This study presents a methodology for predicting the duration of surgical procedures using Machine Learning (ML). The methodology incorporates a new set of predictors emphasizing the significance of surgical team dynamics and composition, including experience, familiarity, social behavior, and gender diversity. By applying ML techniques to a comprehensive dataset of over 77,000 surgeries, we achieved a 24% improvement in the mean absolute error (MAE) over a model that mimics the current approach of the decision maker. Our results also underscore the critical role of surgeon experience and team composition dynamics in enhancing prediction accuracy. These advancements can lead to more efficient operational planning and resource allocation in hospitals, potentially reducing downtime in operating rooms and improving healthcare delivery.

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BACKGROUND: Systematic biases in group decision making (i.e., group biases) may result in suboptimal decisions and potentially harm patients. It is not well known how impaired group decision making in patient care may affect medical training. This study aimed to explore medical residents\' experiences and perspectives regarding impaired group decision making and the role of group biases in medical decision making.
METHODS: This study used a qualitative approach with thematic analysis underpinned by a social constructionist epistemology. Semi-structured interviews of medical residents were conducted at a single internal medicine residency program. Residents were initially asked about their experiences with suboptimal medical decision making as a group or team. Then, questions were targeted to several group biases (groupthink, social loafing, escalation of commitment). Interviews were transcribed and transferred to a qualitative data analysis software. Thematic analysis was conducted to generate major themes within the dataset.
RESULTS: Sixteen interviews with residents revealed five major themes: (1) hierarchical influence on group decision making; (2) group decision making under pressure; (3) post-call challenges in decision making; (4) interactions between teamwork and decision making; and (5) personal and cultural influences in group decision making. Subthemes were also identified for each major theme. Most residents were able to recognize groupthink in their past experiences working with medical teams. Residents perceived social loafing or escalation of commitment as less relevant for medical team decision making.
CONCLUSIONS: Our findings provide unique insights into the complexities of group decision making processes in teaching hospitals. Team hierarchy significantly influenced residents\' experiences with group decision making-most group decisions were attributed to consultants or senior team members, while lower ranking team members contributed less and perceived fewer opportunities to engage in group decisions. Other factors such as time constraints on decision making, perceived pressures from other staff members, and challenges associated with post-call days were identified as important barriers to optimal group decision making in patient care. Future studies may build upon these findings to enhance our understanding of medical team decision making and develop strategies to improve group decisions, ultimately leading to higher quality patient care and training.

This comparative study investigates the effectiveness of two teaching methods, individual verbal encouragement and collective verbal encouragement, in enhancing the technical-tactical skills and mood state of obese students during handball matches. This study employs a randomized controlled design and involves 28 overweight students (50% females), age: 17.4 ± 2.08 years and BMI: 26.8 ± 1.5 for females and 27.3 ± 2.1 for males. Technical-tactical skills are assessed through performance metrics (individual evaluation proposal by Gréhaigne) such as Ball Played (BP), Conquered Ball (CB), Lost Ball (LB), Shoots/Goals, Conservation index, and defensive index, while mood states are evaluated using pre- and post-tests (BRUMS Scale). Results reveal that individual verbal encouragement significantly enhances technical-tactical skills and positively influences the mood state of overweight students compared to collective verbal encouragement. Boys in Session 1 with VEI displayed a significantly higher number of ball plays (mean difference = 0.94 standard deviations, p = 0.004) and conquered balls (mean difference = 0.78 standard deviations, p = 0.006) compared to VEC. They also had a lower number of Lost Balls (mean difference = -0.62 standard deviations, p = 0.018) and a higher shooting efficiency (Shoots/Goals ratio, mean difference = 0.67 standard deviations; p = 0.013). Similar trends were observed in Session 2, with VEI, again, demonstrating advantages. Girls exhibited analogous improvements with VEI in both sessions. Notably, these performance enhancements coincided with positive emotional changes, with VEI leading to a greater decrease in depression and fatigue scores for both boys and girls. The study highlights the importance of tailoring teaching methods to the specific needs of overweight students in the context of handball, emphasizing the effectiveness of individualized verbal encouragement for skill development and emotional well-being. These findings offer practical implications for educators and coaches involved in physical education, advocating for personalized approaches to optimize learning experiences for overweight students in sports settings.

Rationale: Endotracheal intubation is the third most common bedside procedure in U.S. hospitals. In over 40% of intubations, preventable complications attributable to human factors occur. A better understanding of team dynamics during intubation may improve patient safety. Objectives: To explore team dynamics and safety-related actions during emergent endotracheal intubations in the emergency department and intensive care unit and to engage members of the care team in reflection for process improvement through a novel video-based team debriefing technique. Methods: Video-reflexive ethnography involves in situ video recording and reflexive discussions with practitioners to scrutinize behaviors and to identify opportunities for improvement. In this study, real-time intubations were recorded in the emergency department and intensive care unit at Mayo Clinic Rochester, and facilitated video-reflexive sessions were conducted with the multidisciplinary procedural teams. Themes about team dynamics and safety-related action were identified inductively from transcriptions of recorded sessions. Results: Between December 2022 and January 2023, eight video-reflexive sessions were conducted with a total of 78 participants. Multidisciplinary members included nurses (n = 23), respiratory therapists (n = 16), pharmacists (n = 7), advanced practitioners (n = 5), and physicians (n = 26). In video-reflexive discussions, major safety gaps were identified and several solutions were proposed related to the use of a multidisciplinary intubation checklist, standardized communication and team positioning, developing a culture of safety, and routinely debriefing after the procedure. Conclusions: The findings of this study may inform the development of a team supervision model for emergent endotracheal intubations. This approach could integrate key components such as a multidisciplinary intubation checklist, standardized communication and team positioning, a culture of safety, and debriefing as part of the procedure itself.

The reader of this article will now have the ability to reflect on all aspects of high-quality trauma bay care, from resuscitation to diagnosis and leadership to debriefing. Although there is no replacement for experience, both clinically and in a simulation environment, trauma clinicians are encouraged to make use of this article both as a primer at the beginning of a trauma rotation and a reference text to revisit after difficult cases in the trauma bay. Also, periods of reflection seem appropriate in the busy but, of course, rewarding career in trauma care.

UNASSIGNED: We recently reported the first part of a study testing the impact of data literacy training on \"assessing pain, spontaneous awakening and breathing trials, choice of analgesia and sedation, delirium monitoring/management, early exercise/mobility, and family and patient empowerment\" [ABCDEF [A-F]) compliance. The purpose of the current study, part 2, was to evaluate the effectiveness of the implementation approach by surveying clinical staff to examine staff knowledge, skill, motivation, and organizational resources.
METHODS: The Clark and Estes Gap Analysis framework was used to study knowledge, motivation, and organization (KMO) influences. Assumed influences identified in the literature were used to design the A-F bundle implementation strategies. The influences were validated against a survey distributed to the ICU interprofessional team.
METHODS: Single-center study was conducted in eight adult ICUs in a quaternary academic medical center.
METHODS: Interprofessional ICU clinical team.
METHODS: A quantitative survey was sent to 386 participants to evaluate the implementation design postimplementation. An exploratory factor analysis was performed to understand the relationship between the KMO influences and the questions posed to validate the influence. Descriptive statistics were used to identify strengths needed to sustain performance and weaknesses that required improvement to increase A-F bundle adherence.
RESULTS: The survey received an 83% response rate. The exploratory factor analysis confirmed that 38 of 42 questions had a strong relationship to the KMO influences, validating the survey\'s utility in evaluating the effectiveness of implementation design. A total of 12 KMO influences were identified, 8 were categorized as a strength and 4 as a weakness of the implementation.
CONCLUSIONS: Our study used an evidence-based gap analysis framework to demonstrate key implementation approaches needed to increase A-F bundle compliance. The following drivers were recommended as essential methods required for successful protocol implementation: data literacy training and performance monitoring, organizational support, value proposition, multidisciplinary collaboration, and interprofessional teamwork activities. We believe the learning generated in this two-part study is applicable to implementation design beyond the A-F bundle.

BACKGROUND: The COVID-19 pandemic has challenged health care professionals and changed our approach to care delivery. The aim in this study was to explore nurses\' experiences providing care in the ED during the COVID-19 pandemic in Australia and the impact of this on ED team functioning.
METHODS: A qualitative explorative descriptive study was conducted using thematic analysis strategies. Participants comprised: Registered Nurses (n = 18) working in clinical roles in the Emergency Department and Leadership Registered Nurses (n = 6) within the organisation. One on one interviews (n = 21) and one focus group interview were conducted utilising semi-structured, conversational style, in-depth interviews between January 2022 and April 2022.
RESULTS: Two major themes were identified that described the impact on ED team dynamics and longer-term impacts on the ED nursing workforce. The first major theme was: \'Changed Emergency Department team identity and dynamics\' and included four sub-themes: i) PPE is a barrier to team camaraderie; ii) outsiders versus insiders - ambivalence to PPE spotter role; iii) personal safety comes first in a pandemic; and iv) using PPE depersonalises the whole patient experience. The second major theme was: \'This pandemic caught everyone off guard\' and had three sub-themes. The associated sub-themes were: i) People outside ED have no understanding of what it has been like; ii) COVID-19 is here to stay - Permanent changes to care delivery and nursing practice; and iii) tenacity of a true profession.
CONCLUSIONS: Study findings illuminated the dynamics and functionality of ED nursing, encompassing the unique qualities of camaraderie, autonomy, resilience and tenacity.

Health care requires the effort of a team, and nowhere is this more evident than in the care of the surgical patient. No single clinician can perform all aspects of the continuum of surgical care. The basic operating room (OR) team consists of nurses, technicians, surgeons, and anesthesiologists with unique and well-defined roles and expertise in perioperative care. The modern OR team continues to grow and evolve in size, diversity, and complexity to meet the needs of growing patient and procedural complexity. This growing complexity makes achieving optimal team performance paramount and challenging.

A questionnaire that can properly measure communal coping in sport is required to further investigate and understand how individuals in a team collectively cope with stressful sport situations. The Communal Coping Strategies Inventory for Competitive Team Sports (CCSICTS; Leprince et al., 2019) needed to be validated at the collective level and in its situational form to be used in broader sport situations. The aims of the present work were to improve and further validate the factorial structure of the CCSICTS at both individual and team levels. With a sample of 380 French athletes, representing 56 teams, Study 1 showed support for a multilevel, hierarchical and four-dimensional factorial structure of the revised version of the CCSICTS at both individual and team levels. With a sample of 641 French athletes, representing 75 teams, Study 2 confirmed the factorial structure obtained in Study 1 at individual and team levels, and its validity in sport-specific situations. The results of both studies also highlighted a bifactorial structure, allowing interpretation of communal coping as an overall team capacity to adapt to stress. As such, the psychometric qualities of the CCSICTS-R have been established at individual and team levels. The CCSICTS-R enables proper and distinct measurement of the characteristics of communal coping in sport (i.e., hierarchical, multidimensional, multilevel, both situational and dispositional) and can be used from both research and practical perspectives.