Leveraging virtual reality to improve medication adherence among marginalized populations with high-risk chronic health conditions: Proof-of-concept protocol, considerations, and next steps.

Marginalized populations experience high prevalence of chronic health conditions - many of which require optimal medication adherence to avoid significant consequences for mortality and morbidity. Yet, marginalization and its complex sequelae create barriers for adherence and access to care, creating a cycle of health inequity. Individuals are not fully benefiting from evidence-based behavioral adherence interventions, like "Life-steps", potentially due to lack of embedded experiential learning, which is key for individuals experiencing complex barriers to medication adherence.

Consensus on Key Attributes of Cardiac Surgeons' Intraoperative Performance.

Objective: To generate a comprehensive model of cardiac surgeons' intraoperative performance, encompassing a wide range of attributes most related to patient safety and surgical outcomes.

Methods: A 3-phase mixed methods study was conducted: (1) an online survey of cardiac surgeons from the National Cardiac Surgery Quality IMPROVEment Network to identify key performance attributes; (2) an expert panel meeting during The Society of Thoracic Surgeons Annual Meeting using video-based recall protocol to extract additional performance attributes; and (3) three rounds of Delphi consensus method to rate attributes' importance. Attributes rated as "very important" or "essential" by ≥80% of participants were included in the final consensus statement.

Incidence of failure-to-rescue after coronary artery bypass grafting: a multicenter observational study from the REPLICCAR II registry in Brazil.

Background: Failure-to-rescue refers to the rate of failure amongst healthcare teams in reversing complications that occur during a patient's hospitalization. This study aimed to investigate the failure-to-rescue rate following coronary artery bypass grafting (CABG).

Methods: Cross-sectional cohort study of the multicenter database "Registro Paulista de Cirurgia Cardiovascular II" (REPLICCAR II), which includes data from nine reference centers for cardiac surgery in São Paulo State.

Multicenter Analysis of the Relationship Between Operative Team Familiarity and Safety and Efficiency Outcomes in Cardiac Surgery.

Background: Safety in cardiac surgical procedures is predicated on effective team dynamics. This study associated operative team familiarity (ie, the extent of clinical collaboration among surgical team members) with procedural efficiency and Society of Thoracic Surgeons (STS) adjudicated patient outcomes.

Methods: Institutional STS adult cardiac surgery registry and electronic health record data from 2014 to 2021 were evaluated across 3 quaternary hospitals.

An Advanced Cardiac Life Support Application Improves Performance during Simulated Cardiac Arrest.

Objectives:  Variability in cardiopulmonary arrest training and management leads to inconsistent outcomes during in-hospital cardiac arrest. Existing clinical decision aids, such as American Heart Association (AHA) advanced cardiovascular life support (ACLS) pocket cards and third-party mobile apps, often lack comprehensive management guidance. We developed a novel, guided ACLS mobile app and evaluated user performance during simulated cardiac arrest according to the 2020 AHA ACLS guidelines via randomized controlled trial.

Exploring Intraoperative Cognitive Biases in Cardiac Surgery Teams.

This study focuses on understanding the influence of cognitive biases in the intra-operative decision-making process within cardiac surgery teams, recognizing the complexity and high-stakes nature of such environments. We aimed to investigate the perceived prevalence and impact of cognitive biases among cardiac surgery teams, and how these biases may affect intraoperative decisions and patient safety and outcomes. A mixed-methods approach was utilized, combining quantitative ratings across 32 different cognitive biases (0 to 100 visual analogue scale), regarding their "likelihood of occurring" and "potential for patient harm" during the intraoperative phase of cardiac surgery.

Feasibility of Wearable Sensors to Assess Cognitive Load During Clinical Performance: Lessons Learned and Blueprint for Success.

Introduction: Cognitive load (CogL) is increasingly recognized as an important resource underlying operative performance. Current innovations in surgery aim to develop objective performance metrics via physiological monitoring from wearable digital sensors. Surgeons have access to consumer technology that could measure CogL but need guidance regarding device selection and implementation.

A novel multimodal, intraoperative cognitive workload assessment of cardiac surgery team members.

Objective: To characterize cognitive workload (CWL) of cardiac surgery team members in a real-world setting during coronary artery bypass grafting (CABG) surgery using providers' heart rate variability (HRV) data as a surrogate measure of CWL.

Methods: HRV was collected from the surgeon, anesthesiologist, perfusionist, and scrub nurse, and audio/video recordings were made during isolated, nonemergency CABG surgeries (n = 27). Eight surgical phases were annotated by trained researchers, and HRV was calculated for each phase.

Deep Learning Analysis of Surgical Video Recordings to Assess Nontechnical Skills.

Importance: Assessing nontechnical skills in operating rooms (ORs) is crucial for enhancing surgical performance and patient safety. However, automated and real-time evaluation of these skills remains challenging.

Objective: To explore the feasibility of using motion features extracted from surgical video recordings to automatically assess nontechnical skills during cardiac surgical procedures.

Adapting the World Health Organization's Surgical Safety Checklist to High-Income Settings: A Hybrid Effectiveness-Implementation Trial Protocol.

Objectives: The proposed study aims to assess users' perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites.

Background: The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization's SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams' modification, implementation, training on, and evaluation of the SSC.

Data-driven coaching to improve statewide outcomes in CABG: before and after interventional study.

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.

Surgical Sabermetrics: A Scoping Review of Technology-enhanced Assessment of Nontechnical Skills in the Operating Room.

Objective: To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance.

Background: Surgeons need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability.

Nontechnical Skills for Intraoperative Team Members.

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).

Implementing ultrasound-guided nerve blocks in the emergency department: A low-cost, low-fidelity training approach.

Background: Managing acute pain is a common challenge in the emergency department (ED). Though widely used in perioperative settings, ED-based ultrasound-guided nerve blocks (UGNBs) have been slow to gain traction. Here, we develop a low-cost, low-fidelity, simulation-based training curriculum in UGNBs for emergency physicians to improve procedural competence and confidence.

Using Digital Biomarkers for Objective Assessment of Perfusionists' Workload and Acute Stress During Cardiac Surgery.

The cardiac operating room (OR) is a high-risk, high-stakes environment inserted into a complex socio-technical healthcare system. During cardiopulmonary bypass (CPB), the most critical phase of cardiac surgery, the perfusionist has a crucial role within the interprofessional OR team, being responsible for optimizing patient perfusion while coordinating other tasks with the surgeon, anesthesiologist, and nurses. The aim of this study was to investigate objective digital biomarkers of perfusionists' workload and stress derived from heart rate variability (HRV) metrics captured via a wearable physiological sensor in a real cardiac OR.

Generative Adversarial Networks in Medicine: Important Considerations for this Emerging Innovation in Artificial Intelligence.

The advent of artificial intelligence (AI) and machine learning (ML) has revolutionized the field of medicine. Although highly effective, the rapid expansion of this technology has created some anticipated and unanticipated bioethical considerations. With these powerful applications, there is a necessity for framework regulations to ensure equitable and safe deployment of technology.

The impact of a smartphone-based cognitive aid on clinical performance during cardiac arrest simulations: A randomized controlled trial.

Objectives: In-hospital cardiac arrests are common and associated with high mortality. Smartphone applications offer quick access to algorithms and timers but often lack real-time guidance. This study assesses the impact of the Code Blue Leader application on the performance of providers leading cardiac arrest simulations.