Roger Daglius Dias

Harvard Medical School | Brigham and Women's Hospital · Emergency Medicine

Providing care for simulated emergency patients may induce considerable acute stress in physicians. However, the acute stress provoked in a real-life emergency room is not well known. Our aim was to assess acute stress responses in residents during real emergency care and investigate the related personal and situational factors. A cross-sectional o...

Background: Surgeons in the operating theatre deal constantly with high-demand tasks that require simultaneous processing of a large amount of information. In certain situations, high cognitive load occurs, which may impact negatively on a surgeon's performance. This systematic review aims to provide a comprehensive understanding of the different...

Purpose: To identify the different machine learning (ML) techniques that have been applied to automate physician competence assessment and evaluate how these techniques can be used to assess different competence domains in several medical specialties. Method: In May 2017, MEDLINE, EMBASE, PsycINFO, Web of Science, ACM Digital Library, IEEE Xplor...

Brief periods of extreme gravitational transition are anticipated during interplanetary spaceflight, including transitions between microgravity, hypogravity, and hypergravity. Rapid sensorimotor adaptation will occur following these G-transitions which may affect astronaut performance including gaze control and dynamic visual acuity. Significant de...

Introduction Surgeons need high fidelity, high quality, objective, non-judgemental and quantitative feedback to measure their performance in order to optimise their performance and improve patient safety. This can be provided through surgical sabermetrics, defined as ‘advanced analytics of digitally recorded surgical training and operative procedur...

Medical events can affect space crew health and compromise the success of deep space missions. To successfully manage such events, crew members must be sufficiently prepared to manage certain medical conditions for which they are not technically trained. Extended Reality (XR) can provide an immersive, realistic user experience that, when integrated...

Introduction Literature has shown cognitive overload which can negatively impact learning and clinical performance in surgery. We investigated learners’ cognitive load during simulation-based trauma team training using an objective digital biomarker. Methods A cross-sectional study was carried out in a simulation center where a 3-h simulation-base...

Purpose Articulated hand pose tracking is an under-explored problem that carries the potential for use in an extensive number of applications, especially in the medical domain. With a robust and accurate tracking system on surgical videos, the motion dynamics and movement patterns of the hands can be captured and analyzed for many rich tasks. Meth...

Excessive intra-operative noise in cardiac surgery has the potential to serve as source of distraction and additional cognitive workload for the surgical team, and may interfere with optimal performance. The separation from bypass phase is a technically complex phase of surgery, making it highly susceptible to communication breakdowns due to high c...

Situational awareness (SA) at both individual and team levels, plays a critical role in the operating room (OR). During the pre-incision time-out, the entire OR team comes together to deploy the surgical safety checklist (SSC). Worldwide, the implementation of the SSC has been shown to reduce intraoperative complications and mortality among surgica...

Several studies have reported low adherence and high resistance from clinicians to adopt digital health technologies into clinical practice, particularly the use of computer-based clinical decision support systems. Poor usability and lack of integration with the clinical workflow have been identified as primary issues. Few guidelines exist on how t...

Objectives The aim of this study was to conduct the translation and cross-cultural adaptation of the original Team Emergency Assessment Measure (TEAM) tool into the Brazilian Portuguese language and investigate the internal consistency, inter-rater reliability, and concurrent validity of this new version (bp-TEAM). Methods Independent medical tran...

Objective Our primary aim was to investigate crew performance during medical emergencies with and without ground-support from a flight surgeon located at mission control. Background There are gaps in knowledge regarding the potential for unanticipated in-flight medical events to affect crew health and capacity, and potentially compromise mission s...

Purpose: War negatively impacts health professional education when healthcare is needed most. The aims of this scoping review are to describe the scope of barriers and targeted interventions to maintaining health professional education during war and summarize the research. Methods: We conducted a scoping review between June 20, 2018, and August...

Objective:. The aims of this study were to describe the process of integrating 2 established training programs, Nontechnical skills for surgeons, and a traditional essential surgical skills course and to measure the impact of this integrated course on the behaviors of interprofessional surgical teams in Rwandan district hospitals. Background:. Surg...

Introdução A falta de estratégias proativas de cuidados influenciam a fragmentação dos cuidados, desparametrização de processos e prolongamento de tempos hospitalares, 1 enquanto evidências mostraram que protocolos multiprofissionais baseados em evidências executados por equipes sincronizadas, com padronização de processos, proatividade e cuidados...

The cardiac surgery operating room (OR) is a complex sociotechnical environment requiring the seamless integration of human-human and human-machine teams. Perfusionists in particular play a critical role in ensuring patient stability by operating the cardiopulmonary bypass (CPB) machine. Goal-directed perfusion (GDP) (oxygen delivery [DO2] ≥ 280 mL...

Space travel imposes significant risks to crew health due to physiological adaptations, exposure to physical and psychological stressors, and limited capabilities to provide medical care. When medical emergencies occur, appropriate use of diagnostic and procedural guidance tools are crucial countermeasures against the risks of injury and mission fa...

The cardiac surgery operating room is a high-risk and complex environment in which multiple experts work as a team to provide safe and excellent care to patients. During the cardiopulmonary bypass phase of cardiac surgery, critical decisions need to be made and the perfusionists play a crucial role in assessing available information and taking a ce...

Objective (s): This study aimed to develop the Perfusionists’ Intraoperative Non-Technical Skills (PINTS) tool, specifically to the perfusionists’ context, and test its inter-rater reliability. Methods An expert panel was convened to review existing surgical non-technical skills taxonomies and develop the PINTS tool. During a workshop held at a na...

Objective: Evaluate how emotional intelligence (EI) has been measured among surgeons and to investigate interventions implemented for improving EI. Summary background: EI has relevant applications in surgery given its alignment with non-technical skills. In recent years, EI has been measured in a surgical context to evaluate its relationship wit...

Background Familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. Methods Adult cardiac surgical procedures (n = 4,445) involving intraoperative providers were evaluated at a tertiary hospital between 2016 and 2020. Team familiarity (mean of prior cardiac...

While the influence of surgical flow disruptions (SFDs) on surgical performance has been observed in live cardiovascular surgery and their influence on cognitive workload has been evaluated in high-fidelity simulations, the relationship between SFDs and cognitive workload of surgical providers in the live cardiac surgery operating room has yet to b...

Shared mental models are critical to team success; however, in practice, team members may have misaligned models due to a variety of factors. In safety-critical domains (e.g., aviation, healthcare), lack of shared mental models can lead to preventable errors and harm. Towards the goal of mitigating such preventable errors, here, we present a Bayesi...

Shared mental models are critical to team success; however, in practice, team members may have misaligned models due to a variety of factors. In safety-critical domains (e.g., aviation, healthcare), lack of shared mental models can lead to preventable errors and harm. Towards the goal of mitigating such preventable errors, here, we present a Bayesi...

Surgical time-outs are designed to promote situation awareness, teamwork, and error prevention. The pre-incision time-out in particular aims to facilitate shared mental models prior to incision. Objective, unbiased measures to confirm its effectiveness are lacking. We hypothesized that providers' mental workload would reveal team psychophysiologica...

Objective: To assess the impact of intensive care unit bed availability, distractors and choice framing on intensive care unit admission decisions. Methods: This study was a randomized factorial trial using patient-based vignettes. The vignettes were deemed archetypical for intensive care unit admission or refusal, as judged by a group of expert...

Background As surgical systems are forced to adapt and respond to new challenges, so should the patient safety tools within those systems. We sought to determine how the WHO SSC might best be adapted during the COVID-19 pandemic. Methods 18 Panelists from five continents and multiple clinical specialties participated in a three-round modified Delp...

Shared mental models are critical to team success; however, in practice, team members may have misaligned models due to a variety of factors. In safety-critical domains (e.g., aviation, healthcare), lack of shared mental models can lead to preventable errors and harm. Towards the goal of mitigating such preventable errors, here, we present a Bayesi...

Objective Nontechnical skills, such as situation awareness, decision making, leadership, communication, and teamwork play a crucial role on the quality of care and patient safety in the operating room (OR). In our previous work, we developed an interdisciplinary training program, based on the NOTSS (Non-Technical Skills for Surgeons) taxonomy. The...

Articulated hand pose tracking is an underexplored problem that carries the potential for use in an extensive number of applications, especially in the medical domain. With a robust and accurate tracking system on in-vivo surgical videos, the motion dynamics and movement patterns of the hands can be captured and analyzed for rich tasks including sk...

With the tremendous advances in technology and computational systems that occurred in the last three decades, we have integrated novel technologies in virtually all human activities, with the ultimate goal of improving performance and enhancing safety in the workplace. As a high-stakes, high-risk human activity, with increasing level of complexity,...

Objective This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. Background Estimations of operators’ cognitive workload states in naturalistic settings have been deri...

Effectiveness of computer vision techniques has been demonstrated through a number of applications, both within and outside healthcare. The operating room environment specifically is a setting with rich data sources compatible with computational approaches and high potential for direct patient benefit. The aim of this review is to summarize major t...

Monitoring healthcare providers' cognitive workload during surgical procedures can provide insight into the dynamic changes of mental states that may affect patient clinical outcomes. The role of cognitive factors influencing both technical and non-technical skill are increasingly being recognized, especially as the opportunities to unobtrusively c...

Cardiac surgery is one of the most complex specialties in medicine, akin to a complex sociotechnical system. Patient outcomes are vulnerable to surgical flow disruptions (SFDs), a source of preventable harm. Healthcare providers’ (HCPs) sympathetic activation secondary to emotional states represent an underappreciated source of SFDs. This study’s o...

Introduction Trauma patients are complex and diverse with the team leader playing a crucial role in team performance. Trauma team leadership (TTL) skills are critical according to many studies, yet no assessment tool has been developed for this important skill set. The aim of this study was to develop and validate a TTL assessment tool for use in b...

The tremendous and rapid technological advances that humans have achieved in the last decade have definitely impacted how surgical tasks are performed in the operating room (OR). As a high-tech work environment, the contemporary OR has incorporated novel computational systems into the clinical workflow, aiming to optimize processes and support the...

Objectives: This study aimed to narratively summarize the literature reporting on the effect of teamwork and communication training interventions on culture and patient safety in emergency department (ED) settings. Methods: We searched PubMed, EMBASE, Psych Info CINAHL, Cochrane, Science Citation Inc, the Web of Science, and Educational Resource...

Objective Mirrored psychophysiological change in cognitive workload indices may reflect shared mental models and effective healthcare team dynamics. In this exploratory analysis, we investigated the frequency of mirrored changes, defined as concurrent peaks in heart rate variability (HRV) across team members, during cardiac surgery. Design Objecti...

Cardiac surgery represents a complex sociotechnical environment relying on a combination of technical and non-technical team-based expertise. Surgical flow disruptions (SFDs) may be influenced by a variety of sources, including social, environmental, and emotional factors affecting healthcare providers (HCPs). Many of these factors can be readily o...

Surgical processes are rapidly being adapted to address the COVID-19 pandemic, with changes in procedures and responsibilities being made to protect both patients and medical teams. These process changes put new cognitive demands on the medical team and increase the likelihood of miscommunication, lapses in judgment, and medical errors. We describe...

BACKGROUND Of the 150,000 patients annually undergoing coronary artery bypass grafting surgery, 35% develop complications that increase mortality 5-fold and expenditures by 50%. Differences in patient risk and operative approach explain only 2% of hospital variation in some complications. The intraoperative phase remains understudied as a source of...

Background Of the 150,000 patients annually undergoing coronary artery bypass grafting, 35% develop complications that increase mortality 5 fold and expenditure by 50%. Differences in patient risk and operative approach explain only 2% of hospital variations in some complications. The intraoperative phase remains understudied as a source of variati...

The mental and physiological stress experienced by surgeons during operations has been identified as an important human factor that impacts surgical performance and patient safety. It is crucial to objectively measure and quantify surgeons' stress via physiological signals in order to enhance the understanding of how stress contributes to surgical...

Background. The most commonly used subjective assessment of perceived cognitive load, the NASA Task Load Index (TLX), has proven valuable in measuring individual load among general populations. The surgery task load index (SURG-TLX) was developed and validated to measure cognitive load specifically among individuals within a surgical team. Notably,...

Background: The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as w...

Long-duration exploration missions (LDEMs), such as voyages to Mars, will present unique medical challenges for astronaut crews, including communication delays and the inability to return to Earth early. Medical events threaten crewmember lives and increase the risk of mission failure. Managing a range of potential medical events will require excel...

Background: The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we...

Background: The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we...

Background: The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we...

Healthcare organizations rely on simulations of complex processes to provide the training required for individuals and teams to evolve their skills and maintain high levels of competence in medical domains. Inherent in this process is the belief, generally founded on macro-scale measures such as observations and workplace-based assessments, that si...

Cognitive Engineering is focused on how humans can cope and master the complexity of processes and technological environments. In cardiothoracic surgery, the goal is to support safe and effective human performance by preventing medical errors. Strategies derived from cognitive engineering research could be introduced in cardiothoracic surgery pract...

Objective: The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes. Summary background data: Nontechnical skills play a crucial role in sur...

The cardiac operating room (OR) is a high-risk environment where several specialized providers work as team to provide care for patients undergoing complex surgical pro-cedures. Cardiac surgery can be conceptualized as a team-based sociotechnical system with critical requirements for communication and coordination. Contemporary research in this rea...

INTRODUCTION: Long-duration exploration missions (LDEMs) impose unique physical and psychological demands on crew members, affecting their performance during routine activities in space. A relevant gap for the NASA Human Research Roadmap is the lack of knowledge on how space crew should be trained for medical decision making and medical skills to e...

INTRODUCTION : Long-duration spaceflight crews will rely on teamwork and behavioral skills to successfully operate in extreme environments. The development of automated metrics of team dynamics may play an important role on the assessment of team performance in a reliable and unobtrusive manner. In this study, we explored the feasibility of using a...

Background The world’s population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older ( > 60 years) compared with non-older population, as well as the epidemiology of these hospital admissions. Methods Using the...

Purpose: Intensive care unit (ICU) admission triage occurs frequently and often involves highly subjective decisions that may lead to potentially inappropriate ICU admissions. In this study, we evaluated the effect of implementing a decision-aid tool for ICU triage on ICU admission decisions. Methods: This was a prospective, before-after study....

INTRODUCTION: In-flight medical events pose significant risk to crew health and mission success on future long-duration exploration missions (LDEMs). The cognitive load imposed by medical-related tasks will play a critical role in how well flight teams can manage medical events in space. Moreover, teamwork and coordinated crew interactions are esse...

Cognitive workload data of members of the cardiac surgery team can be measured intraoperatively and stored for later analysis. We present a case of a near-miss (medication error) that underwent root cause analysis using workload data. Heart rate variability data, representing workload levels, were collected from the attending surgeon, attending ane...

Procedural flow disruptions secondary to interruptions play a key role in error occurrence during complex medical procedures, mainly because they increase mental workload among team members, negatively impacting team performance and patient safety. Since certain types of interruptions are unavoidable, and consequently the need for multitasking is i...

Objectives Prognostication is an essential ability to clinicians. Nevertheless, it has been shown to be quite variable in acutely ill patients, potentially leading to inappropriate care. We aimed to assess the accuracy of physician’s prediction of hospital mortality in acutely deteriorating patients referred for urgent intensive care unit (ICU) adm...

OBJECTIVE: Despite playing a crucial role on surgical performance, the cognitive processes underlying the intraoperative phase of surgery still lack a proper understanding. Our aim is to describe a novel method of cognitive task analysis that uses a cued-recall protocol based on surgical videos to assess the cognitive processes involved in CABG pro...