A Statewide Mobile Simulation Program For Improving Obstetric Skills in Rural Hospitals.

Background: Closure of rural obstetric (OB) units has led to maternal care deserts, causing mothers to travel long distances for maternity care. Emergency departments (EDs) in hospitals where OB units have closed require regular training for personnel to maintain OB skills, as do rural Level-1 OB units with low volumes of maternity cases. We used a federal grant to develop an OB mobile simulation program to bring simulation-based training to rural providers.

Pioneering the Integration of Artificial Intelligence in Medical Oral Board Examinations.

We evaluated the use of ChatGPT-4, an advanced artificial intelligence (AI) language model, in medical oral examinations, specifically in anesthesiology. Initially proven adept in written examinations, ChatGPT-4's performance was tested against oral board sample sessions of the American Board of Anesthesiology. Modifications were made to ensure responses were concise and conversationally natural, simulating real patient consultations or oral examinations.

Lack of Benefit of Adjusting Adaptively Daily Invitations for the Evaluation of the Quality of Anesthesiologists' Supervision and Nurse Anesthetists' Work Habits.

Introduction Whenever a department implements the evaluation of professionals, a reasonable operational goal is to request as few evaluations as possible. In anesthesiology, evaluations of anesthesiologists (by trainees) and nurse anesthetists (by anesthesiologists) with valid and psychometrically reliable scales have been made by requesting daily evaluations of the ratee's performance on the immediately preceding day. However, some trainees or nurse anesthetists are paired with the same anesthesiologist for multiple days of the same week.

Long-term capacity planning for obstetric surgical suites using quantile linear regression.

Obstetric surgical suites differ from most inpatient surgical suites, serving one specialty, and often small. We evaluated long-term capacity planning for these operating rooms. The retrospective cohort study included all caesarean births in three operating rooms over 28 years, 1994 through 2021, plus all other obstetric procedures over the latter 19 years.

Patients in Iowa Counties Lacking Hospitals With Labor and Delivery Services Disproportionately Receive Care at Level III Maternal Care Hospitals When Undergoing Cesarean Delivery: A Retrospective Longitudinal Study.

Introduction Many obstetrical patients from rural areas in the United States lack hospitals that provide labor and delivery care. Our objective was to examine the effects of such patients on caseloads of cesarean deliveries at Iowa hospitals with level III maternal care, as defined by the Iowa Department of Public Health (e.g.

Using Simulation to Improve and Maintain Obstetrical Skills in Rural Hospitals.

Rural obstetric providers have differing educational needs, compared with those in large urban settings based on challenges faced when delivering maternal health care. There are 2 groups of rural obstetric providers, those with and without previous obstetric training, which dictates for each group, differing goals for skills improvement and maintenance. Training in rural hospitals should focus on infrequent high-risk events, constrained by systems deficiencies, all which are ideally addressed with in-situ simulation.

Comparison of Percentage Prolonged Times to Tracheal Extubation Between a Japanese Teaching Hospital and One in the United States, Without and With a Phase I Postanesthesia Care Unit.

Background: Prolonged times to tracheal extubation are those from end of surgery (dressing on the patient) to extubation 15 minutes or longer. They are so long that others in the operating room (OR) generally have exhausted whatever activities can be done. They cause delays in the starts of surgeons' to-follow cases and are associated with longer duration workdays.

Case Series of Adaptive Changes in Clinical Practice and Trainee Education for Cesarean Delivery due to Drug Shortages of 0.75% Hyperbaric Bupivacaine in 2018.

Hyperbaric bupivacaine, the local anesthetic routinely selected for single-injection spinal anesthesia for cesarean delivery (CD), was in short supply in 2018. Hospital stocks were significantly less than before and after the shortage period. We developed a contingency plan to communicate with pharmacy and retrieve, restrict, and reallocate remaining stocks of drug to continue performing CD under neuraxial anesthesia, specifically spinal anesthesia for emergency CD, when time appropriate.

Unintentionally Retained Guidewires: A Descriptive Study of 73 Sentinel Events.

Background: Unintentionally retained foreign objects remain the sentinel events most frequently reported to The Joint Commission. Many of these objects are guidewires used to facilitate placement of catheters, tubes, and other devices. The purpose of this study was to describe reports of unintentionally retained guidewires in order to make recommendations to improve patient safety.

Time to recovery after general anesthesia at hospitals with and without a phase I post-anesthesia care unit: a historical cohort study.

Purpose: There is little knowledge about how hospitals can best handle disruptions that reduce post-anesthesia care unit (PACU) capacity. Few hospitals in Japan have any PACU beds and instead have the anesthesiologists recover their patients in the operating room. We compared postoperative recovery times between a hospital with (University of Iowa) and without (Shin-yurigaoka General Hospital) a PACU.

At all hospitals in the State of Iowa over a decade, the number of cases performed during weekends or holidays increased approximately proportionally to the total caseload.

Study Objective: We tested the hypothesis that over many years - a decade - hospitals' proportions of surgical cases that were performed on weekends and holidays remained stable.

Design: Retrospective cohort study.

Setting: Iowa Hospital Association data were from January 1, 2007, through June 30, 2017.

Large Variability in the Diversity of Physiologically Complex Surgical Procedures Exists Nationwide Among All Hospitals Including Among Large Teaching Hospitals.

Background: Multiple previous studies have shown that having a large diversity of procedures has a substantial impact on quality management of hospital surgical suites. At hospitals with substantial diversity, unless sophisticated statistical methods suitable for rare events are used, anesthesiologists working in surgical suites will have inaccurate predictions of surgical blood usage, case durations, cost accounting and price transparency, times remaining in late running cases, and use of intraoperative equipment. What is unknown is whether large diversity is a feature of only a few very unique set of hospitals nationwide (eg, the largest hospitals in each state or province).

Mean operating room times differ by 50% among hospitals in different countries for laparoscopic cholecystectomy and lung lobectomy.

We explored whether there were large differences in operating room (OR) times for two common procedures performed by multiple surgeons at each of several hospitals thousands of miles apart. Mean OR time, "wheels in" to "wheels out," for ten consecutive cases of each of laparoscopic cholecystectomy and lung lobectomy were obtained for each of ten hospitals in eight countries from their OR logs. After log transformation, the OR times were analyzed by analysis of variance.

Effect of mannitol and furosemide on plasma osmolality and brain water.

Background: Mannitol and furosemide are used to reduce increased intracranial pressure (ICP) and to reduce brain bulk during neurosurgery. One mechanism by which these changes might occur is via a reduction in brain water content. Although mannitol and furosemide are commonly used in combination, there has been no formal evaluation of the interactive effects of these two drugs on brain water.