Discrimination, Reliability, Sensitivity, and Specificity of Robotic Surgical Proficiency Assessment With Global Evaluative Assessment of Robotic Skills and Binary Scoring Metrics: Results From a Randomized Controlled Trial.

Objective: To compare binary metrics and Global Evaluative Assessment of Robotic Skills (GEARS) evaluations of training outcome assessments for reliability, sensitivity, and specificity.

Background: GEARS-Likert-scale skills assessment are a widely accepted tool for robotic surgical training outcome evaluations. Proficiency-based progression (PBP) training is another methodology but uses binary performance metrics for evaluations.

The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training.

Unlabelled: Although radical nephrectomy (RN) is the most common treatment for kidney cancer, no data on the learning curve for RN are available. In this study we investigated the effect of surgical experience (EXP) on RN outcomes using data for 1184 patients treated with RN for a cT1-3a cN0 cM0 renal mass. EXP was defined as the total number of RNs performed by each surgeon before the patient's operation.

Changes in heart rate variability during the induction and decay of heat acclimation.

Purpose: We evaluated the changes in core temperature, heart rate, and heart rate variability (HRV) during the induction and decay of heat acclimation.

Methods: Ten males (23 ± 3 years; 79.5 ± 3.

Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients?

Introduction: Prolonged ventilation and failed extubation are associated with increased harm and cost. The added value of heart and respiratory rate variability (HRV and RRV) during spontaneous breathing trials (SBTs) to predict extubation failure remains unknown.

Methods: We enrolled 721 patients in a multicenter (12 sites), prospective, observational study, evaluating clinical estimates of risk of extubation failure, physiologic measures recorded during SBTs, HRV and RRV recorded before and during the last SBT prior to extubation, and extubation outcomes.

Heart rate variability during exertional heat stress: effects of heat production and treatment.

Purpose: We assessed the efficacy of different treatments (i.e., treatment with ice water immersion vs.

Comparison of heart and respiratory rate variability measures using an intermittent incremental submaximal exercise model.

To better understand the alterations in cardiorespiratory variability during exercise, the present study characterized the patterns of change in heart rate variability (HRV), respiratory rate variability (RRV), and combined cardiorespiratory variability (HRV-RRV) during an intermittent incremental submaximal exercise model. Six males and six females completed a submaximal exercise protocol consisting of an initial baseline resting period followed by three 10-min bouts of exercise at 20%, 40%, and 60% of maximal aerobic capacity (V̇O2max). The R-R interval and interbreath interval variability were measured at baseline rest and throughout the submaximal exercise.

Do physiological and pathological stresses produce different changes in heart rate variability?

Although physiological (e.g., exercise) and pathological (e.

Continuous multiorgan variability analysis to track severity of organ failure in critically ill patients.

Purpose: The purpose of this study is to evaluate the utility of using continuous heart rate variability (HRV) and respiratory rate variability (RRV) monitoring for (a) tracking daily organ dysfunction in critically ill patients and (b) identifying patterns of variability changes during onset of shock and resolution of respiratory failure.

Materials And Methods: Thirty-three critically ill patients experiencing respiratory and/or cardiac failure underwent continuous recording of their electrocardiogram and capnogram (CO2) waveforms from admission or intubation until discharge (maximum 14 days). HRV and RRV were computed in 5-minute overlapping windows, using Continuous Individualized Multi-organ Variability Analysis software.

Monitoring and identification of sepsis development through a composite measure of heart rate variability.

Tracking the physiological conditions of a patient developing infection is of utmost importance to provide optimal care at an early stage. This work presents a procedure to integrate multiple measures of heart rate variability into a unique measure for the tracking of sepsis development. An early warning system is used to illustrate its potential clinical value.

Variability analysis and the diagnosis, management, and treatment of sepsis.

Severe sepsis leading to organ failure is the most common cause of mortality among critically ill patients. Variability analysis is an emerging science that characterizes patterns of variation of physiologic parameters (e.g.

Continuous Multiorgan Variability monitoring in critically ill patients--complexity science at the bedside.

Complex systems science has led to valuable insights regarding the care and understanding of critical illness, but has not led to fundamental improvements to care to date. Realizing the fact that there is inherent uncertainty in patient trajectory, we have developed Continuous Individual Multiorgan Variability Analysis (CIMVA) as a tool theoretically and practically designed to track the systemic emergent properties of the host response to injury or infection. We present an overview of CIMVA software, and discuss four separate potential clinical applications that we are evaluating; including early detection of infection, better prediction of extubation failure, continuous monitoring of severity of illness in the ICU, and the evaluation of cardiopulmonary fitness.

Review and classification of variability analysis techniques with clinical applications.

Analysis of patterns of variation of time-series, termed variability analysis, represents a rapidly evolving discipline with increasing applications in different fields of science. In medicine and in particular critical care, efforts have focussed on evaluating the clinical utility of variability. However, the growth and complexity of techniques applicable to this field have made interpretation and understanding of variability more challenging.