The Sequence of Steps: A Key Concept Missing in Surgical Training-A Systematic Review and Recommendations to Include It.

Background: Surgical procedures have an inherent feature, which is the sequence of steps. Moreover, studies have shown variability in surgeons' performances, which is valuable to expose residents to different ways to perform a procedure. However, it is unclear how to include the sequence of steps in training programs.

ProDeM: A Process-Oriented Delphi Method for systematic asynchronous and consensual surgical process modelling.

Surgical process models support improving healthcare provision by facilitating communication and reasoning about processes in the medical domain. Modelling surgical processes is challenging as it requires integrating information that might be fragmented, scattered, and not process-oriented. These challenges can be faced by involving healthcare domain experts during process modelling.

Cross-cultural adaptation and validation of the Spanish version of the Anesthetists' Non-Technical Skills (ANTS) assessment tool.

Study Objective: Establish the transcultural validity of Anesthetists Non-Technical Skills (ANTS) in a Spanish-speaking country.

Design: Prospective cohort.

Setting: Clinical simulation center.

Process-oriented metrics to provide feedback and assess the performance of students who are learning surgical procedures: The percutaneous dilatational tracheostomy case.

Purpose: Assessing competency in surgical procedures is key for instructors to distinguish whether a resident is qualified to perform them on patients. Currently, assessment techniques do not always focus on providing feedback about the order in which the activities need to be performed. In this research, using a Process Mining approach, process-oriented metrics are proposed to assess the training of residents in a Percutaneous Dilatational Tracheostomy (PDT) simulator, identifying the critical points in the execution of the surgical process.

Biomarkers as predictors of renal damage in neonates undergoing cardiac surgery.

Background: Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery.

Methods: Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied.

Development of a comprehensive Percutaneous Dilatational Tracheostomy process model for procedural training: A Delphi-based experts consensus.

Background: Deconstructing a complex procedure improves skills learning, but no model has covered all relevant Percutaneous Dilatational Tracheostomy (PDT) procedural aspects. Moreover, the heterogeneity of techniques described may hinder trainees' competency acquisition. Our objective was to develop a PDT model for procedural training that includes a comprehensive step-by-step design.

Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy: Competency Acquisition and Skills Transfer to a Cadaveric Model.

Introduction: Although simulation-based training has demonstrated improvement of procedural skills and clinical outcomes in different procedures, there are no published training protocols for bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT). The objective of this study was to assess the acquisition of BG-PDT procedural competency with a simulation-based mastery learning training program, and skills transfer into cadaveric models.

Methods: Using a prospective interventional design, 8 trainees naive to the procedure were trained in a simulation-based mastery learning BG-PDT program.

Delphi Method to Achieve Clinical Consensus for a BPMN Representation of the Central Venous Access Placement for Training Purposes.

Unlabelled: Proper teaching of the technical skills necessary to perform a medical procedure begins with its breakdown into its constituent steps. Currently available methodologies require substantial resources and their results may be biased. Therefore, it is difficult to generate the necessary breakdown capable of supporting a procedural curriculum.

Process-Oriented Instrument and Taxonomy for Teaching Surgical Procedures in Medical Training: The Ultrasound-Guided Insertion of Central Venous Catheter.

Procedural training is relevant for physicians who perform surgical procedures. In the medical education field, instructors who teach surgical procedures need to understand how their students are learning to give them feedback and assess them objectively. The sequence of steps of surgical procedures is an aspect rarely considered in medical education, and state-of-the-art tools for giving feedback and assessing students do not focus on this perspective.

Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator.

Introduction: Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries.

Control-flow analysis of procedural skills competencies in medical training through process mining.

Background: Procedural skills are key to good clinical results, and training in them involves a significant amount of resources. Control-flow analysis (ie, the order in which a process is performed) can provide new information for those who train and plan procedural training. This study outlines the steps required for control-flow analysis using process mining techniques in training in an ultrasound-guided internal jugular central venous catheter placement using a simulation.

Process-Oriented Feedback through Process Mining for Surgical Procedures in Medical Training: The Ultrasound-Guided Central Venous Catheter Placement Case.

Developing high levels of competence in the execution of surgical procedures through training is a key factor for obtaining good clinical results in healthcare. To improve the effectiveness of the training, it is advisable to provide feedback to each student tailored to how the student has performed the procedure on each occasion. Current state-of-the-art feedback is based on Checklists and Global Rating Scales, which indicate whether all process steps have been carried out and the quality of each execution step.

[Perioperative lumbar plexus block and cardiac ischemia in patients with hip fracture: randomized clinical trial].

Background: Perioperative myocardial ischemia is common among patients undergoing hip fracture surgery. Our aim is to evaluate the efficacy of perioperative continuous lumbar plexus block in reducing the risk of cardiac ischemic events of elderly patients undergoing surgery for hip fractures, expressed as a reduction of ischemic events per subject.

Methods: Patients older than 60 years, ASA II–III, with risk factors for or known coronary artery disease were enrolled in this randomized controlled study.

Implementation of a norepinephrine-based protocol for management of septic shock: a pilot feasibility study.

Background: The subject of the best vasopressor for hemodynamic management of septic shock (SS) is controversial. One of the difficulties in planning such studies is that physicians are reluctant to use one vasopressor exclusively, and there is considerable variation in practice. The aim of this study was to test the feasibility of implementing a single pressor-based algorithm (in this case, norepinephrine [NE]).

Management of septic shock with a norepinephrine-based haemodynamic algorithm.

Unlabelled: Management of septic shock (SS) with a norepinephrine (noradrenaline)-based haemodynamic algorithm.

Introduction: The choice of the best vasopressor for haemodynamic management of septic shock is controversial. Nevertheless, very few studies have been focused on evaluating different management algorithms.