problem. About a series of 42 patients and review of the literature. Acta Neurol Belg 2021; 121:119-124. [PMID: 32651878 DOI: 10.1007/s13760-020-01424-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the management of iatrogenic nerve injuries (iNI) in 42 patients. METHODS Retrospective analysis of the charts. RESULTS The iNI occurred mostly during a surgical procedure (n = 39), either on a nerve or plexus (n = 13), on bone, joint, vessel or soft tissue (n = 24) or because of malpositioning (n = 2). The most commonly injured nerves were the brachial plexus, radial, sciatic, femoral, or peroneal nerves. 42.9% of the patients were referred later than 6 months. A neurological deficit was present in 37 patients and neuropathic pain in 17. Two patients were lost to follow-up. Conservative treatment was applied in 23 patients because of good spontaneous recovery or compensation or because of expected bad prognosis whatever the treatment. Surgical treatment was performed in 17 patients because of known nerve section (n = 2), persistent neurological deficit (n = 12) or invalidating neuropathic pain (n = 3); nerve reconstruction with grafts (n = 8) and neurolysis (n = 8) were the most common procedures. Outcome was satisfactory in 50%. Potential reasons of poor outcome were a very proximal injury, placement of very long grafts, delayed referral and predominance of neuropathic pain. According to the literature delayed referral of iNI for treatment is frequent. We provide an illustrative case of a young girl operated on at 6.5 months for femoral nerve reconstruction with grafts while nerve section was obvious from the operative note and pathological tissue analysis. Litigation claims (n = 10) resulted in malpractice (n = 2) or therapeutic alea (n = 5) (3 unavailable conclusions). i CONCLUSIONS: NI can result in considerable disability, pain and litigation. Optimal management is required.
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Alexandrino H, Baptista S, Vale L, Júnior JHZ, Espada PC, Junior DS, Vane LA, Carvalho VH, Marcelo L, Madeira F, Duarte R, Ferreira L, Pereira J, Pinheiro LF, Fraga GP, Mesquita C. Improving Intraoperative Communication in Trauma: The Educational Effect of the Joint DSTC™-DATC™ Courses. World J Surg 2021; 44:1856-1862. [PMID: 32072223 DOI: 10.1007/s00268-020-05421-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario. METHODS Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most. RESULTS All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course. CONCLUSIONS Joint training in the DSTC-DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.
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Affiliation(s)
- Henrique Alexandrino
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal. .,Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Sérgio Baptista
- Centro Hospitalar Médio Tejo, EPE, Av. Maria de Lurdes Melo e Castro, Ap. 118, 2304-909, Tomar, Portugal
| | - Luís Vale
- Hospital Nélio Mendonça and Regional Emergency Service (SRPC/IPRAM) - Serviço de Saúde da RAM, E.P.E, Avenida Luís de Camões, no 57, 9004-514, Funchal, Portugal
| | - José Hélio Zen Júnior
- Hospital e Maternidade Galileo, Valinhos, São Paulo, Brazil.,Faculdade de Ciências Médicas, Pós Graduação em Ciências Médicas, Universidade Estadual de Campinas/UNICAMP, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil
| | - Paulo César Espada
- Departamento de Cirurgia Geral, Faculdade Medicina de São José do Rio Preto-FAMERP, São José de Rio Preto, Brazil
| | | | - Luiz Antonio Vane
- Faculdade de Ciências Médicas, Avenida Brigadeiro Faria Lima, 811, Putim, São José dos Campos, São Paulo, Brazil
| | - Vanessa Henriques Carvalho
- School of Medical Science - Unicamp - Campinas-Brazil School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Lara Marcelo
- Centro Hospitalar Universitário do Porto, EPE, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Filipa Madeira
- Department of Anesthesiology, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | | | - Luís Ferreira
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - Jorge Pereira
- Department of Surgery, Tondela-Viseu Hospital Center, Viseu, Portugal
| | | | - Gustavo Pereira Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Carlos Mesquita
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
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Parsa-Parsi RW. Physician Well-Being and Medical Ethics. South Med J 2021; 114:1-3. [PMID: 33398351 DOI: 10.14423/smj.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sensors for Continuous Monitoring of Surgeon's Cognitive Workload in the Cardiac Operating Room. SENSORS 2020; 20:s20226616. [PMID: 33227967 PMCID: PMC7699221 DOI: 10.3390/s20226616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
Monitoring healthcare providers’ cognitive workload during surgical procedures can provide insight into the dynamic changes of mental states that may affect patient clinical outcomes. The role of cognitive factors influencing both technical and non-technical skill are increasingly being recognized, especially as the opportunities to unobtrusively collect accurate and sensitive data are improving. Applying sensors to capture these data in a complex real-world setting such as the cardiac surgery operating room, however, is accompanied by myriad social, physical, and procedural constraints. The goal of this study was to investigate the feasibility of overcoming logistical barriers in order to effectively collect multi-modal psychophysiological inputs via heart rate (HR) and near-infrared spectroscopy (NIRS) acquisition in the real-world setting of the operating room. The surgeon was outfitted with HR and NIRS sensors during aortic valve surgery, and validation analysis was performed to detect the influence of intra-operative events on cardiovascular and prefrontal cortex changes. Signals collected were significantly correlated and noted intra-operative events and subjective self-reports coincided with observable correlations among cardiovascular and cerebral activity across surgical phases. The primary novelty and contribution of this work is in demonstrating the feasibility of collecting continuous sensor data from a surgical team member in a real-world setting.
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Perez B, Lang C, Henriet J, Philippe L, Auber F. Risk prediction in surgery using case-based reasoning and agent-based modelization. Comput Biol Med 2020; 128:104040. [PMID: 33197734 DOI: 10.1016/j.compbiomed.2020.104040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/14/2020] [Accepted: 10/03/2020] [Indexed: 11/29/2022]
Abstract
Managing the risks arising from the actions and conditions of the various elements that make up an operating room is a major concern during a surgical procedure. One of the main challenges is to define alert thresholds in a non-deterministic context where unpredictable adverse events occur. In response to this problematic, this paper presents an architecture that couples a Multi-Agent System (MAS) with Case-Based Reasoning (CBR). The possibility of emulating a large number of situations thanks to MAS, combined with analytical data management thanks to CBR, is an original and efficient way of determining thresholds that are not defined a priori. We also compared different similarity calculation methods (Retrieve phase of CBR). The results presented in this article show that our model can manage alert thresholds in an environment that manages data as disparate as infectious agents, patient's vitals and human fatigue. In addition, they reveal that the thresholds proposed by the system are more efficient than the predefined ones. These results tend to prove that our simulator is an effective alert generator. Nevertheless, the context remains a simulation mode that we would like to enrich with real data from, for example, monitoring sensors (bracelet for human fatigue, monitoring, etc).
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Affiliation(s)
- Bruno Perez
- FEMTO-ST Institute, Univ. Bourgogne-Franche-Comt é, CNRS, DISC, 16 Route de Gray, 25030, Besan çon, France.
| | - Christophe Lang
- FEMTO-ST Institute, Univ. Bourgogne-Franche-Comt é, CNRS, DISC, 16 Route de Gray, 25030, Besan çon, France.
| | - Julien Henriet
- FEMTO-ST Institute, Univ. Bourgogne-Franche-Comt é, CNRS, DISC, 16 Route de Gray, 25030, Besan çon, France.
| | - Laurent Philippe
- FEMTO-ST Institute, Univ. Bourgogne-Franche-Comt é, CNRS, DISC, 16 Route de Gray, 25030, Besan çon, France.
| | - Frédéric Auber
- Service de Chirurgie Pédiatrique, CHU Besançon, F-25000, Besançon, France; Laboratoire de Nanomédecine, Imagerie, Thérapeutique EA 4662, Université Bourgogne Franche-Comté, F-25000, Besançon, France.
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Mackenzie CF, Elster EA, Bowyer MW, Sevdalis N. Scoping Evidence Review on Training and Skills Assessment for Open Emergency Surgery. JOURNAL OF SURGICAL EDUCATION 2020; 77:1211-1226. [PMID: 32224033 DOI: 10.1016/j.jsurg.2020.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Scope evidence on technical performance metrics for open emergency surgery. Identify surgical performance metrics and procedures used in trauma training courses. DESIGN Structured literature searches of electronic databases were conducted from January 2010 to December 2019 to identify systematic reviews of tools to measure surgical skills employed in vascular or trauma surgery evaluation and training. SETTING AND PARTICIPANTS Faculty of Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland and Implementation Science, King's College, London. RESULTS The evidence from 21 systematic reviews including over 54,000 subjects enrolled into over 840 eligible studies, identified that the Objective Structured Assessment of Technical Skill was used for elective surgery not for emergency trauma and vascular control surgery procedures. The Individual Procedure Score (IPS), used to evaluate emergency trauma procedures performed before and after training, distinguished performance of residents from experts and practicing surgeons. IPS predicted surgeons who make critical errors and need remediation interventions. No metrics showed Kirkpatrick's Level 4 evidence of technical skills training benefit to emergency surgery outcomes. CONCLUSIONS Expert benchmarks, errors, complication rates, task completion time, task-specific checklists, global rating scales, Objective Structured Assessment of Technical Skills, and IPS were found to identify surgeons, at all levels of seniority, who are in need of remediation of technical skills for open surgical hemorrhage control. Large-scale, multicenter studies are needed to evaluate any benefit of trauma technical skills training on patient outcomes.
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Affiliation(s)
| | - Eric A Elster
- The Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Mark W Bowyer
- The Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nick Sevdalis
- Center for Implementation Science, King's College, London, United Kingdom
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