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OBJECTIVES: Training in cardiothoracic surgery coincides with a time when many plan their families. Many choose to delay childbearing until the end of training, 33% of women and 20% of men reported using assisted reproductive technology (ART). States have varying laws regarding abortion and ART, which can influence these decisions. Our purpose was to elucidate the intersection of such laws and the training positions available in cardiothoracic surgery. METHODS: We identified abortion laws, abortion laws regarding insurance coverage, personhood laws that potentially influence ART, and insurance coverage of ART using publicly available data. We created choropleth maps with cardiothoracic surgery training positions identified using the National Resident Matching Program Match data for 2024. RESULTS: We found that 29.4% of cardiothoracic surgery programs (47 out of 160) are situated in states with abortion restrictions. Of 48 integrated training positions, 10 are in states with abortion restrictions. Similarly, 32 of 95 traditional thoracic positions and 5 of 17 congenital positions are in states abortion restrictions. A total of 25.6% of cardiothoracic training programs reside in states that grant personhood before birth, potentially affecting ART. Insurance coverage for abortion and ART are variable. CONCLUSIONS: Valuing reproductive rights like access to abortion, insurance coverage, and ART can potentially influence training opportunities in cardiothoracic surgery.
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Variations in parathyroid gland positions often cause failure in initial parathyroid adenoma surgery, especially when imaging fails to localise the adenoma. This report describes a female patient with primary hyperparathyroidism for which preoperative localisation studies did not determine the position of the hyperfunctioning gland. The initial approach with bilateral cervical exploration and intraoperative parathyroid hormone monitoring was performed unsuccessfully. A mediastinal adenoma was suspected due to meticulous negative neck exploration and repeated negative images for a neck adenoma. Subsequently, a second approach involving mediastinal exploration was performed. After the removal of remnant thymic tissue in the mediastinal space, a significant drop in intraoperative parathyroid hormone levels was achieved. The pathological result confirmed the presence of a tiny pathological parathyroid adenoma within the thymus. At 6 months follow-up, postoperative biochemical assessment was consistent with normal calcium and parathyroid hormone levels.
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Adenoma , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Humanos , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Feminino , Hiperparatireoidismo Primário/cirurgia , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/diagnóstico por imagem , Adenoma/complicações , Adenoma/cirurgia , Adenoma/diagnóstico por imagem , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Hormônio Paratireóideo/sangue , Pessoa de Meia-Idade , Glândulas Paratireoides/diagnóstico por imagem , ParatireoidectomiaRESUMO
OBJECTIVE: To investigate whether or not gender influences letters of recommendation for cardiothoracic surgery fellowship. METHODS: From applications to an Accreditation Council Graduate Medical Education cardiothoracic surgery fellowship program between 2016 and 2021, applicant and author characteristics were examined with descriptive statistics, analysis of variance, and Pearson χ2 tests. Linguistic software was used to assess communication differences in letters of recommendation, stratified by author and applicant gender. An additional higher-level analysis was then performed using a generalized estimating equations model to examine linguistic differences among author-applicant gender pairs. RESULTS: Seven hundred thirty-nine recommendation letters extracted from 196 individual applications were analyzed; 90% (n = 665) of authors were men and 55.8% (n = 412) of authors were cardiothoracic surgeons. Compared with women authors, authors who are men wrote more authentic (P = .01) and informal (P = .03) recommendation letters. When writing for women applicants, authors who are men were more likely to display their own leadership and status (P = .03) and discuss women applicants' social affiliations (P = .01), like occupation of applicant's father or husband. Women authors wrote longer letters (P = .03) and discussed applicants' work (P = .01) more often than authors who are men. They also mentioned leisure activities (P = .03) more often when writing for women applicants. CONCLUSIONS: Our work identifies gender-specific differences in letters of recommendation. Women applicants may be disadvantaged because their recommendation letters are significantly more likely to focus on their social ties, leisure activities, and the status of the letter writer. Author and reviewer awareness of gender-biased use of language will aid in improvements to the candidate selection process.
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Internato e Residência , Masculino , Humanos , Feminino , Fatores Sexuais , Seleção de Pessoal , Educação de Pós-Graduação em Medicina , SexismoRESUMO
ABSTRACT Introduction: Cardiothoracic surgery (CTS) has seen a decline in interest and application rates in recent years. As a relatively small speciality, teaching and placements in CTS are often not included during undergraduate study and postgraduate training. We aim to evaluate the exposure to CTS during both undergraduate study and postgraduate training. Methods: A ten-question online survey was designed and delivered to Foundation Year Two (FY2) doctors who graduated in 2017 and completed their two-year postgraduate foundation training in 2019. Medical schools with no graduates in 2017 and 2018 were excluded from our study. IBM® SPSS Statistics, version 25, and Microsoft Excel 365® were used for Student's t-test statistical analysis. Results: Three hundred and six FY2 doctors across 16 medical schools completed the survey, none of which included compulsory CTS attachments as their undergraduate curriculum. Thirty-two respondents (10.5%) underwent CTS attachments lasting between one to three weeks. Only 14 (43.8%) had worked in a cardiothoracic unit during their two-year Foundation Programme; 10 of which (71.2%) subsequently made an application for cardiothoracic speciality training. Most of the participants with previous exposure to CTS, during either undergraduate study or postgraduate Foundation Programme training or both, were significantly more likely to make an application to CTS training (P<0.05). Conclusion: Our study suggests that doctors with increased exposure to CTS during undergraduate study and postgraduate training are more likely to pursue a career in CTS. Targeted interventions at both stages may improve interests in CTS and the number of prospective applicants.
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INTRODUCTION: Cardiothoracic surgery (CTS) has seen a decline in interest and application rates in recent years. As a relatively small speciality, teaching and placements in CTS are often not included during undergraduate study and postgraduate training. We aim to evaluate the exposure to CTS during both undergraduate study and postgraduate training. METHODS: A ten-question online survey was designed and delivered to Foundation Year Two (FY2) doctors who graduated in 2017 and completed their two-year postgraduate foundation training in 2019. Medical schools with no graduates in 2017 and 2018 were excluded from our study. IBM® SPSS Statistics, version 25, and Microsoft Excel 365® were used for Student's t-test statistical analysis. RESULTS: Three hundred and six FY2 doctors across 16 medical schools completed the survey, none of which included compulsory CTS attachments as their undergraduate curriculum. Thirty-two respondents (10.5%) underwent CTS attachments lasting between one to three weeks. Only 14 (43.8%) had worked in a cardiothoracic unit during their two-year Foundation Programme; 10 of which (71.2%) subsequently made an application for cardiothoracic speciality training. Most of the participants with previous exposure to CTS, during either undergraduate study or postgraduate Foundation Programme training or both, were significantly more likely to make an application to CTS training (P<0.05). CONCLUSION: Our study suggests that doctors with increased exposure to CTS during undergraduate study and postgraduate training are more likely to pursue a career in CTS. Targeted interventions at both stages may improve interests in CTS and the number of prospective applicants.
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Escolha da Profissão , Educação Médica , Humanos , Faculdades de Medicina , Currículo , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: The goal of this study was to describe and evaluate our simulation training program on biological models for the cardiovascular surgery residency program at our institution. MATERIAL AND METHODS: Since 2016, with the purpose to develop better practical performance and evaluate the improvement of resident's surgical skills, a simulation training program was implemented, composed of some elemental procedures in cardiovascular surgery. It was established with one wet lab session weekly lasting 2 h, coached by two expert cardiovascular surgeons. Bovine and porcine hearts were used as biological models. At the end of the hands-on program, an objective assessment consisting of two practical modules was applied and performance was rated by way of a 5-point scale. In addition, to provide a subjective assessment, each resident filled out a questionnaire consisting of three items reviewing the overall quality of the workshops on a 10-point scale. RESULTS: The objective evaluation applied at the end of the training program consisted of valve replacement and coronary artery bypass grafting (CABG) modules. The mean performance rating scores for the valve replacement module ranged from 4.2 to 4.79, and CABG, from 4.33 to 4.87. Regarding subjective assessment, all items evaluated, such as expert's didactics, simulation performance, and biological simulator fidelity, received high grades (above 9 on a 10-point scale). CONCLUSIONS: Simulator training on biological models for cardiac surgery medical residents is a simple and effective learning method of surgical skills.
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Currículo , Internato e Residência , Animais , Bovinos , Competência Clínica , Simulação por Computador , Educação de Pós-Graduação em Medicina , Modelos Biológicos , SuínosRESUMO
OBJECTIVES: . In the last decade, concern regarding the preparedness of general surgery graduates to effectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experience implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation. DESIGN: . Firstly, for validation purposes 8 junior residents, 8 recently graduated general surgeons, and 3 cardiothoracic surgery attendings from Pontificia Universidad Católica de Chile Clinical Hospital were recruited. Proficiency in performing a pulmonary tractotomy and a myocardial injury repair was assessed with global and specific rating scales. Secondly, to evaluate the effectiveness of the model as a learning tool, 16 general surgery residents from different programs across the country were recruited receiving intensive, personalized training on the models. Proficiency was measured before and after the training. RESULTS: . For the validation phase, significant differences among groups according to the previous level of expertise were shown, and therefore construct validity was established. The results of the second phase showed a significant overall improvement in participant's performance. CONCLUSION: . Effective training and assessment for advanced surgical skills in cardiothoracic trauma can be achieved using a low-cost pulsatile simulation model.
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Cirurgia Geral , Internato e Residência , Treinamento por Simulação , Animais , Chile , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina , Cirurgia Geral/educação , HumanosRESUMO
OBJECTIVE: To compare methylene blue with hydroxocobalamin as a rescue therapy for vasoplegic syndrome. DESIGN: Retrospective cohort. SETTING: Academic medical center. PARTICIPANTS: Patients undergoing cardiothoracic surgery treated for vasoplegic syndrome. INTERVENTIONS: Thirty-five patients were treated with methylene blue (nâ¯=â¯16) or hydroxocobalamin (nâ¯=â¯19). MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure, systemic vascular resistance, and vasopressor exposures were recorded before and after medication administration. Change in time-averaged norepinephrine equivalents in the hour after administration was the primary outcome. The average norepinephrine equivalent observed at baseline in this cohort was 0.347 µg/kg/min. Methylene blue patients had greater Acute Physiological Assessment and Chronic Health Evaluation II scores (29.8 v 22.2; pâ¯=â¯0.01) and trended toward greater European System for Cardiac Operative Risk Evaluation II values (26.8% v 15.1%; pâ¯=â¯0.07). Methylene blue and hydroxocobalamin were associated with increased mean arterial pressure and systemic vascular resistance 1 hour after administration (10.6 mmHg and 192 dyn*sec/cm5; pâ¯=â¯0.01 and pâ¯=â¯0.01, respectively; 11.8 mmHg and 254 dyn*sec/cm5; pâ¯=â¯0.002 and pâ¯=â¯0.015, respectively). Hemodynamic changes were not different between the rescue therapy groups (pâ¯=â¯0.79 and pâ¯=â¯0.53, respectively). No significant differences were observed within the 1-hour change in time-averaged norepinephrine equivalents for either agent or when methylene blue and hydroxocobalamin were compared (0.012 ± 0.218 µg/kg/min v -0.037 ± 0.027 µg/kg/min; pâ¯=â¯0.46, respectively). When compared with baseline time-averaged norepinephrine equivalent (0.326 ± 0.106 µg/kg/min), only hydroxocobalamin was associated with decreased vasopressor requirements at the 1-hour (0.255 ± 0.129 µg/kg/min; pâ¯=â¯0.03) and 4-hour time points (0.247 ± 0.180 µg/kg/min; pâ¯=â¯0.04) post-administration. CONCLUSION: Methylene blue and hydroxocobalamin increased mean arterial pressures and systemic vascular resistance without significantly decreasing time-averaged norepinephrine exposure in the hour after administration.
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Hidroxocobalamina , Vasoplegia , Humanos , Azul de Metileno , Estudos Retrospectivos , Resistência Vascular , Vasoplegia/diagnóstico , Vasoplegia/tratamento farmacológico , Vasoplegia/etiologiaRESUMO
Lung cancers may extend along or grow through the pulmonary veins to invade or lie within the left atrium (LA). A 62-year-old man, previously healthy, presented with 1-month ventilatory-independent right hemithorax back pain, dry cough and large effort dyspnea. He also referred weight loss of 12 kg in 10 months and denied hemoptysis. As antecedents, he smoked for 40 years and moderate daily alcoholism. On physical examination, the patient was in good general condition, hydrated and regular respiration at rest [blood pressure (BP) =120/80 mmHg; heart rate (HR) =90 bpm; respiratory rate (RR) =16 rpm]. Cardiac auscultation revealed two standard rhythmic sounds without murmurs. Pulmonary auscultation revealed a slightly diminished vesicular murmur in the lower 1/3 of the right hemithorax without adventitious noises. Chest radiography showed a mass over the right lower lung. A CT scan confirmed the radiography image with the mass extending along the right inferior pulmonary vein and a tumor in the LA. Transthoracic and transesophageal echocardiography revealed large mass within the LA (occupying almost the entire cavity), measuring about 10 cm × 3 cm at its largest diameter, prolapsing into the left ventricle. Bronchoscopy, head CT scan, and whole-body bone scintigraphy investigation did not show any distant metastasis. The patient was successfully operated removing the intracardiac and inferior pulmonary vein tumor with the aid of cardiopulmonary bypass, followed by a right inferior lobectomy carried out after 25 days. After 30 days from surgery presented seizures associated a brain metastasis evidenced by CT when adjuvant radio and chemotherapy was started. During the next 90 days, the clinical conditions worsened, and the patient died 4 months after the surgical treatment. The case report has two primary justifications, even considering the poor outcome: (I) rarity and (II) the possibility of the surgical treatment.
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Background: Atrial septal defects are generally classified into three types: ostium secundum, ostium primum, and sinus venosus. Diagnose is normaly confirmed with Doppler echocardiography, which can identify and classify atrial septal defects types. This cardiac anomaly may be corrected by different surgical approaches, such as cardiopulmonary bypass or transvenous approaches. Therefore, we chose to close the atrial septal defect using a total venous inflow occlusion technique (TIVO), which has been successfully used in other procedures without major postoperative complications, and are notably cheaper and requires no specialized equipment, been able to be done in different places.Case: An American Pit Bull Terrier was referred to our surgical service for ostium secundum atrial septal defect correction, by the time of surgery the patient presented dyspneic; normal capillary refill time and rectal temperature; the owner mentioned the patient exhibited exercise intolerance and delayed development compared to other dogs of the same age or from the same litter. Cardiac auscultation revealed a systolic murmur at the left base, femoral pulse was normokinetic, and patient was emaciated and prostrated at the time of clinical evaluation. Atrial septal defect was suspected and then confirmed by Doppler echocardiography that revealed a discontinuous area in the interatrial septum, and by color doppler images an aliased signal, that extended through the interatrial septum and shunted from the left to the right atria, was visualized, confirming an ostium secundum atrial septal defect. After a right intercostal thoracotomy, a subphrenic pericardiectomy was performed to provide access to the heart. Cranial and caudal vena cava as well as the azygos vein, were dissected, which allowed placement of a Satinskys clamp to proceed with TIVO. Before TIVO initiation, a pursestring suture with 3-0 polypropylene was applied to the right atrium.[...]
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Animais , Cães , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/patologia , Comunicação Interatrial/veterinária , Procedimentos Cirúrgicos Cardíacos/veterinária , Cardiopatias Congênitas/veterinária , Ecocardiografia Doppler/veterináriaRESUMO
Background: Atrial septal defects are generally classified into three types: ostium secundum, ostium primum, and sinus venosus. Diagnose is normaly confirmed with Doppler echocardiography, which can identify and classify atrial septal defects types. This cardiac anomaly may be corrected by different surgical approaches, such as cardiopulmonary bypass or transvenous approaches. Therefore, we chose to close the atrial septal defect using a total venous inflow occlusion technique (TIVO), which has been successfully used in other procedures without major postoperative complications, and are notably cheaper and requires no specialized equipment, been able to be done in different places.Case: An American Pit Bull Terrier was referred to our surgical service for ostium secundum atrial septal defect correction, by the time of surgery the patient presented dyspneic; normal capillary refill time and rectal temperature; the owner mentioned the patient exhibited exercise intolerance and delayed development compared to other dogs of the same age or from the same litter. Cardiac auscultation revealed a systolic murmur at the left base, femoral pulse was normokinetic, and patient was emaciated and prostrated at the time of clinical evaluation. Atrial septal defect was suspected and then confirmed by Doppler echocardiography that revealed a discontinuous area in the interatrial septum, and by color doppler images an aliased signal, that extended through the interatrial septum and shunted from the left to the right atria, was visualized, confirming an ostium secundum atrial septal defect. After a right intercostal thoracotomy, a subphrenic pericardiectomy was performed to provide access to the heart. Cranial and caudal vena cava as well as the azygos vein, were dissected, which allowed placement of a Satinskys clamp to proceed with TIVO. Before TIVO initiation, a pursestring suture with 3-0 polypropylene was applied to the right atrium.[...](AU)
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Animais , Cães , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/patologia , Comunicação Interatrial/veterinária , Procedimentos Cirúrgicos Cardíacos/veterinária , Ecocardiografia Doppler/veterinária , Cardiopatias Congênitas/veterináriaRESUMO
INTRODUCCIÓN: los procedimientos de cirugía cardiotorácica mínimamente invasiva (MICS, su sigla en Inglés) buscan reducir las complicaciones de las grandes disecciones. No obstante, ante la falta de contacto directo con el tejido por parte del cirujano, éste recibe una sensación parcial de tacto y fuerza, lo que puede originar errores de procedimiento, inadecuada fuerza aplicada al tejido y fatiga durante el acto quirúrgico. La inclusión de dispositivos robóticos con la técnica MICS ha potencializado las habilidades del cirujano para la manipulación de los tejidos, y aunque los desarrollos del mercado no cuentan aún con retroalimentación táctil, se trabaja en prototipos robóticos que incorporan realimentación de fuerza y torque. OBJETIVO: proponer las condiciones y restricciones relacionadas con la incorporación de realimentación de fuerza y torque en MICS robótica, aplicables a diferentes configuraciones de manipuladores, y analizar la implementación de dichas condiciones en un simulador quirúrgico. MATERIAL Y MÉTODOS: partiendo del análisis de necesidades durante procedimientos cardiotorácicos y las condiciones de cirugía mínimamente invasiva, se identificaron los requerimientos para garantizar reflexión de fuerza y se realizó un análisis matemático de dichas consideraciones. Finalmente, se verificaron los análisis matemáticos mediante técnicas de modelización y simulación utilizando la plataforma computacional Matlab®. RESULTADOS: se argumentaron tres tipos de consideraciones: a) Cinemático: la existencia de un punto fijo, las formas de garantizarlo durante procedimientos MICS robóticos, y las trayectorias de movimiento que el manipulador sigue en aplicaciones de cirugía cardiotorácica; b) Dinámico: la repercusión de fuerzas externas en el manipulador y la manera de considerarlas en el desarrollo de controladores que permitan al cirujano percibir una sensación de contacto con el tejido; c) Sensorial: requerimientos de los sensores de fuerza y relación necesaria entre el número de sensores y actuadores para realimentar fuerza en MICS robótica. Posteriormente se implementaron dichas consideraciones en un simulador y se verificó el cumplimiento de las mismas. CONCLUSIONES: las condiciones relacionadas con la incorporación de un sensor de fuerza y la percepción del cirujano en cuanto al tacto y la fuerza aplicada, resultan ser importantes en procedimientos de MICS robótica y requiere la inclusión de un sistema de control que permita la optimización de procedimientos por telepresencia.
INTRODUCTION: the procedures in minimally invasive cardiothoracic surgery (MICS) aim to reduce the complications of major dissections. However, in the absence of direct contact of the surgeon with the tissue, he receives a partial sense of touch and strength, which can lead to procedural errors, inadequate force applied to the tissue and fatigue during surgery. The inclusion of robotic devices with the MICS technique has enhanced the technical skills of the surgeon to manipulate tissue, and although the market devices still do not have tactile feedback, research in robotic prototypes that incorporate feedback of force and torque is being done. OBJECTIVE: to propose the conditions and restrictions related to the integration of force and torque feedback in robotics MICS applicable to different configurations of manipulators and analyze the implementation of those conditions in a surgical simulator. MATERIAL AND METHODS: from the analysis of needs during cardiothoracic procedures and conditions of minimally invasive surgery, we identified the requirements to ensure reflection of force and performed a mathematical analysis of such considerations. Finally, mathematical analysis were verified by modeling and simulation techniques using the Matlab® computing platform. RESULTS: three types of considerations were argued: a) Kinematic: the existence of a fixed point; the way to guarantee it for robotic MICS procedures, and the trajectories of motion followed by the controller in the applications of Cardiothoracic Surgery, b) Dynamic: the impact of external forces on the manipulator and the way to consider them in the development of controllers that allow the surgeon to feel a sense of contact with the tissue, c) Sensory: requirements of the force sensors and necessary relationship between the number of sensors and actuators to feedback force in MICS robotics. Subsequently these considerations were implemented in a simulator and were checked for compliance. CONCLUSIONS: the conditions related to the incorporation of a force sensor and the perception of the surgeon in terms of touch and force applied turns out to be important in robotics MICS procedures and requires the inclusion of a control system that enables the optimization of telepresence procedures.
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Cirurgia Geral , RobóticaRESUMO
INTRODUCTION: The role of allied health personnel (not physician) in cardiothoracic surgery has evolved substantially since the beginnings of this discipline in the 70´s, especially in developed countries. METHODS: To explore the status of allied health personnel in cardiothoracic surgery in Latin America, a research was geared to know the general context of human resources in public health and specifically in cardiothoracic surgery. Official data from the World Health Organization and the Pan American Health Organization were acquired. An on-line survey was sent to Latin-American cardiothoracic surgeons through either scientific societies or personal e-mail, to get direct information on human resources management of the surgical services. RESULTS: There is lack of information on the medical literature regarding the allied health personnel activities in the region. Sixty one Latin American cardiothoracic centers answered the survey. The survey revealed that the profile of the allied health personnel is outlined by nurses, perfusion and anesthesiology technicians; whose routine activities are restricted to minor controls. CONCLUSIONS: At the moment, the lack of information and official data generates difficulties in analyzing the development status of allied health personnel in cardiothoracic surgery departments in the region of Latin America. In the light of the results and growing interest of developed countries in incorporating the allied health personnel to improve the work capacity and the quality of care in cardiothoracic surgery centers, it would be sensible to develop policies oriented to train and organize this activity in Latin America.