Assuntos
Anestesia em Procedimentos Cardíacos/métodos , Anestesiologia/educação , Infecções por Coronavirus/prevenção & controle , Educação de Pós-Graduação em Medicina/métodos , Bolsas de Estudo/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , COVID-19 , Humanos , Internato e Residência , SARS-CoV-2 , Estados UnidosRESUMO
The Program Evaluation Committee has an essential role in the quality improvement process of the adult cardiothoracic anesthesiology fellowship. The annual program evaluation presents all stakeholders with an opportunity to evolve with the changing needs and opportunities of the fellowship milieu. The active engagement of the program in this process is a high-quality approach to successful planning, preparation and conduct of the self-study and site visit that are important extensions of the annual program evaluation and the program evaluation committee.
Assuntos
Anestesiologia , Internato e Residência , Adulto , Anestesiologia/educação , Bolsas de Estudo , Humanos , Avaliação de Programas e Projetos de SaúdeRESUMO
Cardiac risk stratification before noncardiac surgery remains important. Two major areas have been emphaized, namely, cost-effective risk stratification and enhanced identification of high risk populations. Recent studies have highlighted the lack of quality and affordable medical consultation. The indications for resting preoperative echocardiography merit streamlining, given recent data that failed to demonstrate tangible benefit. Further more, noninvasive cardiac stress testing is expensive and unnecessary in low risk patients. Perioperative troponin determination significantly improves the detection of myocardial infarction, facilitating its early management. The revised cardiac risk index is a standard tool for risk stratification, despite multiple limitations. The first approach has been tore calibrate the traditional risk index to specific high-risk surgical subgroups. The second approach has been to develop new cardiac risk models with more power. Both approaches have yielded risk calculators that out perform the traditional risk model. Furthermore, this latest generation of risk models is available as online calculators that can be accessed at the bedside. Further clinical trials are indicated to test the validity, clinical utility, and cost-effectiveness of these novel risk calculators. It is likely that these powerful instruments will refine the indications for specialized cardiac testing, offering multiple opportunities to reduce perioperative risk and cost simultaneously.