RESUMEN
This special article is the third in an annual series of the Journal of Cardiothoracic and Vascular Anesthesia that highlights significant literature from the world of graduate medical education published over the past year. Major themes addressed in this review include the potential uses and pitfalls of artificial intelligence in graduate medical education, trainee well-being and the rise of unionized house staff, the effect of gender and race/ethnicity on residency application and attrition rates, and the adoption of novel technologies in medical simulation and education. The authors thank the editorial board for again allowing us to draw attention to some of the more interesting work published in the field of graduate medical education during 2023. We hope that the readers find these highlights thought-provoking and informative as we all strive to successfully educate the next generation of anesthesiologists.
RESUMEN
As the demand for heart allografts for transplantation continues to rise, ex vivo organ perfusion strategies are playing an increasingly important role in the preservation of organs from donation after circulatory death and extended-criteria donors. One such method uses the Organ Care System (TransMedics, Andover, MA). Traditionally, this technique of preservation requires 2 periods of warm ischemia and subsequent cardioplegic arrest. In a novel surgical technique pioneered at the authors' institution, heart allograft implantation no longer requires a second cardioplegic arrest. This article discusses the surgical approach for this procedure, the advantages and disadvantages of this approach, and analogs to current clinical practice to theorize what impact this may have on cardiac transplantation volumes in the future.
Asunto(s)
Trasplante de Corazón , Obtención de Tejidos y Órganos , Humanos , Anestesiólogos , Preservación de Órganos/métodos , Trasplante de Corazón/métodos , Donantes de Tejidos , Circulación Extracorporea , Perfusión/métodosRESUMEN
As the understanding of aortic diseases and their complications grow, increasing importance of uniformity in diagnosis and management is crucial for optimal care of this patient population. The 2022 American College of Cardiology and American Heart Association Guidelines for Diagnosis and Management of Aortic Disease discusses these considerations in detail. The purpose of this review is to highlight essential recommendations that are of relevance to the perioperative physician who manages these patients. A few notable points include, shared decision-making with patients, creation of multidisciplinary aortic teams, lower diameter thresholds for surgery in certain situations, and increased testing for patients with heritable aortic diseases. In addition to briefly reviewing basics of aortic diseases, the authors discuss changes to guidelines that are especially relevant to perioperative care.
Asunto(s)
Enfermedades de la Aorta , Cardiología , Humanos , Estados Unidos , American Heart Association , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/cirugía , Aorta/cirugíaAsunto(s)
Buprenorfina , Procedimientos Quirúrgicos Cardíacos , Bloqueo Nervioso , Analgésicos Opioides , Buprenorfina/uso terapéutico , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Humanos , Manejo del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & controlRESUMEN
BACKGROUND: Individuals who have agentic traits (eg, assertive, confident, competent) that are more commonly associated with men are often selected for leadership roles. For women, this poses a potential barrier to entry into the higher ranks of academic medicine. OBJECTIVE: We analyzed anesthesiology resident feedback for differences in the use of agentic descriptors using qualitative and quantitative methods based on resident gender and year of training. METHODS: This study uses textual analysis of 435 assessments of residents over a 1-year period within a single residency program. We performed a qualitative content analysis on the words used in resident feedback and performed negative binomial regression analyses to determine significant differences in the way residents were described based on gender and year of training. RESULTS: Female residents were less likely than male residents to be described as agentic after controlling for excerpt length, year of training, and evaluator variability (ß = -0.347; 95% confidence interval [CI] -0.666, -0.028; P = .033). Senior residents were more likely to be described as agentic (ß = 0.702; 95% CI 0.402-1.002; P < .001) compared to junior residents. The increased number of agentic codes among senior residents was driven by increased agentic description of female residents' ratings in the senior cohort (ß = 0.704; 95% CI 0.084-1.324; P = .026). CONCLUSIONS: Female residents were described as agentic less often than male residents in early years of training, but the gap was not present among senior residents.