Testing Machine Learning Models to Predict Postoperative Ileus after Colorectal Surgery.

Background: Postoperative ileus (POI) is a common complication after colorectal surgery, leading to increased hospital stay and costs. This study aimed to explore patient comorbidities that contribute to the development of POI in the colorectal surgical population and compare machine learning (ML) model accuracy to existing risk instruments. Study Design: In a retrospective study, data were collected on 316 adult patients who underwent colorectal surgery from January 2020 to December 2021. The study excluded patients undergoing multi-visceral resections, re-operations, or combined primary and metastatic resections. Patients lacking follow-up within 90 days after surgery were also excluded. Eight different ML models were trained and cross-validated using 29 patient comorbidities and four comorbidity risk indices (ASA Status, NSQIP, CCI, and ECI). Results: The study found that 6.33% of patients experienced POI. Age, BMI, gender, kidney disease, anemia, arrhythmia, rheumatoid arthritis, and NSQIP score were identified as significant predictors of POI. The ML models with the greatest accuracy were AdaBoost tuned with grid search (94.2%) and XG Boost tuned with grid search (85.2%). Conclusions: This study suggests that ML models can predict the risk of POI with high accuracy and may offer a new frontier in early detection and intervention for postoperative outcome optimization. ML models can greatly improve the prediction and prevention of POI in colorectal surgery patients, which can lead to improved patient outcomes and reduced healthcare costs. Further research is required to validate and assess the replicability of these results.

Application of Machine Learning in Predicting Perioperative Outcomes in Patients with Cancer: A Narrative Review for Clinicians.

This narrative review explores the utilization of machine learning (ML) and artificial intelligence (AI) models to enhance perioperative cancer care. ML and AI models offer significant potential to improve perioperative cancer care by predicting outcomes and supporting clinical decision-making. Tailored for perioperative professionals including anesthesiologists, surgeons, critical care physicians, nurse anesthetists, and perioperative nurses, this review provides a comprehensive framework for the integration of ML and AI models to enhance patient care delivery throughout the perioperative continuum.

Translation of Credentialing Examination for Providers with English as a Second Language: An Exploratory Study.

Racial and ethnic minorities disproportionately suffer the burden of adverse health outcomes in the United States. Increasing the diversity of healthcare providers may help decrease disparities in outcomes. Unfortunately, language barriers may affect performance in nursing school and credentialing examinations. The purpose of this exploratory study was to identify current practices and trends affecting the translation of credentialing examinations. Commissioned by the National Board of Certification and Recertification for Nurse Anesthetists, a survey was sent to the credentialing organizations soliciting information about their exam translation practices and considerations. Among the 27 credentialing organizations (two licensure and 25 certification organizations) that completed the survey, 63% were from healthcare. All the organizations offered their credentialing examinations in English. Some offered their examination in Chinese/Mandarin (15%), Spanish (11%), French (7%), and Arabic (7%). The majority (78%) do not translate their examinations into another language. Among the six credentialing organizations translating their examinations, 67% translate one, and 17% translate two examinations. Most use the forward and back-translation techniques. For organizations embarking on a multilingual credentialing program, it is imperative to ensure psychometric equivalence of their examinations. Translation can help ensure that candidates are tested on their intended competencies, not their language proficiency.

Oncologic Emergencies.

A new cancer diagnosis is expected to affect approximately 1.9 million people in the United States in 2021. A small percentage of these patients will experience an emergent cancer-related complication. Oncologic emergencies may be encountered in emergency departments or require intensive care management. Patients newly diagnosed with cancer are more likely to present with emergencies related to the underlying malignancies. Oncologic emergencies can have various manifestations, ranging from mechanical obstruction due to tumor growth to metabolic derangements due to abnormal secretions from the tumor. Therefore, early identification and treatment of life-threatening oncologic events is critical. Although there are several different types of oncologic emergencies, this article focuses on metabolic emergencies (tumor lysis syndrome and cytoreductive hyperthermic intraperitoneal chemotherapy) and structural emergencies (increased intracranial pressure and vena cava thrombus). The purpose of this article is to provide acute care clinicians with an overview of selected oncologic emergencies and their evidence-based management.

Assessing Executive Nurse Leaders' Financial Literacy Level: A Mixed-Methods Study.

OBJECTIVES: To evaluate the reliability and validity of the Financial Management Competency Self-assessment (FMCA) in executive nurse leaders (ENLs) and to determine how ENLs develop and apply financial knowledge. BACKGROUND: Financial literacy (FL) helps in planning, implementing, and evaluating fiscal decisions, but many ENLs report weaknesses in this core competency. METHODS: An explanatory-sequential mixed-methods study was conducted to psychometrically test the FMCA and explore how ENLs with different levels of FL develop and apply financial knowledge. Eligible participants (n = 178) were recruited from a population of ENLs across the United States. RESULTS: The test-retest reliability of the FMCA was good (mean difference, 6.80; 95% confidence interval). Correlations between domain scores (P < .01) and the overall score (Cronbach's α = .99) demonstrated the reliability and validity of the instrument. The cutoff scores were fair indicators of different levels of FL in ENLs (P < .001). Self-awareness, gaps in hospital and graduate nursing education, application of financial knowledge, and a micro versus macro view emerged as important themes in the qualitative analysis. CONCLUSION: FMCA reliability and validity were established. FMCA cutoff scores were established to determine FL level, and the ENL lived experience described in financial knowledge development and application.

Awake craniotomy: a practice overview.

Craniotomies are a common neurological intervention for intracranial tumor resections. Anesthesia techniques allow surgeons to aggressively and optimally resect neoplastic tissue while sparing normal cerebral tissue. Awake craniotomies are surgical techniques that enable surgeons to avoid damaging normal cerebral regions and allow real-time patient feedback. Such surgical interventions would not be possible without anesthesia. The role of anesthesia providers is critical in gaining the trust and motivation of the patient. Preoperative evaluation, regional anesthesia, general anesthesia, and monitored anesthesia are necessary to achieve a successful surgical intervention with awake craniotomy. As awake craniotomy gains more popularity, dependable anesthesia techniques remain critical. A discussion follows of the role of anesthesia providers in awake craniotomy during the entire perioperative continuum.

Treatment of tracheal and bronchial tumors and tracheal and bronchial stent placement.

Tumors of and trauma to the trachea and bronchi can result in loss of integrity of the airway and death. Once treated primarily with thoracic surgery, these conditions are increasingly being managed with interventional pulmonary procedures outside the operating room but requiring the assistance of anesthetists. These interventional procedures require airway instrumentation, necessitating anesthesia care for ventilation and obtundation of airway reflexes. A thorough preoperative assessment and consultation with the pulmonologist or surgeon performing the procedure are essential for successful completion of the tumor and scar reduction and subsequent stent placement. In addition, anesthetists may care for patients undergoing nonpulmonary surgery who have an existing bronchial or tracheal stent or patients requiring correction of displaced stents. A discussion on the preferred methods for caring for patients in these situations is included.