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PubMedDate not supplied

[Improvement of equipment for anesthesiological and resuscitation monitoring in military hospitals].

Contemporary state and trends in further improvement of equipment for anesthesiological and resuscitation monitoring are considered on the bases of multiyear experience in the use and upgrade of this equipment in military hospitals of the USSR and RF. The developed and implemented policy and concept of technological engineering support of military anesthesiology and resuscitation allowed the priority directions to be determined and a number of its mane applications to be realized in military hospitals. Analysis of technological engineering support of anesthesiology and resuscitation equipment carried out in 2002-2003 revealed a trend toward improvement in supply of equipment for inhalation narcosis, artificial lung ventilation, and control diagnostic devices. On the other hand, certain disadvantages were found and their causes were analyzed. The main directions in improvement of monitoring support of military medical organizations were determined taking into account modern requirements for anesthesiological and resuscitation service.

Anesthesia↗
PubMedDate not supplied

[Anesthesiologic support of endoscopic laser surgery of the upper respiratory tract].

This paper discusses anesthesiological aspects of laser operations in the nasal cavity and pharynx, describes optimal anesthesiological procedures during endolaryngeal laser operations, and outlines anesthesiological methods during laser endoscopic interventions in the trachea and bronchi. In order to provide safety of anesthesiological support of laser operations of the upper respiratory tract, the present authors recommend to discontinue for no more than 1 to 1.5 min supply of the gas mixture or oxygen. On the basis of their own expertise and analysis of data in the literature, the authors assert that endolaryngeal laser operations, surgery of the trachea and bronchi of children as well as intervention using a rigid bronchoscope in adults should be performed with the help of general anesthesia. Laser operations using a fibrobronchoscope in adults as well as operations of the nasal cavity and pharynx can be carried out using local anesthesia.

Adult↗
PubMed1995

Managing pharmaceutical sales activities in an academic anesthesiology department.

To contain costs, departments of anesthesiology must control the use of new, expensive drugs. Conflicts with pharmaceutical companies can arise when they promote drug sales. Pharmaceutical company sales represent anesthesiology department expenses. Anesthesiologists hold diverse opinions on this clash of interests, on the proper roles of pharmaceutical sales representatives in anesthesiology departments, and on the ethics of accepting industry gifts. Our department has managed pharmaceutical sales activities by encouraging discussion of the ethics and legal limits of industry gifts, by banning sales representatives from bringing food into the department, and by adopting The American Medical Association Guidelines on Gifts.

Academic Medical Centers↗
PubMed2005

Pediatric anesthesiology: thoughts on the future.

Pediatric anesthesiology has made a significant contribution to child health and will be necessary for progress in the health sciences and outcomes related to child health in the future. It is likely that the practice of pediatric anesthesiology will remain an interesting and rewarding but demanding profession for the next generations of physicians. Despite this favorable professional profile, stiff competition for resources will come from other segments of the health care community. This article outlines a multidimensional strategy for pediatric anesthesiology to sustain its progress as a profession and contribute to the health of our children.

Anesthesiology↗
PubMed2006

Teaching and evaluating professionalism for anesthesiology residents.

The Accreditation Council for Graduate Medical Education Outcome Project requires teaching and evaluation of 6 core competencies, one of which is professionalism. Because of this initiative, anesthesiology residency programs are obliged to teach and evaluate professionalism for anesthesiology residents. We decided to create a system that would allow the teaching and evaluation of professionalism in the specific context of anesthesiology.

Anesthesiology↗
PubMed2005

[Sex/Gender research -- introduction and anesthesiological aspects].

On the one hand gender studies are based on the differentiation of biological (sex) and social (gender) identities. Above all, gender studies in public health research are seen as an biological, psychological and social entity. To understand the complexity linked to the term "gender" in medicine, different perspectives are required. Apart from the uncertainty, which may occur by the changing perspective on gender, it also holds the option for innovation in anesthesiology, too. The goal of gender based medicine is an optimized, individual adjusted medical care. Precondition to realize this aim is the understanding of the genesis, the consolidation, and the elimination of gender biases in all fields of research, publications and education. The transfer of methods and guidelines for gender sensitive research, adapted from the public health research, allows an access to detect the meaning of gender specifics and gender differences, to verify its clinical relevance and to exercise the results in clinical daily work. With gender sensitive methods desiderata should be reduced, and methodological standards for gender sensitive medical/clinical research can be developed and implemented into medical education. In the light of knowledge about sex specific differences in pharmacokinetic and pharmacodynamic as well as undesired drug interactions, basic research may help to overcome the gender gap and to individualize and optimize the anesthesiological approach as well. A main problem in implementing gender studies into medicine is the limitation of sex sensitive biomedical significance. Nevertheless, the already existing measures in public health should be evaluated and modified for clinical practice. The current review is to be read as an introduction into different aspects of gender studies in medicine, in order to extend the understanding of its importance for anesthesiology, too. It shows that the relevance transcends still existing studies based on biomedical gender diversities.

Adult↗
PubMed1995

Anesthesiology critical care medicine fellowship training.

Anesthesiology critical care medicine (ACCM) fellowship training was accredited in 1989, and a small number of graduating anesthesiology residents pursue this additional training. Considering the flexible program guidelines of the American Board of Anesthesiology (ABA), we hypothesized that ACCM fellowship training programs varied significantly among the 42 institutions accredited to offer this program. This study of ACCM fellowship programs used a six-part, 57-item questionnaire completed by 36 program directors to describe six aspects of the program: institution size, program director, attending staff, fellowship applicants, curriculum, and the role of the American Society of Critical Care Anesthesiologists (ASCCA). Ninety-four percent of ACCM fellowships are in facilities with more than 400 beds; 81% of these institutions have more than 20 intensive care unit (ICU) beds as the basis for fellowship teaching. Eighty-three percent of ACCM program directors have practiced critical care for more than 5 yr. All programs had more than one attending physician, with the majority having a multidisciplinary attending staff. During two academic years (1990-1992), 12 (33%) of 36 programs did not have a fellow, resulting in an average of less than one fellow for each program. ACCM fellow involvement in patient care was characterized as "primary" in medical and pediatric ICUs and "cooperative" in surgical ICUs. Fellowship curricula had varied requirements for research, intraoperative anesthesia, and ICU procedures performed by the fellow. In general, program directors believe that salary and on-call responsibility are not important issues for applicants. Nineteen percent of program directors train ACCM fellows longer than the 12 mo required by the ABA and believe that ACCM training should be lengthened.

Accreditation↗
PubMed1999

Assessing the relative quality of anesthesiology and critical care medicine Internet mailing lists.

UNLABELLED: We studied the relative quality of a subset of anesthesiology and critical care medicine Internet mailing lists regarding the publishing capacity of their members to compare them with the major journals and conferences regarding these specialties. Using systematic searches on MEDLINE and according to the Science Citation Index 1995, we investigated the impact factor of mailing list subscribers, of the first authors of the selected articles, and of the first authors of published abstracts from conferences. We studied six mailing lists, seven journals, and four conferences. Journals and conferences showed a higher percentage of published authors and higher average impact factor among their first authors than the mailing lists did per subscriber. However, when only the subset of publishing authors from the three media was considered, no significant differences were found. We conclude that qualified authors may be found among the subscribers of Internet medical mailing lists on anesthesiology and critical care medicine. These professional discussion groups could complement peer-reviewed publications and conferences in professional information exchange and continuing medical education. IMPLICATIONS: Internet publishing is not governed by rules that assure certain basic quality standards. Methods for assessing these standards are needed. We compared discussion groups with medical journals and conferences on anesthesiology and critical care medicine by calculating the impact factor of their members and first authors, respectively. Our study shows that qualified authors may be found in all three media.

Anesthesiology↗
PubMed1992

Controlled substance dispensing and accountability in United States anesthesiology residency programs.

Controlled substance dependence (CSD) among anesthesiology personnel, particularly residents, has become a matter of increasing concern. Opinions vary as to the effectiveness of controlled substances (CS) accountability in deterring, identifying, or confirming CSD. A survey of program directors of American anesthesiology training programs was conducted in the summer of 1990 to determine the level of CS dispensing and accountability within their programs. The survey demonstrated that CS dispensing and accountability varied considerably among programs, among hospitals associated with individual programs, and within geographically distinct anesthesia delivery areas within the separate hospitals. Nevertheless, most institutions were moving toward improved methods of CS dispensing and providing more and better CS accountability. The presence of significant CSD, particularly among anesthesiology residents, was reconfirmed. We were unable to correlate the level of accountability of CS with the incidence of CSD. It remains to be seen to what extent CS accountability will continue to develop and whether CSD prevalence will then be changed.

Anesthesia Department, Hospital↗
PubMed1986

Predictors of success in an anesthesiology residency.

The selection of residents in medical specialty programs is a difficult task facing all selection committees. The present authors examined factors that contribute to successful residency performance by 26 anesthesiology residents in order to assist the program's selection committee in developing selection criteria. The best predictor of a resident's academic average in the anesthesiology program was the number of years the resident had spent in other specialties. Comparison of the residents' scores on the Anesthesiology In-Training Examination (ITE) and their scores on Part I of the examinations of the National Board of Medical Examiners (NBME) showed a statistically significant negative correlation. The higher that residents scored on the NBME Part I examination, the lower they scored on the ITE. No significant correlations were found between the residents' ITE scores and undergraduate grade-point average or nonacademic variables such as the residents' age or parents' level of education. The residents' composite grade-point average (GPA) for the residency and their interview scores had a strong positive relationship significant at the 0.06 level.

Anesthesiology↗
PubMed1988

A clinical evaluation system for anesthesiology residents.

Practitioners, educators, and residents in anesthesiology are concerned about issues of reliable evaluation, as advocated by such groups as the American Board of Anesthesiology and the Society for Education in Anesthesia. Further, there is a growing demand by accrediting bodies that training programs demonstrate a consistent and equitable means of evaluating residents' performance. In this article, the authors describe the development of the evaluation system employed by the Baylor College of Medicine and its affiliated hospitals to assess the clinical progress of residents in anesthesiology. The system evaluates the residents' progress in terms of levels of performance that are based on case complexity and degree of staff intervention.

Anesthesiology↗
PubMed1990

The role of nonphysician consultants as health-care educators in postgraduate programs of anesthesiology.

Many physicians believe that the tasks of postgraduate medical education and faculty development are best carried out by senior physicians trained in the appropriate specialty. However, many also will admit that, as physicians, they have received too little training for such an educational role, and that the practical demands of medical practice, scientific research, and administration make it difficult if not impossible to allocate time to continuing medical education program development, curriculum design for residency training, teacher training, and other key aspects of postgraduate medical education. Many medical disciplines have attempted to alleviate this problem by using nonphysician health-care educational consultants in their training programs. However, little attention has been paid to the possibilities of using such consultants in anesthesiology residency education and faculty development. Such consultants in postgraduate medical education and training programs in anesthesiology could perform a wide variety of functions and roles because they possess skills and technical expertise in teaching, training, curriculum design, evaluation, program planning, and interpersonal communications that faculty members often lack. The successful use of a nonphysician consultant in the Department of Anesthesiology at Hahnemann University in Philadelphia, Pennsylvania, is described.

Allied Health Personnel↗
PubMed1992

Lecture practices in United States anesthesiology residencies.

We obtained data on lecture practices from 100 of the 110 university-affiliated anesthesiology residency programs certified in the United States in 1988. Of these residency programs, 36% had a majority of their lectures before the operating room schedule began, 57% had no lectures at all in this early time slot, and 78% had morning lectures at least once a week in conjunction with a delayed operating room start. Seventy-one percent of programs had one or more afternoon lectures each week. An attendance of more than 80% was reported in 66% of the programs for morning lectures and in 50% of the programs for afternoon lectures, which is a significant difference. Aggregate pass rates on the American Board of Anesthesiology written examinations in 1987 and 1988 correlated significantly with morning-lecture attendance, but not with afternoon-lecture attendance, number of lecture days per week, or mandatory lecture attendance. These findings suggest the need for further study and definition of the role of lectures in resident education in anesthesiology.

Anesthesiology↗
PubMed2003

Computer-based anesthesiology paging system.

UNLABELLED: For more than a century, Mayo Clinic has used various communication strategies to optimize the efficiency of physicians. Anesthesiology has used colored wooden tabs, colored lights, and, most recently, a distributed video paging system (VPS) that was near the end of its useful life. A computer-based anesthesiology paging system (CAPS) was developed to replace the VPS. The CAPS uses a hands-off paradigm with ubiquitous displays to inform the practice where personnel are needed. The system consists of a dedicated Ethernet network connecting redundant central servers, terminal servers, programmable keypads, and light-emitting diode displays. Commercially available hardware and software tools minimized development and maintenance costs. The CAPS was installed in >200 anesthetizing and support locations. Downtime for the CAPS averaged 0.144 min/day, as compared with 24.2 min/day for the VPS. During installation, neither system was available and the department used beepers for communications. With a beeper, the median response time of an anesthesiologist to a page from a beeper was 2.78 min, and with the CAPS 1.57 min; this difference was statistically significant (P = 0.021, t(67) = 2.36). We conclude that the CAPS is a reliable and efficient paging system that may contribute to the efficiency of the practice. IMPLICATIONS: Mayo Clinic installed a computer-based anesthesiology paging system (CAPS) to inform operating suite personnel when assistance is needed in procedure and recovery areas. The CAPS is more reliable than the system it replaced. Anesthesiologists arrive at a patient's bedside faster when they are paged with the CAPS than with a beeper.

Anesthesiology↗
PubMed2004

The effect of lengthening anesthesiology residency on subspecialty education.

In this study, we sought to determine the long-term effect of the additional year of anesthesia residency (postgraduate year [PGY]-4) instituted in 1989 by the American Board of Anesthesiology on the number of individuals who pursued 12-mo subspecialty anesthesia training. We tested the hypothesis that extending education by a year would decrease the number of anesthesia subspecialty trainees. Surveys were collected from approved anesthesia residency training programs in the United States from 1989 to 2001. The questionnaires determined the number of individuals pursuing subspecialty training during PGY-4 and PGY-5. The subspecialties included cardiac anesthesia, pediatric anesthesia, pain management, obstetrical anesthesia, neuroanesthesia, outpatient anesthesia, intensive care medicine, and research. The number of anesthesiology residents (PGY-5) pursuing 12-mo subspecialty training increased over this period. The specific subspecialty distribution of fellows changed, with the largest increase in number and percentage occurring in pain management. The largest declines occurred in critical care medicine and research. Our data do not indicate a decrease in the number of anesthesiology subspecialists. Factors other than the duration of training appear responsible for the selection of subspecialty education.

Anesthesiology↗
PubMed2005

The quality of randomized controlled trials in major anesthesiology journals.

Increased attention has been directed at the quality of randomized controlled trials (RCTs) and how they are being reported. We examined leading anesthesiology journals to identify if there were specific areas for improvement in the design and analysis of published clinical studies. All RCTs that appeared between January 2000 and December 2000 in leading anesthesiology journals (Anesthesiology,Anesthesia & Analgesia,Anaesthesia, and Canadian Journal of Anaesthesia) were retrieved by a MEDLINE search. We used a previously validated assessment tool, including 14 items associated with study quality, to determine a quality score for each article. The overall mean weighted quality score was 44% +/- 16%. Overall average scores were relatively high for appropriate controls (77% +/- 7%) and discussions of side effects (67% +/- 6%). Scores were very low for randomization blinding (5% +/- 2%), blinding observers to results (1% +/- 1%), and post-beta estimates (16% +/- 13%). Important pretreatment clinical predictors were absent in 32% of all studies. Significant improvement in the reporting and conduct of RCTs is required and should focus on randomization methodology, the blinding of investigators, and sample size estimates. Repeat assessments of the literature may improve the adoption of guidelines for the improvement of the quality of randomized controlled trials.

Anesthesiology↗
PubMed2006

Trends in the financial status of United States anesthesiology training programs: 2000 to 2004.

The decrease in resident applicants for United States (U.S.) anesthesiology training programs in the mid-1990s has resulted in a national anesthesiologist shortage. This shortage has been associated with increased salaries for anesthesiologists in academic institutions. Salary increases have placed the financial condition of academic training departments in jeopardy, requiring increasing support from their institutions. In the year 2000, a nationwide survey of the financial status of the U.S. anesthesiology training programs was conducted. Follow-up surveys have been conducted each year thereafter. We present the results of the fifth such survey. One-hundred-twenty-eight departments were surveyed, with a response rate of 73%. The average department employs 45 faculty and 81% of those departments have an average of 3.3 open positions. Of the 91% of departments who employ Certified Registered Nurse Anesthetists (CRNAs) (an average of 25 CRNAs/department), 73% have an average of 4.2 open CRNA positions. The average department received 3,787,835 dollars (or 97,621 dollars/faculty) in institutional support, which is an increase over the 2003 amount of 85,607 dollars/faculty. In 36.6% of the departments a portion of these support dollars (1,888,111 dollars) was provided to support CRNA salaries. Therefore, the support to departments for faculty averaged 81,696 dollars/faculty, after the CRNA dollars were removed. Faculty academic time averaged 16% (where 20% is 1 day/wk) and departments billed an average of 11,954 anesthesia units/faculty/yr. These results demonstrate a continued shortage of anesthesiology faculty and continued institutional support to keep these training programs financially viable.

Anesthesia Department, Hospital↗
PubMed2006

Residents' and program directors' attitudes toward research during anesthesiology training: a Canadian perspective.

We assessed the attitudes of residents and program directors (PD) toward research training in Canadian anesthesiology residency programs. Questionnaires were sent to all 476 anesthesiology residents in Canada and a modified questionnaire was sent to the PD of each of the 16 anesthesiology programs between November 2003 and April 2004. There was a 60% response rate to the resident questionnaire and 95% from the PDs. Eighty-one percent of programs have mandatory research activity, although only 41% of residents think research should be mandatory. A majority of residents were recently involved in a research project. There was a discrepancy between PDs' and residents' views about the availability of some resources to facilitate research. Residents regard the time needed to learn clinical anesthesia, schedule conflicts, inadequate faculty support, and a lack of protected research time as the top barriers to undertaking a research project. PDs do not consider schedule conflicts or a lack of time as important barriers for resident research. Seventy-five percent of residents would prefer to do another academic activity, such as learning transesophageal echocardiography or taking postgraduate programs in education, rather than completing a research project during their residency.

Anesthesiology↗