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Department/Unit:Anesthesiology, Perioperative Care and Pain Medicine

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Dishonest Physician Reviews: Challenging Physician Online Reviews and the Appeals Process

Malhotra, Ria; Reddy, Anika; Jotwani, Rohan; Schatman, Michael E.; Mehta, Neel D.
Physician reviews influence how patients seek care, but dishonest reviews can be detrimental to a physician practice. It is unclear if reviews can be challenged, and processes differ and are not readily apparent. The objective of this observational study was to determine the ability to challenge dishonest negative reviews online. Commonly used websites for physician reviews as of August 2021 were utilized: Healthgrades, Vitals, RateMDs, Zocdoc, Yelp, and Google Business. Each review platform"™s website was tested for leaving a physician review and process of appeal and possible removal of a negative review. The process for appeal and the steps involved in posting and appealing a review were determined, whether individuals are verified patients and criteria for verification, how physicians can respond, and the process of appealing false or defamatory reviews.Any individual can leave reviews by searching for a physician"™s name or practice and visiting their profile page and can then provide a rating and written review of their experience with the physician. Many require verification to prevent suspicious activity but not proof of a medical visit, allowing significant potential for inaccurate review postings. Posting a review can be done by anyone without verification of a visit. It is challenging for physicians to remove negative online reviews, as most review platforms have strict policies against. This review concludes that physicians should be aware of their online presence and the steps that can be taken to address issues to mitigate adverse effects on their practices.
ISSN: 0148-5598
CID: 5620572

Development and Publication of Clinical Practice Parameters, Reviews, and Meta-analyses: A Report From the Society of Cardiovascular Anesthesiologists Presidential Task Force

Kertai, Miklos D; Makkad, Benu; Bollen, Bruce A; Grocott, Hilary P; Kachulis, Bessie; Boisen, Michael L; Raphael, Jacob; Perry, Tjorvi E; Liu, Hong; Grant, Michael C; Gutsche, Jacob; Popescu, Wanda M; Hensley, Nadia B; Mazzeffi, Michael A; Sniecinski, Roman M; Teeter, Emily; Pal, Nirvik; Ngai, Jennie Y; Mittnacht, Alexander; Augoustides, Yianni G T; Ibekwe, Stephanie O; Martin, Archer Kilbourne; Rhee, Amanda J; Walden, Rachel L; Glas, Kathryn; Shaw, Andrew D; Shore-Lesserson, Linda
The Society of Cardiovascular Anesthesiologists (SCA) is committed to improving the quality, safety, and value that cardiothoracic anesthesiologists bring to patient care. To fulfill this mission, the SCA supports the creation of peer-reviewed manuscripts that establish standards, produce guidelines, critically analyze the literature, interpret preexisting guidelines, and allow experts to engage in consensus opinion. The aim of this report, commissioned by the SCA President, is to summarize the distinctions among these publications and describe a novel SCA-supported framework that provides guidance to SCA members for the creation of these publications. The ultimate goal is that through a standardized and transparent process, the SCA will facilitate up-to-date education and implementation of best practices by cardiovascular and thoracic anesthesiologists to improve patient safety, quality of care, and outcomes.
PMID: 37788388
ISSN: 1526-7598
CID: 5639592

The vial can help: Standardizing vial design to reduce the risk of medication errors

Bitan, Yuval; O'Connor, Michael F; Nunnally, Mark E
PMID: 38251720
ISSN: 1537-1913
CID: 5624642

A Review and Discussion of Full-Time Equivalency and Appropriate Compensation Models for an Adult Intensivist in the United States Across Various Base Specialties

Nurok, Michael; Flynn, Brigid C; Pineton de Chambrun, Marc; Kazemian, Mina; Geiderman, Joel; Nunnally, Mark E
OBJECTIVES/OBJECTIVE:Physicians with training in anesthesiology, emergency medicine, internal medicine, neurology, and surgery may gain board certification in critical care medicine upon completion of fellowship training. These clinicians often only spend a portion of their work effort in the ICU. Other work efforts that benefit an ICU infrastructure, but do not provide billing opportunities, include education, research, and administrative duties. For employed or contracted physicians, there is no singular definition of what constitutes an intensive care full-time equivalent (FTE). Nevertheless, hospitals often consider FTEs in assessing hiring needs, salary, and eligibility for benefits. DATA SOURCES/METHODS:Review of existing literature, expert opinion. STUDY SELECTION/METHODS:Not applicable. DATA EXTRACTION/METHODS:Not applicable. DATA SYNTHESIS/RESULTS:Not applicable. CONCLUSIONS:Understanding how an FTE is calculated, and the fraction of an FTE to be assigned to a particular cost center, is therefore important for intensivists of different specialties, as many employment models assign salary and benefits to a base specialty department and not necessarily the ICU.
PMID: 38533294
ISSN: 2639-8028
CID: 5644842

The current state of training in pain medicine fellowships: An Association of Pain Program Directors (APPD) survey of program directors

Wahezi, Sayed Emal; Emerick, Trent D; Caparó, Moorice; Choi, Heejung; Eshraghi, Yashar; Naeimi, Tahereh; Kohan, Lynn; Anitescu, Magdalena; Wright, Thelma; Przkora, Rene; Patel, Kiran; Lamer, Tim J; Moeschler, Susan; Yener, Ugur; Alerte, Jonathan; Grandhe, Radhika; Bautista, Alexander; Spektor, Boris; Noon, Kristen; Reddy, Rajiv; Osuagwu, Uzondu C; Carpenter, Anna; Gerges, Frederic J; Horn, Danielle B; Murphy, Casey A; Kim, Chong; Pritzlaff, Scott G; Marshall, Cameron; Kirchen, Gwynne; Oryhan, Christine; Swaran Singh, Tejinder S; Sayed, Dawood; Lubenow, Timothy R; Sehgal, Nalini; Argoff, Charles E; Gulati, Amit; Day, Miles R; Shaparin, Naum; Sibai, Nabil; Dua, Anterpreet; Barad, Meredith
INTRODUCTION/BACKGROUND:The Accreditation Council for Graduate Medical Education (ACGME) approved the first pain medicine fellowship programs over three decades ago, designed around a pharmacological philosophy. Following that, there has been a rise in the transition of pain medicine education toward a multidisciplinary interventional model based on a tremendous surge of contemporaneous literature in these areas. This trend has created variability in clinical experience and education amongst accredited pain medicine programs with minimal literature evaluating the differences and commonalities in education and experience of different pain medicine fellowships through Program Director (PD) experiences. This study aims to gather insight from pain medicine fellowship program directors across the country to assess clinical and interventional training, providing valuable perspectives on the future of pain medicine education. METHODS:This study involved 56 PDs of ACGME-accredited pain fellowship programs in the United States. The recruitment process included three phases: advanced notification, invitation, and follow-up to maximize response rate. Participants completed a standard online questionnaire, covering various topics such as subcategory fields, online platforms for supplemental education, clinical experience, postgraduate practice success, and training adequacy. RESULTS:Surveys were completed by 39/56 (69%) standing members of the Association of Pain Program Directors (APPD). All PDs allowed fellows to participate in industry-related and professional society-related procedural workshops, with 59% encouraging these workshops. PDs emphasized the importance of integrity, professionalism, and diligence for long-term success. Fifty-four percent of PDs expressed the need for extension of fellowship training to avoid supplemental education by industry or pain/spine societies. CONCLUSION/CONCLUSIONS:This study highlights the challenge of providing adequate training in all Pain Medicine subtopics within a 12-month pain medicine fellowship. PDs suggest the need for additional training for fellows and discuss the importance of curriculum standardization.
PMID: 38553945
ISSN: 1533-2500
CID: 5645372

Evaluation of Washout Periods After Dorsal Root Ganglion Stimulation Trial

Chapman, Kenneth B; Amireh, Ahmad; van Helmond, Noud; Yousef, Tariq A
OBJECTIVE:Dorsal root ganglion stimulation (DRG-S) is a novel therapy to treat chronic pain. It has shown efficacy when delivered intermittently, suggesting a delayed washout effect exists. To measure the washout period, and to determine whether there are differences in washout times among different types of treated pain, we measured the time for pain to return at the end of the patients' one-week DRG stimulation trials. MATERIALS AND METHODS/METHODS:Patients who completed a successful DRG-S trial were included. The times until 25% (t25) and 90% (t90) of baseline pain level returned were recorded. The patients were divided into neuropathic, nociceptive, and mixed pain groups for subgroup comparison. t25 and t90 were plotted in the entire cohort and subgroups using reverse Kaplan-Meier plots (failure curves) and compared using a log-rank test. RESULTS:In total, 29 consecutive patients were included. Median t25 and t90 times were 7.1 and 19.5 hours, respectively. Median (interquartile range) times were longest for the nociceptive pain group (n = 17) and shortest for the neuropathic pain group (n = 6), with the mixed-pain group (n = 6) in between (t25: 7.1 [1.7-19.4], 3.40 [1.4-8.4], and 5.7 [0.8-17.6]; t90, 22.0 [10.7-71.0], 7.6 [3.6-19.8], and 20.9 [14.2-31.2], respectively). t90 times differed significantly by pain type (p = 0.040). CONCLUSIONS:This study showed a prolonged washout period after cessation of DRG-S therapy. Washout times vary according to pain type. The observed effects are possibly due to long-term depression of pain signaling and could allow the implementation of alternative stimulation strategies with DRG-S. Further investigations evaluating DRG-S washout times are warranted.
PMID: 38551547
ISSN: 1525-1403
CID: 5645272

Virtual reality cybersickness and the headache patient

Chen, Qian Cece; Fleming, Andrew; Lepkowsky, Adam; Narouze, Samer
PMID: 38521538
ISSN: 1526-4637
CID: 5641152

Care of the Pediatric Patient for Ambulatory Tonsillectomy With or Without Adenoidectomy: The Society for Ambulatory Anesthesia Position Statement

Brennan, Marjorie P; Webber, Audra M; Patel, Chhaya V; Chin, Wanda A; Butz, Steven F; Rajan, Niraja
The landscape of ambulatory surgery is changing, and tonsillectomy with or without adenoidectomy is one of the most common pediatric surgical procedures performed nationally. The number of children undergoing tonsillectomy on an ambulatory basis continues to increase. The 2 most common indications for tonsillectomy are recurrent throat infections and obstructive sleep-disordered breathing. The most frequent early complications after tonsillectomy are hemorrhage and ventilatory compromise. In areas lacking a dedicated children's hospital, these cases are managed by a nonpediatric specialized anesthesiologist and general otolaryngology surgeon. In response to requests from our members without pediatric fellowship training and/or who care for pediatric patients infrequently, the Pediatric Committee of the Society for Ambulatory Anesthesia (SAMBA) developed a position statement with recommendations for the safe perioperative care of pediatric patients undergoing tonsillectomy with and without adenoidectomy in freestanding ambulatory surgical facilities. This statement identifies children that are more likely to experience complications and to require additional dedicated provider time that is not conducive to the rapid pace and staffing ratios of many freestanding ambulatory centers with mixed adult and pediatric practices. The aim is to provide health care professionals with practical criteria and suggestions based on the best available evidence. When high-quality evidence is unavailable, we relied on group consensus from pediatric ambulatory specialists in the SAMBA Pediatric Committee. Consensus recommendations were presented to the Pediatric Committee of SAMBA.
PMID: 38517763
ISSN: 1526-7598
CID: 5640832

Mitral Leaflet Shortening as an Ancillary Procedure in Obstructive Hypertrophic Cardiomyopathy

Swistel, Daniel G; Massera, Daniele; Stepanovic, Alexandra; Adlestein, Elizabeth; Reuter, Maria; Wu, Woon; Scheinerman, Joshua A; Nampi, Robert; Paone, Darien; Kim, Bette; Sherrid, Mark V
BACKGROUND:Mitral leaflet elongation is common in hypertrophic cardiomyopathy (HCM), contributes to obstructive physiology, and presents a challenge to dual surgical goals of abolition of outflow gradients and mitral regurgitation. Anterior leaflet shortening, performed as an ancillary surgical procedure during myectomy, is controversial. METHODS:This was a retrospective study of all patients undergoing myectomy from 1/2010 to 3/2020 analyzing survival and echocardiographic results. We compared outcomes of patients treated with myectomy and concomitant mitral leaflet shortening with patients treated with myectomy alone. Over this time technique for mitral shortening evolved from anterior leaflet plication to residual leaflet excision (ReLex). RESULTS:Myectomy was performed on 416 patients age 57.5±13.6 years, 204 (49%) female. Average follow up was 5.4±2.8 years. Survival follow-up was complete in 415. Myectomy without valve replacement was performed in 332 patients, of whom 192 had mitral valve shortening (58%). Mitral leaflet plication was performed in 73, ReLex in 151 and both in 32. Hospital mortality for patients undergoing myectomy was 0.7%. At 8 years, cumulative survival was 95% for both myectomy plus leaflet shortening and myectomy alone groups, with no difference in survival between the two. There was no difference in survival between anterior leaflet plication and ReLex groups. Echocardiography 2.5 years after surgery showed a decrease in resting and provoked gradients, mitral regurgitation and left atrial volume and no difference in key variables between ancillary leaflet shortening and myectomy alone patients. CONCLUSIONS:These results affirm that mitral shortening may be an appropriate surgical judgment for selected patients.
PMID: 38518836
ISSN: 1552-6259
CID: 5640912

Long-term outcomes with spinal versus general anesthesia for hip fracture surgery: A randomized trial

Vail, Emily A; Feng, Rui; Sieber, Frederick; Carson, Jeffrey L; Ellenberg, Susan S; Magaziner, Jay; Dillane, Derek; Marcantonio, Edward R; Sessler, Daniel I; Ayad, Sabry; Stone, Trevor; Papp, Steven; Donegan, Derek; Mehta, Samir; Schwenk, Eric S; Marshall, Mitchell; Jaffe, J Douglas; Luke, Charles; Sharma, Balram; Azim, Syed; Hymes, Robert; Chin, Ki-Jinn; Sheppard, Richard; Perlman, Barry; Sappenfield, Joshua; Hauck, Ellen; Tierney, Ann; Horan, Annamarie D; Neuman, Mark D; ,
BACKGROUND:The effects of spinal versus general anesthesia on long-term outcomes have not been well-studied. We tested the hypothesis that spinal anesthesia is associated with better long-term survival and functional recovery than general anesthesia. METHODS:We conducted a pre-specified analysis of long-term outcomes of a completed randomized superiority trial that compared spinal anesthesia versus general anesthesia for hip fracture repair. Participants included previously ambulatory patients 50 years of age or older at 46 US and Canadian hospitals. Patients were randomized 1:1 to spinal or general anesthesia, stratified by sex, fracture type, and study site. Outcome assessors and investigators involved in the data analysis were masked to the treatment arm. Outcomes included survival at up to 365 days after randomization (primary); recovery of ambulation among 365-day survivors; and composite endpoints for death or new inability to ambulate and death or new nursing home residence at 365 days. Patients were included in the analysis as randomized. RESULTS:1,600 patients were enrolled between February 12, 2016, and February 18, 2021; 795 were assigned to spinal anesthesia, and 805 were assigned to general anesthesia. Among 1,599 patients who underwent surgery, vital status information at or beyond the final study interview (conducted at approximately 365 days after randomization) was available for 1,427 (89.2%). Survival did not differ by treatment arm; at 365 days after randomization, there were 98 deaths in patients assigned to spinal anesthesia versus 92 deaths in patients assigned to general anesthesia (hazard ratio: 1.08; 95% confidence interval (CI): 0.81, 1.44, P=0.59). Recovery of ambulation among patients who survived a year did not differ by type of anesthesia (adjusted odds ratio, spinal vs. general: 0.87; 95% CI: 0.67, 1.14, P=0.31). Other outcomes did not differ by treatment arm. CONCLUSIONS:Long-term outcomes were similar with spinal versus general anesthesia.
PMID: 37831596
ISSN: 1528-1175
CID: 5604212