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Fedoruk KA, Chan YK, Williams CE. Scholarship in anesthesiology: the role of critical appraisal, literature review, quality improvement, journal club, and presentation skills. Int J Obstet Anesth 2023; 54:103639. [PMID: 36841065 DOI: 10.1016/j.ijoa.2023.103639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/27/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
If asked to describe the term "anesthesiologist scholar", one may receive a variety of definitions depending on the individual's area of practice, location in the world, and the generation in which they trained. In this article, we review the roles of five core elements that make an anesthesiologist a "scholar": skills in critical appraisal, literature review, quality improvement, journal club participation, and presentation delivery. Although this list of scholarly components is not comprehensive, review of each element's role in the everyday practice and training of physicians will offer insight into their evolution and may offer a glimpse into the future of anesthesiologist scholars. Overall, through the dissemination, recognition, and support of scholarship through these practices, we will continue to achieve meaningful outcomes for our patients and promote a culture of collaboration worldwide. We should ensure that these topic areas become a bedrock of medical education globally, and we must foster opportunities for those who have already completed training to develop and master these skills as a part of their clinical and academic practice.
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Affiliation(s)
- K A Fedoruk
- Center for Academic Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Y K Chan
- Department of Anaesthesiology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - C E Williams
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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Villar J, González-Martin JM, Añón JM, Ferrando C, Soler JA, Mosteiro F, Mora-Ordoñez JM, Ambrós A, Fernández L, Montiel R, Vidal A, Muñoz T, Pérez-Méndez L, Rodríguez-Suárez P, Fernández C, Fernández RL, Szakmany T, Burns KEA, Steyerberg EW, Slutsky AS. Clinical relevance of timing of assessment of ICU mortality in patients with moderate-to-severe Acute Respiratory Distress Syndrome. Sci Rep 2023; 13:1543. [PMID: 36707634 PMCID: PMC9883467 DOI: 10.1038/s41598-023-28824-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
Mortality is a frequently reported outcome in clinical studies of acute respiratory distress syndrome (ARDS). However, timing of mortality assessment has not been well characterized. We aimed to identify a crossing-point between cumulative survival and death in the intensive care unit (ICU) of patients with moderate-to-severe ARDS, beyond which the number of survivors would exceed the number of deaths. We hypothesized that this intersection would occur earlier in a successful clinical trial vs. observational studies of moderate/severe ARDS and predict treatment response. We conducted an ancillary study of 1580 patients with moderate-to-severe ARDS managed with lung-protective ventilation to assess the relevance and timing of measuring ICU mortality rates at different time-points during ICU stay. First, we analyzed 1303 patients from four multicenter, observational cohorts enrolling consecutive patients with moderate/severe ARDS. We assessed cumulative ICU survival from the time of moderate/severe ARDS diagnosis to ventilatory support discontinuation within 7-days, 28-days, 60-days, and at ICU discharge. Then, we compared these findings to those of a successful randomized trial of 277 moderate/severe ARDS patients. In the observational cohorts, ICU mortality (487/1303, 37.4%) and 28-day mortality (425/1102, 38.6%) were similar (p = 0.549). Cumulative proportion of ICU survivors and non-survivors crossed at day-7; after day-7, the number of ICU survivors was progressively higher compared to non-survivors. Measures of oxygenation, lung mechanics, and severity scores were different between survivors and non-survivors at each point-in-time (p < 0.001). In the trial cohort, the cumulative proportion of survivors and non-survivors in the treatment group crossed before day-3 after diagnosis of moderate/severe ARDS. In clinical ARDS studies, 28-day mortality closely approximates and may be used as a surrogate for ICU mortality. For patients with moderate-to-severe ARDS, ICU mortality assessment within the first week of a trial might be an early predictor of treatment response.
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Affiliation(s)
- Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain. .,Research Unit, Hospital Universitario Dr. Negrín, Barranco de La Ballena S/N, 4th Floor - South wing, 35019, Las Palmas de Gran Canaria, Spain. .,Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.
| | - Jesús M González-Martin
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Research Unit, Hospital Universitario Dr. Negrín, Barranco de La Ballena S/N, 4th Floor - South wing, 35019, Las Palmas de Gran Canaria, Spain
| | - José M Añón
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Intensive Care Unit, Hospital Universitario La Paz, IdiPaz, 28046, Madrid, Spain
| | - Carlos Ferrando
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Surgical Intensive Care Unit, Department of Anesthesia, Hospital Clinic, IDIBAPS, 08036, Barcelona, Spain
| | - Juan A Soler
- Intensive Care Unit, Hospital Universitario Virgen de Arrixaca, 30120, Murcia, Spain
| | - Fernando Mosteiro
- Intensive Care Unit, Hospital Universitario de A Coruña, 15006, La Coruña, Spain
| | - Juan M Mora-Ordoñez
- Intensive Care Unit, Hospital Universitario Regional Carlos Haya, 29010, Málaga, Spain
| | - Alfonso Ambrós
- Intensive Care Unit, Hospital General Universitario de Ciudad Real, 13005, Ciudad Real, Spain
| | - Lorena Fernández
- Intensive Care Unit, Hospital Universitario Río Hortega, 47012, Valladolid, Spain
| | - Raquel Montiel
- Intensive Care Unit, Hospital Universitario NS de Candelaria, 38010, Santa Cruz de Tenerife, Spain
| | - Anxela Vidal
- Intensive Care Unit, Hospital Universitario Fundación Jiménez Díaz, 28040, Madrid, Spain
| | - Tomás Muñoz
- Intensive Care Unit, Hospital Universitario de Cruces, 48903, Barakaldo, Vizcaya, Spain
| | - Lina Pérez-Méndez
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Research Unit, Hospital Universitario NS de Candelaria, 38010, Santa Cruz de Tenerife, Spain
| | - Pedro Rodríguez-Suárez
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Thoracic Surgery, Hospital Universitario Dr. Negrín, 35019, Las Palmas de Gran Canaria, Spain
| | - Cristina Fernández
- Research Unit, Hospital Universitario Dr. Negrín, Barranco de La Ballena S/N, 4th Floor - South wing, 35019, Las Palmas de Gran Canaria, Spain
| | - Rosa L Fernández
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029, Madrid, Spain.,Research Unit, Hospital Universitario Dr. Negrín, Barranco de La Ballena S/N, 4th Floor - South wing, 35019, Las Palmas de Gran Canaria, Spain
| | - Tamas Szakmany
- Department of Intensive Care Medicine and Anesthesia, Bevan University Health Board, Newport, NP20 2UB, UK.,Honorary Professor in Intensive Care, Cardiff University, Cardiff, CF14 4XW, Wales, UK
| | - Karen E A Burns
- Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.,Critical Care Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, M5B 1W8, Canada.,Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ewout W Steyerberg
- Department Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur S Slutsky
- Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.,Division of Critical Care Medicine, University of Toronto, Toronto, ON, M5T 3A1, Canada
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