共找到 20 条结果
Aims/Background Mentorship is crucial to research success, but a detailed assessment and evaluation of the different types of mentorship models in hospital medicine have not been conducted. We sought to identify and define research mentorship models in hospital medicine. We also assessed the effectiveness of each model for the identified studies that met this narrative review's criteria. Methods Narrative review of peer-reviewed, USA-published literature on hospital medicine research mentorship. Articles from 1996 to 2023 with selected search terms on hospitalists' mentorship in research were searched in PubMed, Scopus and Embase. Finalized articles obtained from the search were approved by the Society of Hospital Medicine's Research Committee. Results Ten articles published between 2008 and 2023 were identified and assessed by the Society of Hospital Medicine's Research Committee members. Three major research mentorship models were identified: (1) traditional mentor-mentee dyad, (2) peer mentorship, and (3) research coaching. Some hospital medicine groups combined mentorship models. All articles reported successful implementation with positive faculty receptivity and/or research output. However, the studies had small sample sizes and short evaluation periods. Conclusion Hospitalist research mentorship is essential to bolstering and enhancing research in hospital medicine. Further studies with larger samples, extended time frames, those conducted outside the USA, and frequent reassessments are urgently needed to determine the sustained effectiveness of any model.
Perioperative patient-reported outcomes (PROs) allow patients to share their experiences of surgical procedures with their health care teams using standardized measures. Despite increasing recognition of their value, PROs are not routinely used in clinical practice, partly due to limited evidence of their impact on traditional clinical outcomes and uncertainty among clinicians about their use. Digital health tools offer a promising way to integrate PROs into clinical workflows and enhance patient-clinician interaction, but their success depends on person-centered design to ensure usability and relevance. Safe Surgery South Africa, a nonprofit organization, developed the Perioperative Shared Health Record (PSHR), a secure web-based tool that enables patients to share personal health information and PROs with their anesthetist and surgeon before and after surgery. Initial implementation revealed significant user experience challenges, which contributed to poor uptake. This study aimed to explore factors influencing the PSHR user experience in a low- and middle-income country (LMIC) using human-centered design principles. This observational qualitative user experience study followed the 5 design thinking stages: empathize, define, ideate, prototype, and test. Semistructured interviews were conducted with postoperative patients from both the public and private health care sectors, including those with and with no prior experience using the PSHR. Thematic analysis followed the 6-phase framework described by Braun and Clarke and was structured using Karagianni's Optimized Honeycomb user experience model. A problem statement was developed, followed by ideation to explore solutions. Paper prototypes were created, refined, and tested through observation, interviews, and validated usability questionnaires. In the empathize stage, 22 interviews were conducted in the private and public health care sectors in South Africa; 7 participants had previous experience using the PSHR. In the define stage, participants emphasized the need for connection, feedback, information, and support through their surgical journey. Contrary to expectations, patients were not discouraged by the length of questionnaires if they perceived them as purposeful. In the ideate stage, the team considered user expectations and PSHR integration into care processes. In the prototype stage, low-fidelity mock-ups were created and refined into paper prototypes. In the test stage, testing with 5 participants highlighted the importance of trust, communication, and user-friendly interfaces. Feedback loops and clinician engagement were identified as key motivators for sustained use. The mean usability questionnaire scores indicated excellent usability and high levels of user satisfaction across most domains. This study is one of the first to apply human-centered design principles to a perioperative digital health tool in an LMIC setting, addressing usability challenges and patient engagement. Key user experience factors influencing patient engagement included communication, feedback, and access to information throughout the surgical journey. Digital health tools such as the PSHR can strengthen communication and support person-centered perioperative care by integrating PROs into clinical workflows and care processes.
Perioperative stress hinders patient recovery and poses significant challenges for clinical nursing. It triggers a vicious cycle of negative psychological emotions and adverse physiological stress responses. Immersive virtual reality (VR), an innovative nonpharmacological intervention, has been gradually incorporated into perioperative care, showing promise in alleviating patient stress. However, comprehensive evaluations of its multidimensional efficacy remain lacking. This study aims to systematically evaluate the dual regulatory effects of VR interventions on both psychological emotions and objective physiological stress in adult patients undergoing perioperative care. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we comprehensively searched 9 electronic databases for randomized controlled trials (RCTs) published from January 2000 to March 2026. Eligible RCTs evaluated VR combined with routine care vs routine care alone in adult patients (≥18 years). The risk of bias was assessed using the Cochrane Risk of Bias 2 tool (Cochrane Collaboration). Meta-analyses were performed using a random-effects model based on the Hartung-Knapp-Sidik-Jonkman method. We reported 95% CIs and 95% prediction intervals (PIs) to interpret clinical heterogeneity and evaluated evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We included 42 RCTs involving 4648 participants. Compared to routine care, VR significantly reduced anxiety (standardized mean difference -1.17, 95% CI -1.50 to -0.85; 95% PI -3.16 to 0.81) and depression (standardized mean difference -1.26, 95% CI -1.71 to -0.81; 95% PI -2.39 to -0.13). Physiologically, VR effectively decreased systolic blood pressure (mean difference [MD] -5.12, 95% CI -7.21 to -3.03; 95% PI -11.73 to 1.49), diastolic blood pressure (MD -3.45, 95% CI -5.18 to -1.73; 95% PI -8.63 to 1.72), and heart rate (MD -4.45, 95% CI -5.94 to -2.97; 95% PI -10.15 to 1.24). Subgroup analyses revealed that the anxiolytic effect was more pronounced in Asian populations. VR serves as a safe and effective adjunctive intervention that exhibits a dual regulatory mechanism, simultaneously mitigating psychological distress and stabilizing hemodynamic parameters in perioperative adults. Unlike existing systematic reviews that are predominantly limited to a single psychological metric (eg, anxiety) or focused on pediatric populations, this review integrates both psychological (anxiety and depression) and objective physiological (blood pressure and heart rate) dimensions into a unified evaluation framework. While average benefits are robust, the wide PIs suggest that true effects may vary across individuals due to clinical heterogeneity. Future standardized, large-scale RCTs with strict blinding are warranted to elevate the certainty of evidence.
Perioperative neurocognitive disorder (PND) is a prevalent complication among older patients undergoing general anesthesia, imposing significant burdens on individuals, health care systems, and society. While electroacupuncture shows promise for PND prevention, current evidence remains inconclusive. This study aims to critically evaluate the effectiveness and safety of perioperative electroacupuncture for PND prevention in older patients undergoing surgery under general anesthesia. A comprehensive literature search will be conducted in 8 electronic databases (PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP Chinese Science and Technology Periodical Database, Wan Fang Database, and China Biomedical Literature Database) and 3 clinical trial registries from inception to March 16, 2025. The search strategy aims to identify all relevant randomized controlled trials evaluating perioperative electroacupuncture for PND prevention in older patients (aged ≥60 years) undergoing general anesthesia. The primary outcome will be the incidence of PND. Secondary outcomes will include (1) neuropsychological assessment scores (Mini-Mental State Examination and Montreal Cognitive Assessment), (2) serum inflammatory biomarker levels (interleukin-1β, interleukin-6, and tumor necrosis factor-α), (3) serum neurological damage marker levels (neuron-specific enolase and S100 calcium-binding protein β), and (4) safety outcomes (incidence of adverse events). Two independent reviewers will perform study selection, data extraction, and methodological quality assessment using the revised Cochrane risk of bias tool for randomized trials. All statistical analyses will be conducted in RevMan 5.4 using suitable meta-analysis models based on heterogeneity testing. The certainty of evidence will be evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The study selection process will be presented through a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram, detailing the number of records identified, screened, and included. Characteristics of eligible studies will be summarized in evidence tables, including study designs and populations, intervention protocols, and outcome measures. The results will be visualized through a risk of bias graph, forest plots displaying pooled effect estimates with 95% CIs, and funnel plots for publication bias evaluation (when ≥10 studies are available). This protocol is currently in the active phase. The literature search has been completed as of April 2025, with an updated search planned until December 31, 2025. Data extraction is scheduled to commence on January 15, 2026, followed by data analysis starting February 1, 2026. Results are expected to be submitted for publication in March 2026. The effectiveness and safety of perioperative electroacupuncture for PND prevention in older patients undergoing general anesthesia remain uncertain. This systematic review will provide an evidence-based evaluation of perioperative electroacupuncture's effectiveness in preventing PND, offer practical recommendations for optimizing surgical care for older adults, and identify knowledge gaps to inform future research.
Traditional Chinese medicine (TCM) hasbeen widely used to treat various diseases in China for thousands of years and has shown satisfactory effectiveness. However, many surveys found that TCM receives little recognition from Western medicine (WM) physicians and students. At present, TCM is offered as a compulsory course for WM students in WM schools. This study aimed to investigate whether TCM courses can affect the WM students' attitude toward TCM. WM students from Xiangya Medical School were invited to completeaweb-based questionnaire before and immediately after a TCM course. Their attitude toward TCM and treatment preferences for different kinds of diseases were tested. The Attitude Scale of TCM (ASTCM) was used. The main part of the ASTCM was designed to measure the attitude of medical students towardTCM. It consisted of 18 items, divided into cognitive dimension (5 terms), emotional dimension (8 terms), and behavioral tendencyfactor (5 terms). Finally, the results of 118 five-year program (FYP) and 36 eight-year program (EYP) students were included. For FYP students, there was a significant increase in the total mean score (66.42, SD 7.66 vs 71.43, SD 7.38;P<.001) of ASTCM after the TCM course. Significant increases in mean scores of the 3 factors of attitude (cognition: 21.64, SD 2.08 vs 22.90, SD 1.94; affection: 25.21, SD 4.39 vs 27.96, SD 4.4; and behavioral tendency: 19.577, SD 3.02 vs 20.58, SD 2.76; P<.001)were also observed. Except for the score of behavioral tendency (17.50, SD 3.54 vs 18.78, SD 3.22; P=.02), a significant increase was not detected in total score, cognition, and affection in EPY students (total score: mean 60.36, SD 10.53 vs mean 62.92, SD 10.05; cognition: mean 20.50, SD 2.73 vs mean 20.69, SD 2.73; and affection: mean 22.36, SD 6.32 vs mean 23.44, SD 5.84; all P>.05). The treatment preference of FYP students in acute (P=.02), chronic (P=.003), and physical diseases (P=.02) showed remarkable change. A major change was also detected in internal diseases (P=.02), surgical diseases (perioperative period; P=.01), and mental illnesses (P=.02) in EYP students. This change mainly appeared as a decline in WM preference and an increase in TCM and WM preference. The study showed that earlier exposure to the TCM course increased the positive attitude toward TCM in students majoring in WM. The results provide some suggestions for arraging TCM courses in WM schools.
Social determinants of health continue to drive persistent disparities in perioperative care. Our team has previously demonstrated racial and socioeconomic disparities in perioperative processes, notably in the administration of antiemetic prophylaxis, in several large perioperative registries. Given how neighborhoods are socially segregated in the United States, we examined geospatial clustering of perioperative antiemetic disparities. The study aimed to determine whether disparities in perioperative antiemetic prophylaxis exhibit geographic clustering based on neighborhood-level disadvantage and whether patients from disadvantaged communities are more likely to be undertreated after adjusting for individual postoperative nausea and vomiting risk. We conducted a retrospective cohort study of anesthetic records from the University of Utah Hospital involving 19,477 patients who met the inclusion criteria. We geocoded patient home addresses and combined them with the census block group-level neighborhood disadvantage, a composite index from the National Neighborhood Data Archive. We stratified our patients by antiemetic risk score and calculated the number of antiemetic interventions. We used Poisson spatial scan statistics, implemented in SaTScan (Information Management Services, Inc), to detect geographic clusters of undertreatment. We identified 1 significant cluster (P<.001) of undertreated perioperative antiemetic prophylaxis cases. The relative risk of the whole cluster was 1.44, implying that patients within the cluster were 1.44 times more likely to receive fewer antiemetics after controlling for antiemetic risk. Patients from more disadvantaged neighborhoods were more likely to receive below-median antiemetic prophylaxis after controlling for risk. To our knowledge, this is the first geospatial cluster analysis of perioperative process disparities; we leveraged innovative geostatistical methods and identified a spatially defined, geographic cluster of patients whose home address census-tract level neighborhood deprivation index predicted disparities in risk-adjusted antiemetic prophylaxis.
Cesarean section (CS) requires perioperative antibiotic prophylaxis (PAP) for the prevention of surgical site infections. However, systemic antibiotics during the peripartum period may induce compositional perturbations of the maternal gut microbiome, a system already characterized by reduced resilience. Data on maternal gut microbiome dynamics after CS with PAP are scarce, largely due to logistical and feasibility barriers that limit the participation of pregnant women and new mothers in conventional clinical studies. This protocol primarily aims to evaluate the feasibility of a fully decentralized, remote study design for longitudinal gut microbiome research in the peripartum period. Secondary exploratory objectives include the comparative analyses of microbiome composition between CS with PAP and vaginal delivery (VD) without antibiotic exposure to inform future adequately powered studies. The MAMA (Microbiome Changes Due to Antibiotic Prophylaxis in Mothers at Birth) study is a prospective, 2-arm observational cohort study conducted entirely off-site. Women in the third trimester of pregnancy were recruited at 2 German level-1 perinatal centers and affiliated outpatient facilities. Participants underwent either CS with PAP (single dose cefuroxime 1.5 g intravenously) or VD without antibiotics. Stool samples were self-collected at home and returned by mail at 3 predefined time points: late pregnancy (T0), 2 to 3 days post partum (T1), and 90±10 days post partum (T2). Primary outcomes are feasibility indicators, including recruitment rate, sample and questionnaire return rates at each time point, adherence to sampling windows, and participant retention across follow-up. Secondary outcomes are exploratory microbiome measures based on 16S rRNA gene sequencing (V3-V4), including alpha diversity indices, beta diversity metrics, and relative taxonomic abundances. Microbiome analyses are explicitly compositional and hypothesis-generating. Group comparisons and longitudinal within-individual changes will be assessed using nonparametric diversity metrics and multivariate distance-based methods. No confirmatory hypothesis testing is planned. Recruitment occurred between May 2022 and October 2023, with 37 women enrolled (25 CSs and 12 VDs). Follow-up was completed with receipt of the final stool sample in March 2024. DNA extraction and sequencing were completed in a single batch in October 2024. Bioinformatic processing and statistical analyses were initiated in June 2025 and are ongoing as of December 2025. Results from the exploratory microbiome analyses are expected to be published in 2026. This protocol demonstrates the feasibility of conducting fully decentralized, longitudinal microbiome research in a peripartum population without requiring on-site visits. By integrating study procedures into maternal realities, the remote design reduces participation barriers and addresses a clinically relevant research gap that has remained largely unexamined despite routine use of PAP. While microbiome-related outcomes are exploratory, the methodological framework established here provides a scalable model for future maternal and postpartum research, supporting ethically grounded, participant-centered study designs and evidence-informed care strategies.
Surgical resection is the primary curative treatment for early-stage lung cancer-the leading global cause of cancer mortality, responsible for nearly 1 in 5 cancer deaths in 2022. Obesity is a global health concern that may influence surgical outcomes; yet, its impact on perioperative outcomes following lung cancer surgery remains controversial. This protocol outlines a meta-analysis and systematic review to evaluate the association between obesity and perioperative outcomes in patients who underwent a lung cancer resection. Observational studies related to patients with lung cancer who underwent surgical resection were searched in 5 English and 3 Chinese literature databases: PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, Chinese National Knowledge Infrastructure, Wanfang, and the Chinese Biomedical Database. The search period for these 8 electronic databases was from inception to 2025. The PROSPERO database and the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) database were also searched. Qualified studies were screened and selected by 2 authors independently. The literature obtained were imported into NoteExpress to screen the titles and abstracts. After reading the full text of the remaining studies, the final number of studies were determined. Two reviewers independently extracted data from the included studies by using a predesigned data extraction tool. The Newcastle-Ottawa Scale was used to evaluate the quality of the research. The primary outcome of this study was to evaluate the postoperative mortality in people living with obesity undergoing lung cancer surgical procedures. The secondary outcomes were the postoperative complications, average length of stay, blood loss during the operation, and operation time in people living with obesity undergoing lung cancer surgical procedures. For dichotomous data, we plan to present results as risk ratios with 95% CIs. For continuous data, we will use mean difference with 95% CIs. The Review Manager software (version 5.4) will be used for the meta-analysis and statistical analysis. Sensitivity analysis and Egger test will be performed with Stata software (version 16.0). The results are not yet accessible because this is a protocol for a systematic review and meta-analysis. The protocol is registered in PROSPERO under the registration number CRD42025648330. By August 26, 2025, we completed the literature search of the 8 databases and completed the selection and extraction of data. This study will synthesize existing evidence to clarify whether obesity is a risk factor for adverse outcomes or if it confers a protective effect, as suggested by the obesity paradox. These findings will guide clinical decision-making and improve perioperative care for obese people with lung cancer. PROSPERO CRD42025648330; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025648330. PRR1-10.2196/76315.
Patients with breast cancer undergoing chemotherapy experience significant adverse effects, including fatigue, nausea, and taste alterations, leading to malnutrition in 40% of patients. Traditional nutritional counseling has shown limited effectiveness in addressing these challenges during treatment. This study aimed to evaluate the impact of a structured meal kit intervention on quality of life and metabolomic profiles in patients with breast cancer during perioperative anthracycline and taxane-based chemotherapy. This single-center phase 2 randomized crossover trial will enroll 20 patients with breast cancer scheduled for perioperative chemotherapy at Jikei University Hospital between October 2024 and October 2025. Patients will be randomized 1:1 to receive a meal kit intervention either during the first or second 3-month period of chemotherapy. The intervention consists of weekly deliveries of preportioned ingredients with dietitian-designed recipes (one 2-serving meal kit during chemotherapy weeks, two during nonchemotherapy weeks). The primary endpoint is the change in the EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) "appetite loss" domain score. Secondary endpoints include changes in total EORTC QLQ-C30 score, plasma metabolome profiles, body composition, nutritional status, and chemotherapy completion rate. Data will be collected at baseline, crossover (12 wk), and study completion (24 wk). The study was funded in March 2024. Data collection began on March 26, 2025, and as of manuscript submission, 11 participants have been recruited out of the planned 20 participants. Data analysis has not yet commenced, and results are expected to be published in Spring 2026. This trial will provide evidence for the effectiveness of a meal kit intervention in supporting patients with breast cancer during chemotherapy. The findings may help establish evidence-based standards for nutritional support in oncology care.
Otitis media (OM) is a common pediatric infection worldwide. Conventionally, accurate diagnosis depends on in-person pneumatic otoscopy, which is not always accessible, contributing to delayed care and inappropriate prescribing, especially in underserved settings. Rapid advances in telemedicine and digital tools have accelerated the development of remote approaches for assessing pediatric ear diseases, while diagnostic quality maintenance, care models, and real-world outcomes have not been comprehensively mapped in children. This study aimed to map existing telehealth technologies and operational models used for pediatric OM and report their diagnostic and implementation outcomes to guide practice and further research. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided this scoping review (protocol not registered). MEDLINE (via PubMed), Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for original English-language studies (published between January 1, 2010, and February 9, 2026) reporting the clinical implementation of telemedicine or digital health in children (<18 years) with suspected or confirmed OM. We excluded reviews, editorials, and protocols; conference abstracts; adult-only studies; and purely technical evaluations. Two reviewers independently extracted and charted the study characteristics: telemedicine model, technology, users, comparators, outcomes, and limitations. Findings were synthesized using practice-oriented mapping that aligned technologies with care models and implementation conditions. Fifty-two studies across 18 countries and various settings met the inclusion criteria. Sample sizes ranged from 6 to 3950, with heterogeneous reporting units (children, ears, episodes, or screening assessments). Asynchronous store-and-forward tele-otoscopy was the most common approach. The rest used synchronous or hybrid models. Image capture by trained personnel and review by experienced clinicians yielded substantial diagnostic consistency with in-person microscopy (κ 0.68-0.89, sensitivity 72%-94%, specificity 93%-98%, where available). However, the diagnostic yield was highly dependent on the training level: structured instruction improved video capture by parents and nonspecialists, whereas brief or written-only guidance resulted in low rates of diagnostically useful videos. Telemedicine approaches improved access, supported perioperative follow-up, and, in some contexts, reduced reexaminations and promoted more judicious antibiotic use. Televisits without otoscopy were associated with lower confirmation rates of middle ear effusion during tympanostomy tube placement. Evidence was heterogeneous, with predominantly small single-site studies, variable reference standards and operator training, and rapidly evolving device ecosystems. This review provides a practice-oriented map of telehealth approaches for pediatric OM. Tele-otoscopy and adjunct digital tools are feasible, achieving diagnostic accuracy comparable to in-person assessments while enhancing access and service efficiency. However, important evidence gaps remain, including the need for large multisite trials, evaluation of long-term child outcomes, economic evaluations, and robust external validation of artificial intelligence-based diagnostic tools. Standardization of image capture protocols and integration into hybrid care models should be prioritized for scaling up.
The development and introduction of an artificial intelligence (AI)-based clinical decision support system (CDSS) in surgical departments as part of the "Supporting Surgery with Geriatric Co-management and AI" project addresses the challenges of an increasingly aging population. The system enables digital comanagement of older patients by providing evidence-based evaluations of their health status, along with corresponding medical recommendations, with the aim of improving their perioperative care. The use of an AI-based CDSS in patient care raises ethical challenges. Gathering the opinions, expectations, and concerns of older adults (as potential patients) regarding the CDSS enables the identification of ethical opportunities, concerns, and limitations associated with implementing such a system in hospitals. We conducted 5 focus groups with participants aged 65 years or older. The transcripts were evaluated using qualitative content analysis and ethically analyzed. Categories were inductively generated, followed by a thematic classification of participants' statements. We found that technical understanding did not influence the older adults' opinions. Ethical opportunities and concerns were identified. On the one hand, diagnosis and treatment could be accelerated, the patient-AI-physician interaction could enhance medical treatment, and the coordination of hospital processes could be improved. On the other hand, the quality of the CDSS depends on an adequate data foundation and robust cybersecurity. Potential risks included habituation effects, loss of a second medical opinion, and illness severity influencing patients' attitude toward medical recommendations. The risk of overdiagnosis and overtreatment was discussed controversially, and treatment options could be influenced by interests and finances. Additional concerns included challenges with time savings, potential declines in medical skills, and effects on the length of hospital stay. To address the ethical challenges, we recommend allocating sufficient time for use of the CDSS and emphasizing individualized review of the CDSS results. Furthermore, we suggest limiting private financial sponsorship.
Interdepartmental consultations are essential for managing complex inpatient care but are often inefficient. Hospital-wide, data-driven analyses are needed to guide process improvements, yet most existing studies have focused on single departments or specific diseases, leaving a gap in understanding hospital-level collaboration networks. Understanding these patterns is crucial for optimizing clinical workflows, reducing delays, and improving patient outcomes in large tertiary hospitals. To analyze the distribution and network characteristics of interdepartmental consultations across a large tertiary hospital, focusing on high-frequency collaboration pairs and their disease associations. This retrospective cohort study included all interdepartmental consultations for inpatients and emergency patients at Peking Union Medical College Hospital (Beijing, China) from January 1 to December 31, 2024. Secondary data were extracted from the Hospital Information System. In total, 102,858 valid consultations involving 42 clinical departments were analyzed. Outcome measures included consultation requests/receptions per department, per capita request intensity, and pairwise collaboration volume. High-frequency collaboration pairs were defined as those with an annual consultation volume ≥300. Descriptive statistics (medians, interquartile ranges) and proportions with 95% confidence intervals were used. Consultation activity exhibited marked concentration. The Emergency Department issued the most consultation requests (n=19,698, 19.15%), far exceeding the median departmental request volume of 1,899.5 (interquartile range (IQR): 1,359.5-3,759.25). Meanwhile, the Internal Medicine Consultation Service received the highest number of consultations (n=10,428, 10.14%), substantially above the median reception volume of 1,886.0 (IQR: 521.25-4,056.75) across departments. The per capita request intensity varied widely, with Critical Care Medicine highest (21.64) versus a hospital-wide average of 0.32. Collaboration demonstrated a strong Pareto distribution: the top 5.37% of department pairs (65 pairs) accounted for 42.02% (n=43,221) of the total 102,858 consultations. These high-volume pairs were predominantly disease-specific. Examples include: Endocrinology-Ophthalmology primarily for diabetic and thyroid eye disease (n=1,287, 1.25%); General Surgery-Otolaryngology mainly for preoperative thyroid airway assessment (n=1,225, 1.19%); General Surgery-Clinical Nutrition for perioperative support (n=1,032, 1.00%); Endocrinology-Clinical Nutrition for metabolic disease management (n=703, 0.68%); Orthopedics-Rehabilitation Medicine for postoperative rehabilitation (n=686, 0.67%); and Oncology Medical Center-Clinical Nutrition for cancer patient nutrition support (n=681, 0.66%) ; and Rheumatology Immunology-Ophthalmology primarily for immune-related eye disease (n=678, 0.66%). Recurring clinical scenarios generated these stable, predictable consultation pathways. This study provides a novel, hospital‑wide, network‑based mapping of interdepartmental consultations using real‑world data. Unlike prior work limited to single departments or diseases, it reveals that collaboration is concentrated, Pareto‑like, and disease‑driven. The identification of stable, disease-specific consultation pairs offers a data-driven framework for understanding multidisciplinary collaboration. These findings offer a data‑driven framework for understanding multidisciplinary collaboration as a networked system. In practice, administrators and clinicians can use this evidence to prioritize resources, design standardized multidisciplinary team pathways, and implement spatial or digital interventions to reduce delays and improve patient flow and outcomes.
Measuring the optic nerve sheath diameter (ONSD) with ultrasound is a promising, noninvasive way to estimate intracranial pressure (ICP). While magnetic resonance imaging (MRI) provides high-resolution imaging, it is less accessible in urgent or perioperative settings. Comparing ONSD measurements between ultrasound and MRI may help confirm the use of ultrasound in neurosurgical patients. The aim of this study is to evaluate how closely ultrasound and MRI measurements of ONSD align in patients undergoing surgery for supratentorial brain tumors. This prospective, single-center observational study included 50 adult patients scheduled for elective supratentorial tumor resection. ONSD was measured preoperatively using both transorbital ultrasound and MRI. Measurements were compared using Pearson and Spearman correlation coefficients, the intraclass correlation coefficient, and Bland-Altman analysis. The average ONSD measured by ultrasound was 5.94 (0.99) mm, compared to 5.75 (SD 1.08) mm via MRI. The two methods showed a strong correlation (Pearson r=0.88, P<.001) and good agreement (intraclass correlation coefficient=0.86). Bland-Altman analysis showed a mean bias of 0.19 mm (95% limits of agreement: -0.62 to 1.00 mm). Ultrasound-based ONSD measurements closely matched those obtained by MRI in this patient group. These findings support the use of ultrasound as a practical tool for noninvasive ICP assessment in the perioperative care of patients with intracranial tumors.
Preoperative cardiovascular risk stratification is essential in noncardiac surgery, but conventional testing is frequently overused, increasing costs without improving outcomes. Artificial intelligence (AI)-enabled electrocardiography (ECG) may enhance perioperative risk assessment by identifying surgical candidates at very low-risk for adverse events. This study aimed to evaluate whether AI-ECG-based risk stratification could help decrease low-yield preoperative cardiovascular testing and reduce associated costs, without an observed increase in postoperative adverse outcomes, in candidates for noncardiac surgery. We retrospectively analyzed 41,218 patients (46,135 ECG-surgery pairs) undergoing noncardiac surgery at Seoul National University Bundang Hospital (2020-2021). An AI-ECG algorithm generated eight probability scores for cardiac conditions, classifying cases as low- or high-risk. Based on the performance and results of preoperative cardiovascular testing (transthoracic echocardiography, coronary computed tomography angiography, single-photon emission computed tomography, or coronary angiography), cases were classified as no advanced cardiovascular imaging, negative-test, or positive-test. The primary end point was a 30-day composite of all-cause mortality and unplanned percutaneous coronary intervention. AI-ECG classified 92.3% (42,599/46,135) of cases as low-risk, with a composite outcome rate of 0.2% (79/42,599) vs 2.9% (101/3536) in high-risk cases. Preoperative cardiovascular testing was performed in 11.8% (5458/46,135) of cases, with only 16.3% (892/5458) yielding positive findings. In AI-ECG low-risk cases, event rates were uniformly low (0.2%-0.4%) irrespective of whether advanced cardiovascular testing was performed, whereas in high-risk cases, rates were consistently high (2.6%-3.4%). The incidence of the composite outcome was consistently higher in AI-ECG-graded high-risk cases across all European Society of Cardiology surgical risk and Revised Cardiac Risk Index strata. In this retrospective cohort, a multitask AI-ECG identified surgical candidates at low-risk for postoperative complications, for whom advanced cardiovascular testing demonstrated low diagnostic yield. Integrating AI-ECG with conventional risk tools may offer an exploratory strategy to optimize resource use and minimize redundant testing. Prospective studies are needed to confirm the clinical and economic benefits of AI-ECG as a screening tool.
The perioperative environment is complex and may be challenging for patients and guardians to navigate. The emotional burden and stressors inherent to the perioperative process commonly result in preoperative anxiety. Many studies have demonstrated the usefulness of virtual reality (VR) in various patient populations. The aim of this study is to evaluate the impact of a VR-based preoperative education tool on anxiety levels in pediatric patients undergoing ambulatory ear, nose, and throat surgery, as well as in their guardians. We performed a single-center prospective randomized controlled trial including children 6-12 years of age, presenting for ambulatory tonsillectomy and/or adenoidectomy, with or without bilateral ear tube insertion. The patients were randomized to receive VR instruction of the perioperative workflow or standard preoperative experience (non-VR). The primary outcome was patient and guardian preoperative anxiety, as measured by the 6-item State-Trait Anxiety Inventory. The study cohort included 107 patient-guardian dyads-51 in the intervention (VR) group and 56 in the control (non-VR) group. Baseline characteristics between the study and control groups were comparable; however, patients in the control group were more likely to report feeling upset compared to the VR group. The VR intervention was associated with reduced preoperative anxiety in patients and guardians compared to the control group. Patients exposed to the VR intervention had higher odds of feeling calm (OR 4.95, 95% CI 2.32-10.61; P<.001) and lower odds of feeling worried (OR 0.25, 95% CI 0.12-0.53; P<.001) compared to the control group. Similarly, guardians in the VR group had higher odds of feeling calm (OR 3.55, 95% CI 1.69-7.49; P=.001) and lower odds of feeling worried (OR 0.45, 95% CI 0.22-0.93; P=.03) compared to the control group. Both patients and guardians exposed to VR were significantly less likely to have moderate or high levels of preoperative anxiety than the control group (patients: OR 0.15, 95% CI 0.05-0.41, P<.001; guardians: OR 0.14, 95% CI 0.06-0.38, P<.001). VR exposure may be effective in reducing pediatric and guardian anxiety. VR may be a suitable alternative to pharmacologic anxiolysis and future studies should compare the effect to premedication techniques.
Preoperative anxiety affects an estimated 50-70% of children undergoing surgery and is associated with poorer perioperative cooperation, increased postoperative distress, and delayed recovery. Digital storytelling and immersive technologies, including virtual reality (VR) and augmented reality (AR), have emerged as child-centered preparation tools to improve the preoperative experience. This systematic review and meta-analysis aimed to synthesize and critically appraise the available evidence on the effects of these interventions in reducing preoperative anxiety among pediatric patients undergoing elective surgery. Despite increasing research interest, the available evidence remains heterogeneous in intervention type, delivery mode, timing of exposure, surgical populations, and anxiety measurement tools. In addition, the overall certainty of evidence is influenced by variability in study quality and reporting. Therefore, this systematic review and meta-analysis aimed to synthesize and critically appraise the available evidence on the effects of digital storytelling and immersive technology-based interventions (including VR, AR, and app-based storytelling tools) in reducing preoperative anxiety among pediatric patients undergoing elective surgery, compared with standard care or conventional preparation methods. A systematic search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library for studies published between January 2015 and June 2025. Randomized controlled trials and quasi-experimental studies evaluating digital storytelling (e.g., narrative-based apps/videos) or immersive technologies (e.g., VR/AR) were included. Preoperative anxiety was assessed using validated measures such as the Modified Yale Preoperative Anxiety Scale (mYPAS), State-Trait Anxiety Inventory (STAI), or Visual Analog Scale (VAS). Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the Cochrane Risk of Bias tool version 2 (RoB 2). A random-effects meta-analysis was performed in R using standardized mean differences (SMDs). A total of 379 records were identified, and 13 studies met the inclusion criteria. Most studies reported lower preoperative anxiety in intervention groups compared with standard care or conventional preparation. Five studies provided sufficient comparable data for meta-analysis, showing a significant pooled reduction in anxiety favoring digital interventions (SMD = -0.99; 95% CI: -1.44 to -0.54), with substantial heterogeneity (I² = 78.1%; Q = 19.74, df = 4, p = 0.0006). Overall risk of bias was high in most trials, primarily due to deviations from intended interventions and limitations in blinding. This review suggests a trend toward reduced preoperative anxiety among pediatric patients receiving digital storytelling and immersive technology-based interventions. However, the certainty of evidence is limited by substantial heterogeneity, the small number of studies included in the meta-analysis, variability in outcome measures, and overall study quality. Therefore, the pooled estimate should be interpreted with caution. Further high-quality studies using standardized outcomes and robust methodology are needed, including evaluation of parental anxiety and longer-term postoperative effects. CRD420251111293.
Central venous catheters (CVCs) are indispensable to contemporary critical care, perioperative management, and emergency resuscitation, yet their insertion remains fraught with preventable harm and inefficiency. This study aimed to identify all areas of CVC placement that can be improved through device design using human-centered design and qualitative research methods. This qualitative study was a contextual inquiry of CVC placement, which included observation alongside brief face-to-face interviews with physicians. It was aimed at providing a depth of understanding using evidence to demonstrate causality. This study was conducted at 3 hospitals in the emergency department, the intensive care unit, and the operating rooms. Where possible and with additional consent, sessions were recorded in video or still photography, or at times both. This study included 19 observations and 24 interviews. In this study, the approach to CVC insertion was consistent across hospitals and care environments, with moderate variability spanning a few sections, such as suture and dressing use or lack thereof in specific care environments. The described and observed difficulties leave room for improvement in device design. The results of this study indicated that there are 34 discrete steps to placing a CVC line, with most time spent during sterile preparation. As a result of the device or kit design, challenges were observed. These included missing essential materials from kits, difficulty distinguishing between nonsterile and sterile items, challenges with lidocaine ampules, patient claustrophobia from draping, and a lack of user preference for kit contents. Additional challenges included obscured ultrasound views, kinked guidewires, overall procedural untidiness, and considerable waste management issues. An intuitive kit that aligns with predictable human behavior and eliminates unnecessary multistep detours can reduce novice failure rates, cognitive load, and practice inconsistency, and it could also curb nonrecyclable waste from "backup" kits opened for a single missing item. By reframing CVC systems as sociotechnical solutions rather than static assortments of parts, the same design moves that minimize improvisation and coordination errors for physicians may also reduce dwell time and manipulation events for patients, thereby advancing the core triad of safety, procedural efficacy, and everyday usability. By examining how clinicians place central lines, this study reveals modifiable design flaws that perpetuate risk despite decades of procedural standardization. Contextual inquiry provides the evidentiary bridge between clinical imperatives to reduce complications and the practical realities of device use. Embedding such investigations at the outset of design and iteratively throughout product life cycles offers a path toward safer, more efficient, and more humane central venous access for both patients and providers.
The contemporary causes of postoperative mortality in orthopedic surgery are not well characterized. This study aimed to describe the epidemiology of postoperative complications among adult patients who underwent orthopedic surgery and inform their relationships with 30-day mortality. Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) was a prospective cohort study involving 40,004 adult patients who underwent noncardiac surgery across 28 centers in 14 countries. For the subset of patients who underwent orthopedic surgery, a Cox proportional hazards model was used to determine time-dependent associations between various surgical complications and 30-day postoperative mortality. Analyses were adjusted for preoperative and surgical variables. Among 8385 patients who underwent an orthopedic surgery in VISION, 1.6% (n=132) died within 30 days of surgery. Of the 132 deaths, 63.6% (n=84) occurred in hospital during the index hospitalization, while 36.4% (n=48) occurred after discharge. The incidence of death across the subcategories of orthopedic surgery was above-knee amputation (30/221, 13.6%), internal fixation of femur (29/750, 3.9%), lower leg amputation (9/252, 3.6%), major hip or pelvic surgery (49/2898, 1.7%), major spine surgery (8/1405, 0.6%), and knee arthroplasty (7/2876, 0.2%). A total of 6 postoperative complications (myocardial injury after noncardiac surgery [MINS], major bleeding, infection without sepsis, sepsis, stroke, and atrial fibrillation) were associated with death in adjusted analyses. The greatest attributable fractions of postoperative mortality (ie, proportion of deaths in the cohort that can be attributed to each complication, if causality were established) were from MINS (1454/8385, 17.3%; hazard ratio [HR] 2.08, 95% CI 1.38-3.14; P<.001; attributable fraction=20.6%), major bleeding (2422/8385, 28.9%; HR 1.95, 95% CI 1.34-2.85; P<.001; attributable fraction=16.5%), and sepsis (318/8385, 3.8%; HR 6.24, 95% CI 3.85-10.12; P<.001; attributable fraction=9.7%). The complications most attributable to 30-day mortality following orthopedic surgery were MINS, major bleeding, and sepsis. These findings highlight areas for further study to mitigate perioperative mortality in orthopedic surgery. MINS demonstrated the highest attributable fraction for mortality (20.6%), emphasizing the importance of appropriate MINS screening, diagnosis, and management.
Laparoscopic-guided subcostal transversus abdominis plane (TAP) block has been introduced as a surgeon-performed approach to postoperative analgesia in laparoscopic cholecystectomy (LC), allowing direct visual confirmation of local anesthetic delivery without ultrasound guidance. However, evidence regarding its clinical outcomes, particularly in patients with complicated gallstone disease, remains limited. This study aimed to evaluate postoperative analgesic outcomes and identify factors associated with opioid requirement following laparoscopic-guided subcostal TAP block. A prospective observational study was conducted between November 2023 and October 2024 at Srinakharinwirot University Hospital, Thailand. Patients (aged 18-80 years) undergoing LC for uncomplicated or complicated gallstone disease received a laparoscopic-guided subcostal TAP block with 0.25% bupivacaine. Postoperative pain was assessed using the Visual Analog Scale at 2, 4, 6, 8, 12, and 24 hours. Morphine administration within the first 24 hours was recorded. Associations between perioperative variables and opioid requirement were analyzed using univariate and exploratory multivariable logistic regression. A total of 42 patients were included in the analysis. Of these, 21 (50%) did not require postoperative opioids, while the remaining patients (n=21, 50%) received a mean cumulative morphine dose of 3.86 (SD 1.39) mg within 24 hours. Pain scores were lower during the early postoperative period (2, 4, and 12 h) in patients who did not require opioids. Higher American Society of Anesthesiologists classification was independently associated with postoperative morphine requirement (odds ratio 6.51, 95% CI 1.37-30.96; P=.01). No major complications or local anesthetic toxicity were observed. In this prospective observational cohort, laparoscopic-guided subcostal TAP block may be associated with favorable early postoperative analgesic profiles and relatively low opioid requirements after LC, including in patients with gallstone-related complications. Higher American Society of Anesthesiologists classification may be associated with increased opioid demand, highlighting the importance of individualized, risk-adapted analgesic strategies. Although limited by the absence of a control group and modest sample size, these findings support the clinical feasibility of surgeon-performed TAP block for consideration within multimodal analgesia approaches in enhanced recovery after surgery-oriented perioperative care.
Tunnel anastomosis is a novel anastomotic technique for digestive tract reconstruction following proximal gastrectomy. A previous retrospective study by our team demonstrated its favorable antireflux effect; therefore, we hypothesize that tunnel anastomosis is noninferior to double-tract jejunal interposition reconstruction in preventing postoperative reflux esophagitis, and we will conduct this prospective study to further validate this assumption. In this study, we will prospectively compare tunnel anastomosis with the currently more prevalent double-tract jejunal interposition reconstruction technique to further validate its safety and efficacy. This is a multicenter prospective randomized controlled study that will enroll 240 patients who will undergo proximal gastrectomy. The study will be divided into 2 groups: the tunnel anastomosis group and the double-tract jejunal interposition reconstruction group, with 120 patients in each group. Patients will undergo clinical assessments and complete questionnaires preoperatively, as well as at the 3rd, 6th, and 12th months postoperatively. The primary end point is the incidence of reflux esophagitis within 1 year. The secondary end points include perioperative safety, postoperative quality of life, and postoperative nutritional status. Recruitment of patients commenced in March 2022 and is scheduled to conclude in February 2027. The follow-up for all enrolled patients will be completed by February 2028. To our knowledge, this is the first prospective study on this technique, aiming to provide novel insights into the methods of digestive reconstruction following proximal gastrectomy.