Citations

The adoptions of briefing and debriefing protocols have evolved from the Joint Commission’s initiative to improve communication and safety in the operating room. Briefing normally occurs prior to incision and is used to discuss and confirm critical information, while debriefing occurs during or after surgery. Debriefing provides a unique opportunity for individuals and teams to immediately reflect on their performance, allowing them to more easily identify errors and develop plans to improve their next performance. Studies have shown that using briefings and debriefings improve communication and teamwork. However, there is still much to learn about the value of both for surgical teams. This paper presents a robust methodology for examining and measuring the impacts of surgical team briefings and debriefings on teamwork. The methodology includes (1) audio/video recording the surgical care process, (2) prospective observations using a validated electronic data collection tool, (3) pre- and post-surgery surveys, and (4) individual surgical team member interviews. The current paper describes the methodology to obtain a robust and comprehensive data set for analyzing the impacts of briefing and debriefing on teamwork; the results of the surgeries recorded using this methodology will be presented in subsequent papers.

Fatigue and recovery have been associated with health, safety, and performance outcomes in hospital nurses. There is a growing emphasis on fatigue risk management and health promotion programs to support nurses and promote quality in hospitals. However, little is known about the relationships between fatigue and wellness measures in nurses. This study used a tree-based classification method to identify associations between self-reported fatigue, recovery and wellness measures in a survey study of hospital nurses. Significant relationships between multiple wellness measures and acute fatigue, chronic fatigue, and intershift recovery levels were identified. Specifically, the findings include critical levels of wellness measures where fatigue and recovery change. These findings have implications for ongoing efforts to develop effective fatigue management programs in this population.

Briefings are suggested to be an important mechanism for establishing and maintaining cohesive teams. However, there is still much to learn about briefings and how best to design and implement them for surgical teams in the operating room. Currently, there are no formally recognized protocols or methodologies for conducting surgical team briefings. This research reports preliminary findings from an effort to develop a model of team briefings for gynecological surgical teams. Semi-structured interviews were conducted using techniques derived from Applied Cognitive Task Analysis (Millitello & Hutton, 1998) with thirteen surgical team members spanning six different roles including surgeon, surgical resident, registered nurse, certified surgical assistant, certified scrub technician, and anesthesia. Findings reveal that informational needs are consistent across the team but also vary by individual role, illustrating the importance of addressing all stakeholders in potential interventions. Implications for the development of a team briefing model are discussed.

Surgical team members are typically defined by professional roles. In many surgical teams, membership changes as staffing decisions are subject to considerations other than keeping surgical teams consistent. These considerations may include staffing patterns on the day of surgery and at the time of a surgical case. Teamwork skill training and safety culture have been emphasized, although much is known about the contribution to team performance from team consistency. We review the literature on cognitive and psychosocial benefits of consistent surgical teams. Although empirical evidence base for consistent surgical teams is lacking, we believe that the theoretical justifications may lay the groundwork for future research on the impact of deliberate staffing decisions by organizations, to complement the current emphasis on individual teamwork knowledge, skills and attitude. We also outline some of barriers based on our experience in our respective healthcare organizations.

Background: Medication use in the intensive care unit (ICU) depends on creatinine-based glomerular filtration rate (GFR) estimates. Urine output deterioration may precede the creatinine rise resulting in delayed recognition of GFR reductions. Our objective was to quantify the disparity between estimated GFR (eGFR) and true GFR in ICU patients with hospital-acquired oligoanuric acute kidney injury (hAKI). Methods: This single-center cohort study examined adults who met the Acute Kidney Injury Network stage III urine output criterion ≥48 hours after ICU admission. True GFR was ≤15 mL/min/1.73 m 2 , and eGFR was described by 6 different creatinine-based equations. True GFR and eGFR were compared on the day of hAKI diagnosis and followed for 4 days using multivariable linear regression with generalized estimating equations, adjusting for day and method. Results: Of the 691 patients screened, we enrolled 61 patients. After adjustment for multiple comparisons and day, there were significant differences in eGFR between the estimation methods and true GFR ( P < .001). After day adjustment, eGFR overestimated true GFR by 17 to 50 mL/min/1.73 m 2 and overestimation persisted through the fourth day of hAKI ( P ≤ .001). Conclusion: Creatinine-based equations overestimated GFR in ICU patients with hAKI. This study highlights a population at risk of medication misadventures in whom systems optimization should be considered.

In this work, a numerical technique suitable for evaluating the ultrasonic scattering from a three-dimensional poroelastic material is presented. Following Biot’s derivation of the macroscopic governing equations for a fluid saturated poroelastic material, the predicted two propagating wave equations are formulated in terms of displacement and pressure. Assuming that porosity variations on a microscopic scale have a cumulative effect in generating a scattered field, the scattering attenuation coefficient of a Biot medium can be determined. The scattered fields of the wave equations are numerically evaluated as Neumann series solutions of the Kirchhoff-Helmholtz integral equation. A Padé approximant technique is employed to extrapolate beyond the Neumann series’ radius of convergence (weak scattering regime). In the case of bovine trabecular bone, the relationship between the scattering attenuation coefficient and the structural and mechanical properties of the trabecular bone is of particular interest. The results demonstrate the validity of the linear frequency-dependent assumption of attenuation coefficient n the low frequency range. Further comparisons, between measured observations and the numerical results will be discussed.

In this work, the generation of difference frequency waves arising from the interaction of dual-incident beams on a solid sphere is considered. The high-frequency incident beams induce a radiation force onto the fluid-saturated sphere causing the scatterer to vibrate. An analysis on the contribution between the difference frequency sound and radiation force pressure is of particular interest. The scattered pressure due to the two primary waves are obtained as solutions to the Kirchhoff–Helmholtz integral equation for the fluid–solid boundary. Due to the contrasting material properties between the host fluid and solid sphere, high-order approximations are used to evaluate the integral equation.

In this work, the results from our Comb Push Ultrasound Shear Elastography (CUSE) assessment of suspicious breast lesions are presented. The elasticity value of the breast lesions are correlated to histopathological findings to evaluate their diagnostic value in differentiating between malignant and benign breast lesions. A total of 44 patients diagnosed with suspicious breast lesions were evaluated using CUSE prior to biopsy. All patient study procedures were conducted according to the protocol approved by Mayo Clinic Institutional Review Board (IRB). Our cohort consisted of 27 malignant and 17 benign breast lesions. The results indicate an increase in shear wave velocity in both benign and malignant lesions compared to normal breast tissue. Furthermore, the Young’s modulus is significantly higher in malignant lesions. An optimal cut-off value of the Young’s modulus ≥ 80 kPa was observed for the receiver operating characteristic (ROC) curve. This is concordant with the published cut-off values of elasticity for suspicious breast lesions. [This work is supported in part by the grant 3R01CA148994-04S1 and 5R01CA148994-04 from NIH.]

Green’s functions effectively simulate shear waves produced by an applied acoustic radiation force in elastic and viscoelastic soft tissue. In an effort to determine the optimal parameters for these simulations, the convergence of Green's function-based calculations is evaluated for realistic spatial distributions of the initial radiation force “push.” The input to these calculations is generated by FOCUS, the “Fast Object-oriented C + + Ultrasound Simulator,” which computes the approximate intensity fields generated by a Phillips L7-4 ultrasound transducer array for both focused and unfocused beams. The radiation force in the simulation model, which is proportional to the simulated intensity, is applied for 200 μs, and the resulting displacements are calculated with the Green's function model. Simulation results indicate that, for elastic media, convergence is achieved when the intensity field is sampled at roughly one-tenth of the wavelength of the compressional component that delivers the radiation force “push.” Aliasing and oscillation artifacts are observed in the model for an elastic medium at lower sampling rates. For viscoelastic media, spatial sampling rates as low as two samples per compressional wavelength are sufficient due to the low-pass filtering effects of the viscoelastic medium. [Supported in part by NIH Grants R01EB012079 and R01DK092255.]

Acoustic radiation force (ARF) provides a simple and yet non-invasive mechanism to induce a localized stress inside human body. The response to this excitation is used to estimate the mechanical properties of the targeted tissue in vivo. This talk covers an overview of three studies that use ARF for estimation of elastic properties of thyroid, breast, and the bladder in patients. The studies on thyroid and breast were aimed at differentiating between malignant and benign nodules. The study on the bladder was aimed at indirect evaluation of bladder compliance; hence, only a global measurement was needed. The study on breast showed that 16 out of 18 benign masses and 21 out of 25 malignant masses were correctly identified. The study on 9 thyroid patients with 7 benign and 2 malignant nodules showed all malignant nodules were correctly classified and only 2 of the 7 benign nodules were misclassified. The bladder compliance study revealed a high correlation between our method and independent clinical measurement of compliance (R-squared of 0.8–0.9). Further investigations on larger groups of patients are needed to fully evaluate the performances of the methods.