Recruiting a Diverse Cardiology Physician Workforce.

Importance: Understanding trends in the representation of women and individuals from underrepresented racial and ethnic populations in cardiovascular disease and cardiovascular subspecialty fellowships is essential to improving the diversity of the cardiology workforce. Objective: To examine changes in the representation of women and underrepresented individuals in cardiovascular disease and cardiovascular subspecialty fellowships over time. Design, Setting, and Participants: This cross-sectional study of trainee sex and race and ethnicity in various training programs from 2008 to 2022 used data from the Accreditation Council for Graduate Medical Education's publicly available online source. Participants included all residents, internal medicine residents, general surgery residents, and fellows in cardiovascular disease and cardiovascular subspecialty fellowships. Main Outcomes and Measures: Percentages of women and Black and Hispanic trainees in these programs were calculated for each year. Mann-Kendall tests were used to determine if changes over the years represented a significant trend. Results: Among the 3320 cardiovascular disease trainees in 2022, 848 (25.5%) were women, and 459 (13.8%) were Black or Hispanic, less than the representation among internal medicine trainees at 43.8% and 15.6%, respectively. However, the percentage of women trainees in cardiovascular disease significantly increased from 17.6% in 2008 (P = .001 for time trend) and also increased for interventional cardiology fellowships (from 6.3% in 2008 to 20.1% in 2022; P = .002). Over the same period, the proportion of women in general surgery increased from 27.4% to 45.2% (P < .001). The percentage of Black and Hispanic trainees in internal medicine significantly increased from 8.6% in 2012 (P < .001) while increases in general surgery were not statistically significant (9.7% to 16.1%; P = .35). There were also important increases in the percentages of Black and Hispanic trainees in cardiovascular disease (from 8.3% in 2012; P = .09) and interventional cardiology (3.8% to 13.4%; P = .12). Conclusions and Relevance: In this study, the representation of women in cardiovascular fellowships, including interventional cardiology, increased over recent years. While representation of Black and Hispanic individuals is low in all residencies, including cardiovascular fellowships, recent positive trends are important to recognize and provide hope to drive future efforts.

Induced Abortion for Maternal Cardiac Indication: 2 Cases of Unintended Pregnancy With LVAD.

We present 2 cases of patients with left ventricular assist device who underwent an induced abortion in the first and second trimester, respectively. Comprehensive counseling is critical for this patient population, and close coordination of interdisciplinary teams is required in the setting of continuing pregnancy or medically indicated abortion.

Maternal and Pregnancy Outcomes Following Heart Transplantation in the United States.

BACKGROUND: Improved survival following heart transplantation (HT) has led to more recipients contemplating pregnancy, but data on outcomes are limited. OBJECTIVES: The authors used a national data set to investigate and describe outcomes of pregnancies and deliveries in the United States in HT recipients. METHODS: Diagnosis and procedure codes from the 2010-2020 Nationwide Readmissions Database identified delivery hospitalizations, history of HT, comorbid conditions, and outcomes. The authors compared rates of severe maternal morbidity (SMM), nontransfusion SMM, cardiovascular SMM (cSMM), and preterm birth from delivery hospitalization between HT recipients and no-HT recipients. The authors evaluated readmission to 330 days postpartum. Logistic and proportional hazard regressions were performed, adjusting for age, socioeconomic and facility characteristics, and clinical comorbidities. RESULTS: Among 19,399,521 deliveries, 105 were HT recipients. Compared with no-HT, HT recipients were at higher risk for all SMM (24.8% vs 1.7%), nontransfusion SMM (20.8% vs 0.7%), cSMM (7.3% vs 0.12%), and preterm birth (43.3% vs 8.2%), all P < 0.001. In adjusted analyses, HT recipients had 16-fold greater odds of SMM, 28-fold greater odds of nontransfusion SMM, 38-fold greater odds of cSMM, and 7-fold greater odds of preterm birth. HT recipients had higher morbidity rates during delivery hospitalization and higher readmission rates within 1 year following delivery (26.9% vs 3.8%; adjusted HR: 6.03 [95% CI: 3.73-9.75]). CONCLUSIONS: Delivery with history of HT is associated with significantly increased rates of SMM, preterm birth, and hospital readmission. These results provide data regarding pregnancy outcomes for use when counseling patients with HT history who are considering pregnancy or who are pregnant.

Design and implementation of two medical escape rooms: An educational case study.

BACKGROUND: Escape rooms (ERs) have become increasingly popular as an interactive educational experience, especially in medical education. We present an educational case study covering the design, implementation and evaluation of two medical ERs. APPROACH: We created ERs for senior medical students from Glasgow University on rotation at Dumfries and Galloway Royal Infirmary. Students assessed and managed a patient presenting with either stroke or sepsis. The information gained during students' assessment 'unlocked' padlocks or generated codes providing further information or equipment. The ERs were evaluated following analysis of video recordings, debriefings and student and faculty feedback. EVALUATION: Evaluation was focused on students' perceptions of the teaching experience, with changes made to the scenario design following student feedback and faculty reflection. Feedback was positive; students enjoyed the 'fun' nature of the learning experience. They felt they gained knowledge covering the subject areas and that the ERs also highlighted the importance of non-technical skills. We discuss the aspects of ER design and implementation that we learnt during the evaluation process. IMPLICATIONS: We have shown that medical ERs provide an immersive and engaging learning experience for students. We recognise a need for a more objective review of knowledge gained. We hope that by sharing our design and assessment of two medical ERs, we may inform and inspire other educators to consider ERs as an innovative learning experience.

Lipid-Lowering Therapy in Women of Childbearing Age: a Review and Stepwise Clinical Approach.

PURPOSE OF REVIEW: Women are less often recognized to have cardiovascular disease (CVD) risk and are underrepresented in randomized trials of lipid-lowering therapy. Here, we summarize non-pharmacologic and pharmacologic strategies for lipid-lowering in women of childbearing age, lipid changes during pregnancy and lactation, discuss sex-specific outcomes in currently available literature, and discuss future areas of research. RECENT FINDINGS: While lifestyle interventions form the backbone of CVD prevention, some women of reproductive age have an indication for pharmacologic lipid-lowering. Sex-based evidence is limited but suggests that both statin and non-statin lipid-lowering agents are beneficial regardless of sex, especially at high cardiovascular risk. Pharmacologic lipid-lowering therapies, both during the pregnancy period and during lactation, have historically been and continue to be limited by safety concerns. This oftentimes limits lipid-lowering options in women of childbearing age. In this review, we summarize lipid-lowering strategies in women of childbearing age and the impact of therapies during pregnancy and lactation. The limited sex-specific data regarding efficacy, adverse events, and cardiovascular outcomes underscore the need for a greater representation of women in randomized controlled trials. More data on lipid-lowering teratogenicity are needed, and through increased clinician awareness and reporting to incidental exposure registries, more data can be harvested.

Comparison of Symptoms and Antibody Response Following Administration of Moderna or Pfizer SARS-CoV-2 Vaccines.

CONTEXT.­: Moderna (mRNA-1272) and Pfizer (BNT162b2) SARS-CoV-2 vaccines demonstrate favorable safety and efficacy profiles, but direct comparison data are lacking. OBJECTIVE.­: To determine the vaccines' side effect profiles and expected antibody responses. These data may help personalize vaccine selection and identify individuals with a suboptimal vaccine response. DESIGN.­: One hundred forty-nine healthy, largely seronegative adults were assigned Moderna (n = 79) or Pfizer (n = 70). Following the second dose, participants completed a survey documenting their side effects. Serum was collected 0 to 4 days prior to dose 2, and 14 ± 4 days, 30 ± 4 days, 90 ± 10 days, and 180 ± 20 days after dose 2. Convalescent serum specimens were collected 32 to 54 days from donors after a polymerase chain reaction-confirmed SARS-CoV-2 infection (n = 20). Anti-spike antibodies were measured using the Roche Diagnostics Elecys Anti-SARS-CoV-2 S assay on a Roche cobas e801 instrument. RESULTS.­: Participants receiving the Moderna vaccine experienced side effects with greater frequency and severity. Both vaccines elicited a robust antibody response, but median signal was higher in Moderna recipients. Symptom severity decreased with age. Antibody response in Pfizer recipients negatively correlated with age. Antibody response decreased after 6 months (84% reduction in Moderna, 79% Pfizer), but values remained greater than for convalescent donors. Antibody response did not correlate with gender or symptom severity. CONCLUSIONS.­: Moderna may be preferred in individuals in need of greater immune stimulation (eg, older individuals), whereas Pfizer may be preferred in those concerned about vaccine reactions. Anti-spike antibody signal varies by vaccine, so specific reference intervals will be needed to identify individuals with a suboptimal response.

Women in Cardiology Twitter Network: An Analysis of a Global Professional Virtual Community From 2016 to 2019.

Background Social media is an effective channel for the advancement of women physicians; however, its use by women in cardiology has not been systematically studied. Our study seeks to characterize the current Women in Cardiology Twitter network. Methods and Results Six women-specific cardiology Twitter hashtags were analyzed: #ACCWIC (American College of Cardiology Women in Cardiology), #AHAWIC (American Heart Association Women in Cardiology), #ilooklikeacardiologist, #SCAIWIN (Society for Cardiovascular Angiography and Interventions Women in Innovations), #WomeninCardiology, and #WomeninEP (Women in Electrophysiology). Twitter data from 2016 to 2019 were obtained from Symplur Signals. Quantitative and descriptive content analyses were performed. The Women in Cardiology Twitter network generated 48 236 tweets, 266 180 903 impressions, and 12 485 users. Tweets increased by 706% (from 2083 to 16 780), impressions by 207% (from 26 755 476 to 82 080 472), and users by 440% (from 796 to 4300), including a 471% user increase internationally. The network generated 6530 (13%) original tweets and 43 103 (86%) amplification tweets. Most original and amplification tweets were authored by women (81% and 62%, respectively) and women physicians (76% and 52%, respectively), with an increase in original and amplification tweets authored by academic women physicians (98% and 109%, respectively) and trainees (390% and 249%, respectively) over time. Community building, professional development, and gender advocacy were the most common tweet contents over the study period. Community building was the most common tweet category for #ACCWIC, #AHAWIC, #ilooklikeacardiologist, #SCAIWIN, and #WomeninCardiology, whereas professional development was most common for #WomeninEP. Conclusions The Women in Cardiology Twitter network has grown immensely from 2016 to 2019, with women physicians as the driving contributors. This network has become an important channel for community building, professional development, and gender advocacy discussions in an effort to advance women in cardiology.

Genomic and Epidemiological Evidence of a Dominant Panton-Valentine Leucocidin-Positive Methicillin Resistant Staphylococcus aureus Lineage in Sri Lanka and Presence Among Isolates From the United Kingdom and Australia.

Objective: To undertake the first detailed genomic analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolated in Sri Lanka. Methods: A prospective observational study was performed on 94 MRSA isolates collected over a 4 months period from the Anuradhapura Teaching Hospital, Sri Lanka. Screening for mecA, mecC, and the Panton-Valentine leucocidin (PVL)-associated lukS-PV/lukF-PV genes and molecular characterization by spa typing was undertaken. Whole genome sequencing (WGS) and phylogenetic analysis was performed on selected multilocus sequence type (MLST) clonal complex 5 (CC5) isolates from Sri Lanka, England, Australia, and Argentina. Results: All 94 MRSA harbored the mecA gene. Nineteen spa types belonging to nine MLST clonal complexes were identified. Where origin of the sample was recorded, most isolates were from skin and soft tissue infections (70/91; 76.9%), with fewer causing bacteremia (16/91; 17.6%), empyema (3/91; 3.3%) and osteomyelitis (2/91; 2.2%). Sixty two (65.9%) isolates were PVL positive with the majority (56 isolates; 90.3%) belonging to a dominant CC5 lineage. This lineage, PVL-positive ST5-MRSA-IVc, was associated with both community and hospital-onset infections. Based on WGS, representative PVL-positive ST5-MRSA-IVc isolates from Sri Lanka, England and Australia formed a single phylogenetic clade, suggesting wide geographical circulation. Conclusions: We present the most detailed genomic analysis of MRSA isolated in Sri Lanka to date. The analysis identified a PVL-positive ST5-MRSA-IVc that is prevalent among MRSA causing clinical infections in Sri Lanka. Furthermore, this clone was also found among isolates from the United Kingdom and Australia.

National Rate of Tobacco and Substance Use Disorders Among Hospitalized Heart Failure Patients.

BACKGROUND: Several cardiotoxic substances impact heart failure incidence. The burden of comorbid tobacco or substance use disorders among heart failure patients is under-characterized. We describe the burden of tobacco and substance use disorders among hospitalized heart failure patients in the United States. METHODS: We calculated the proportion of primary heart failure hospitalizations in the 2014 National Inpatient Sample with tobacco or substance use disorders accounting for demographic factors. RESULTS: Of 989,080 heart failure hospitalizations, 15.5% (n = 152,965) had documented tobacco (n = 119,285, 12.1%) or substance (n = 61,510, 6.2%) use disorder. Female sex was associated with lower rates of tobacco (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.70-0.74) and substance (OR 0.37; 95% CI, 0.36-0.39) use disorder. Tobacco and substance use disorder rates were highest for hospitalizations <55years of age. Native American race was associated with increased risk of alcohol use disorder (OR 1.67; 95% CI, 1.27-2.20) and black race with alcohol (OR 1.09; 95% CI, 1.02-1.16) or drug (OR 1.63; 95% CI, 1.53-1.74) use disorder. Medicaid insurance or income in the lowest quartile were associated with increased risk of tobacco and substance use disorders. CONCLUSIONS: Tobacco and substance use disorders affect vulnerable heart failure populations, including those of male sex, younger age, lower socioeconomic status, and racial/ethnic minorities. Enhanced screening for tobacco and substance use disorders in hospitalized heart failure patients may reveal opportunities for treatment and secondary prevention.

Being there and reconnecting: Midwives' perceptions of the impact of Mindfulness training on their practice.

OBJECTIVE: To ascertain how midwives perceived attending a mindfulness course impacted on their professional practice, particularly in regard to any stress they experienced at work. DESIGN: A qualitative study using Interpretive Phenomenological Analysis. Semi-structured interviews were conducted with nine midwives. SETTING: A large maternity Trust in the United Kingdom. INTERVENTION: An eight-week mindfulness course, adapted from mindfulness-based cognitive therapy. FINDINGS: Four superordinate themes were identified as follows: "being challenged and committing," "containing the self," "reconnecting" and "moving forward with confidence." Focusing on the present moment enabled participants better to identify the boundary between self and other. This led to an increased sense of control and a reconnection with and reframing of relationships with colleagues and the women in their care. KEY CONCLUSIONS: Mindfulness may provide an effective way to address the high levels of stress, role dissatisfaction and workplace bullying found in midwifery, by improving both the working environment and patient care. The pivotal role of positive workplace relationships in this process resonates with other nursing research and with contemporary philosophical thought. RELEVANCE TO CLINICAL PRACTICE: This study adds to a body of evidence which suggests investing in the well-being of midwifery staff improves both job satisfaction and women's experiences of care.

Faculty experience and engagement in a longitudinal integrated clerkship.

The authors sought to understand rewards and challenges of teaching third-year medical students in the University of Colorado School of Medicine (CUSOM) Denver Health Longitudinal Integrated Clerkship (DH-LIC) compared to teaching in rotation-based clerkships (RBCs). The authors considered implications for the recruitment and retention of faculty in clinical educational programs. Preceptors completed surveys at baseline and year-end. Of eligible faculty, 28 of 40 completed both baseline and year-end surveys. The majority (85.2%) of faculty were satisfied with the DH-LIC and 85.7% continued to teach in year-two of the program. Faculty reported increased satisfaction from teaching and improved teaching and mentoring skills. Faculty familiarity with DH-LIC students was significantly higher than with students previously taught (p = .004); 89.3% of faculty knew their DH-LIC student well enough to tailor instruction to individual learning needs. Teaching techniques utilized at baseline and end of year differed significantly; faculty reported asking questions to promote thinking, providing feedback to students, and providing students with practice in clinical reasoning more frequently in the DH-LIC. Innovative models of education such as LICs offer a strategy to recruit and retain excellent, invested faculty in outpatient settings.

Contraception: a guide for midwives.

Women will generally spend more of their reproductive lifetime preventing pregnancy than experiencing it. The choice of contraceptive methods can be confusing for women, each one having its own set of advantages and disadvantages. For new mothers, a method of contraception is important if a reasonable gap between pregnancies is the desired outcome. Given that ovulation can resume four weeks following childbirth, midwives have a clear role in the provision of up to date contraceptive health advice to women, including the availability of emergency contraception. Midwives, especially those working in the community, also need to be familiar with the range of contraceptive health clinics in their locality, together with a working knowledge of the various services offered by them.

Making friends at antenatal classes: a qualitative exploration of friendship across the transition to motherhood.

This study explored how friendships made at antenatal classes preserve new mothers' well-being, postnatally. Eight women from the United Kingdom who had attended antenatal classes in the third trimester were interviewed following the birth of their first baby. Transcripts were analyzed using a constant comparative method. Findings suggest that friendships made at antenatal classes are not only unique but also support women's mental health and enhance self-efficacy because the women give and gain reassurance that their babies are developing normally. Such friendships may reduce demands on overstretched social and health-care services. Childbirth educators, midwives, and nurses can be encouraged to capitalize on the opportunity provided by antenatal classes to facilitate the formation of friendships that can help mothers to find "a new equilibrium."

Nutrition health issues in self-reported postpartum depression.

AIM: In this retrospective survey women with and without self-reported postpartum depression (PPD) were compared in regards to consumption-frequency of foods and supplements rich in nutrients beneficial to nervous system (NS) health, in regards to consumption-frequency of compounds which may counteract the effect of the above and in regards to nutritional support provided to them during a pregnancy between 2003 and 2008. BACKGROUND: Postpartum depression (PPD) is defined as a major depressive episode that begins within 1 month of delivery and is experienced by roughly 13% of mothers. PATIENTS AND METHODS: Four Hundred participants were recruited through the internet. Data gathered via multiple choice questionnaires was statistically analyzed using SPSS and Statistical software; statistical procedures included discriminant analysis, Pearson's product moment correlation, independent t-test and cross-tabulations. RESULTS: Out of 400 participants 83 (20.8%) were affected by self-reported depression after a pregnancy between 2003 and 2008. Depressed subjects consumed oily fish and offal significantly more often than non depressed subjects. Depression was more prevalent among women with vegetarian diets. No significant difference concerning food group intake or the ratios between foods rich in nutrients beneficial to NS health and foods rich in compounds antagonising their effect were found between depressed and non depressed subjects. Iron supplementation correlated positively with zinc supplementation in both groups. Roughly 70% of women reported to have received no information about n-3 fatty acid fish oils during pregnancy; informed subjects consumed fish oils more often. The majority of subjects with self-reported depression described nutritional support during pregnancy as inadequate. CONCLUSION: Within this Austrian sample, the prevalence rate of postpartum depression was high; while the consumption of oily fish and vegetarian diets negatively correlated with depression, Patient information positively correlated with the consumption of fish oil supplements. These results indicate that further studies will be required in order to establish the exact relationship between nutrition and mental health during and after pregnancy.

A video database of moving faces and people.

We describe a database of static images and video clips of human faces and people that is useful for testing algorithms for face and person recognition, head/eye tracking, and computer graphics modeling of natural human motions. For each person there are nine static "facial mug shots" and a series of video streams. The videos include a "moving facial mug shot," a facial speech clip, one or more dynamic facial expression clips, two gait videos, and a conversation video taken at a moderate distance from the camera. Complete data sets are available for 284 subjects and duplicate data sets, taken subsequent to the original set, are available for 229 subjects.