Creative destruction in science

Drawing on the concept of a gale of creative destruction in a capitalistic economy, we argue that initiatives to assess the robustness of findings in the organizational literature should aim to simultaneously test competing ideas operating in the same theoretical space. In other words, replication efforts should seek not just to support or question the original findings, but also to replace them with revised, stronger theories with greater explanatory power. Achieving this will typically require adding new measures, conditions, and subject populations to research designs, in order to carry out conceptual tests of multiple theories in addition to directly replicating the original findings. To illustrate the value of the creative destruction approach for theory pruning in organizational scholarship, we describe recent replication initiatives re-examining culture and work morality, working parents\u2019 reasoning about day care options, and gender discrimination in hiring decisions. Significance statement It is becoming increasingly clear that many, if not most, published research findings across scientific fields are not readily replicable when the same method is repeated. Although extremely valuable, failed replications risk leaving a theoretical void\u2014 reducing confidence the original theoretical prediction is true, but not replacing it with positive evidence in favor of an alternative theory. We introduce the creative destruction approach to replication, which combines theory pruning methods from the field of management with emerging best practices from the open science movement, with the aim of making replications as generative as possible. In effect, we advocate for a Replication 2.0 movement in which the goal shifts from checking on the reliability of past findings to actively engaging in competitive theory testing and theory building. Scientific transparency statement The materials, code, and data for this article are posted publicly on the Open Science Framework, with links provided in the article

Association Between Social Vulnerability Index and Hospital Readmission Following Gunshot Injuries

Introduction: No association regarding classification of social vulnerability and outcomes of patients with gunshot injury have been described. Our goal was to assess whether the socioeconomic vulnerability index (SVI), is associated with an increased risk of hospital readmission following gunshot wounds. Methods: We conducted an exploratory retrospective cohort study on Massachusetts patients with trauma following gunshot wounds from January 1, 2012 to December 31, 2020 using the institutional trauma registry. We estimated the association between high social vulnerability (defined by the Centers for Disease Control and Prevention as ≥90th percentile) and incidence of all-cause readmission at 30, 60, and 90 d (overall and stratified over sex, race, and age groups). Estimates from unadjusted log-binomial regression were reported using relative risks (RRs) and 95% confidence intervals. Time-to-event (readmission) was assessed using Kaplan-Meier plots. Results: A total of 386 patients were included for analysis: 211 (55%) with SVI \u3c0.90 and 175 (45%) with SVI ≥0.90. The mean (standard deviation) age was 29 (13) y, with majority being male (89%). There was no strong risk of readmission associated with SVI ≥0.90; the interval with the greatest risk was at 60 d (RR = 1.34; 95% confidence interval [0.73, 2.45]). Among stratified analyses, the strongest associations were observed when restricting to young adults (aged 18-35) with RRs of 2.49, 2.62, and 2.45 for 30, 60, and 90 d readmission, respectively. Conclusions: Overall, high SVI was not associated with all-cause readmission; however, subanalyses suggest an association among young adults. Future research should explore SVI as a tool for identifying patients with trauma at risk for readmission. Keywords: Gunshot wound; Social vulnerability index; Trauma readmission

Routine Assessment of Surgical Resident Wellness-Related Concerns During Biannual Review

Background: Surgery residency confers stress burdens on trainees. To monitor and mitigate areas of concerns, our education team implemented a six-item biannual survey querying potential stressors. We reviewed the initial five-year experience to assess for trends and improve efforts in maintaining well-being. Methods: Surgery residents from all postgraduate years were asked to complete a survey of common concerns, prioritizing them in order of importance. Ranked items were 1) needs of family/friends, 2) nonwork time for study, 3) financial concerns, 4) personal well-being needs, 5) concerns for clinical performance, and 6) administrative demands. Changes were trended over ten review periods. Results were analyzed using Kruskal-Wallis test. Results: 333 surveys were completed, rendering a 96.5% completion rate. Rankings changed significantly for nonwork time for study (p=0.04), personal well-being needs (p=0.03) and concerns for clinical performance (p=0.004). Nonwork time for study and concerns on clinical performance were consistently ranked as top two stressors over study period, except for Spring 2020. Personal well-being needs ranked highest in Spring 2020; 41% of residents placed this as top two rankings. A decrease in concerns for clinical performance was observed in Spring 2020, corresponding to the COVID-19 pandemic emergency declaration. Conclusion: Surgery residents generally prioritized time for study and concerns for assessment of clinical performance as highest areas of concern. With the occurrence of a pandemic, increased prioritization of personal well-being was observed. Used routinely with biannual reviews, the survey was able to identify plausible changes in resident concerns. Determination of levels of actual stress and actual association with the pandemic requires additional study

Association Between Nil Per Os Status and Intubated Patients Undergoing Surgery

Introduction: Patient outcomes heavily rely on nutritional support. However, holding enteric feeds prior to surgical operations in critically ill patients is still a common practice in intensive critical units. Our objective is to describe the relationship between duration of nil per os (NPO) and respiratory outcomes in intubated, critically ill patients requiring operative intervention. Methods: We conducted a retrospective analysis on intubated, critically ill patients who underwent operative intervention between January 1, 2016, and December 31, 2018, to investigate how the duration of NPO status may affect respiratory outcomes. We compared adverse respiratory events among patients who maintain NPO ≥6 h (NPO group) versus those who were NPO \u3c6 h (non-NPO group) prior to surgery. Results: Two hundred patients met inclusion criteria: 104 for NPO and 96 for non-NPO. Aspiration event was found in 5.8% of NPO patients and 7.3% in non-NPO patients, P = 0.66. Desaturation event was found in 16.3% for NPO and 14.6% in non-NPO, P = 0.73. Pneumonia was found in 18.3% of NPO patients and 19.8% in non-NPO patients, P = 0.78. Reintubated rates were 13.5% for NPO and 16.7% for non-NPO, P = 0.57. Median (range) hours of NPO for non-NPO was 1.0 h (0-3.0) and 13.0 h (6.0-20.0) for NPO, P \u3c 0.05. Conclusions: For intubated, critically ill patients requiring operative intervention, there was no difference observed in adverse respiratory events between those kept NPO for 6 h or greater compared to those kept NPO for less than 6 h. Patients were commonly without enteric nutrition for periods of time much greater than the American Society of Anesthesia\u27s recommended 6-h period. Keywords: Critical care nutrition; Nil per os; Preprocedural fasting

Impact of Telemedicine on Extended Focused Assessment With Sonography for Trauma Performance and Workload by Critical Care Transport Personnel

Introduction: There are currently no reports on whether telementoring for extended focused assessment with sonography for trauma (eFAST) improves critical care transport providers\u27 performance in prehospital settings. Our objective was to determine the impact of teleguidance on eFAST performance and quantify workload experience. Methods: Eight trauma injury modules were selected on simulated patients. Critical care transport (CCT) providers were tasked to complete one independent and one emergency physician-telementored eFAST. The time to completion and the percent of correct findings were obtained. Participants completed the NASA Task Load Index after each iteration to assess workload. Results: Eight independent and 8 telementored eFASTs were completed. The mean times to complete the independent and telementored eFAST were 5 minutes 16 seconds (95% confidence interval [CI], 3 minutes 32 seconds, 6 minutes 59 seconds) and 8 minutes 27 seconds (95% CI, 5 minutes 14 seconds, 11 minutes 39 seconds), respectively (P = .06). The percentage of correctly identified injuries for the independent versus the teleguided eFAST was 65% versus 92.5% (P = .01). The CCT providers experienced higher mental (P = .004), temporal (P = .01), and effort (P = .004) demands; greater frustration (P = .001); and subjective lower performance (P = .003) during independent trials. The emergency physician experienced higher mental (P = .001), temporal (P = .02), effort (P = .005), and frustration (P = .001) demands than the CCT members. Conclusion: The teleguided eFAST yielded higher accuracy than the independent eFAST. The CCT providers relied on teleguidance of the remote physician when performing the eFAST. Teleguidance may improve the accuracy of ultrasounds performed by prehospital personnel in real-life scenarios

Expert laparoscopist performance on virtual reality simulation tasks with and without haptic features

Background: Virtual reality (VR) simulation for laparoscopic training is available with and without haptic feedback features. Currently, there is limited data on haptic feedback\u27s effect on skill development. Our objective is to compare expert laparoscopists\u27 skills characteristics using VR delivered laparoscopic tasks via haptic and nonhaptic laparoscopic surgical interfaces. Methods: Five expert laparoscopists performed seven skills tasks on two laparoscopic simulators, one with and one without haptic features. Tasks consisted of 2-handed instrument navigation, retraction and exposure, cutting, electrosurgery, and complicated object positioning. Laparoscopists alternated platforms at default difficulty settings. Metrics included time, economy of movement, completed task elements, and errors. Progressive change in performance for the final three iterations were determined by repeated measures ANOVA. Iteration quartile means were determined and compared using paired t-tests. Results: No change in performance was noted in the last three iterations for any metric. There were no significant differences between platforms on the final two quartiles for most metrics except avoidance of over-stretch error for retraction; and cutting task was significantly better with haptics on all iteration quartiles (p \u3c 0.03). Economy of movement was significantly better with haptics for both hands for clip application (p \u3c 0.01) and better for right hand on complex object positioning (p \u3c 0.05). Accuracy was better with haptics for retraction and cutting (p \u3c 0.05) and clip application (p \u3c 0.05). Conclusion: Results showed higher performance in accuracy, efficient instrument motion, and avoidance of excessive traction force on selected tasks performed on VR simulator with haptic feedback compared to those performed without haptics feedback. Laparoscopic surgeons interpreted machine-generated haptic cues appropriately and resulted in better performance with VR task requirements. However, our results do not demonstrate an advantage in skills acquisition, which requires additional study. Keywords: Haptic feedback; Surgical simulation; Virtual reality

Feasibility and Acceptance of a Tele-Trauma Surgery Consult Service to Rural and Community Hospitals: A Pilot Study

Background: Many trauma patients currently transferred from rural and community hospitals (RCH) to Level 1 trauma centers (L1TC) for trauma surgery evaluation may instead be appropriate for immediate discharge or admission to the local facility following evaluation by a Trauma and Acute Care Surgery (TACS) surgeon. Unnecessary utilization of resources occurs with current practice. We aimed to demonstrate the feasibility and acceptance of a Tele-Trauma Surgery Consultation (TTSC) service between L1TC and RCH. Study design: L1TC TACS surgeons provided telehealth consults on trauma patients from 3 local RCHs. After consultation, appropriate patients were transferred to L1TC; selected patients remained at or were discharged from RCH. Participating TACS surgeons and RCH physicians were surveyed. Results: 28 patients met inclusion criteria during the 5-month pilot phase, 7 excluded due to workflow issues. Mean (±sd) age 63 (±17) years. Seven of 21 patients had intracranial hemorrhage; 12 had rib fractures. Mean (±sd) injury severity score (ISS) was 8.1(± 4.0). Six patients discharged from RCH, four admitted to RCH hospitalist service, two transferred to a L1TC ER, and nine transferred to L1TC as direct admission. There was one 30-day readmission and no missed injuries or complications, or deaths. RCH providers were highly satisfied with the TTSC service, TACS surgeons, and equipment used. Mental demand and effort of consulting TACS surgeon decreased significantly as consult number increased. Conclusion: TTSC involving three RCH within our system is feasible and acceptable. Ten transfers and 19 ED visits were avoided. There was favorable acceptance by RCHs providers and TACS surgeons