Women are Not at Higher Risk for Reintervention or Major Amputation after Lower Extremity Atherectomy for Peripheral Artery Disease.

BACKGROUND: Our objective was to compare short-term and long-term differences in reintervention-free and major amputation-free survival between female and male patients undergoing lower extremity atherectomy for peripheral artery disease. METHODS: We analyzed lower extremity atherectomy procedures performed on 294 patients between January 2014 and September 2019. Reintervention was defined as either open bypass or endovascular procedure to the same region following the index operation. Kaplan-Meier (KM) survival analysis was performed to compare reintervention-free and major amputation-free survival between sexes. Multivariate logistic regression analyses were performed to determine the adjusted odds of reintervention and major amputation based on sex. We conducted subgroup analyses by anatomic region (femoropopliteal vs. tibial), indication (claudication vs. chronic limb-threatening ischemia (CLTI)), and balloon type (drug-coated balloon (DCB) versus plain balloon angioplasty (POBA)) across sexes. RESULTS: Of the 294 patients, 125 (42.5%) were female. Compared to men, women receiving atherectomy were more likely to be Black (28.0% vs. 16.6%; P = 0.018), a nonsmoker (44.8% vs. 21.3%; P < 0.001), and present with CLTI (55.2% vs. 43.2%; P = 0.042). There were no differences in atherectomy region, lesion type, or balloon type between sexes. KM analysis showed similar 4-year reintervention-free survival (68.8% vs. 75.1%; P = 0.88) and major amputation-free survival (97.6% vs. 97.6%; P = 0.41) between sexes. Women and men had similar reintervention-free survival when grouped by femoropopliteal (67.9% vs. 70.8%; P = 0.69) or tibial (76.2% vs. 83.9%; P = 0.68) atherectomy region. Indication (claudication versus CLTI) did not affect reintervention-free survival in either women (64.5% vs. 69.6%; P = 0.28) or men (68.5% vs. 76.7%; P = 0.84). KM curves for DCB versus POBA were also similar between sexes and showed an early benefit in reintervention rate favoring DCB, which dissipated in both women (65.4% vs. 72.7%; P = 0.61) and men (75.5% vs. 78.4%; P = 0.18) by 3 years. CONCLUSIONS: Compared to men, women demonstrate commensurate benefit from atherectomy for lower extremity revascularization. There were no differences seen in long-term reintervention or major amputation between sexes.

The Climate Change Conversation: Understanding Nationwide Medical Education Efforts.

Despite increasing awareness of the public and global health ramifications of climate change, there is a lack of curricula discussing climate change within medical education. Where greater societal awareness and improved scientific understanding have begun to grab the attention of members of the medical education community, there is the precedent, the desire, and the need to incorporate climate-health topics into medical education. We hosted semi-structured interviews (n=9) with faculty members at different institutions across the country who have been involved with climate change education. We pursued a qualitative approach to begin an inter-institutional conversation and better understand what support our colleagues and peers need to expand climate-health education, and we identified a set of key barriers to implementation: Obtaining Institutional Resources, Formalizing Initiative Leadership, and Empowering Faculty Involvement. We also began to appreciate the creative strategies that programs across the country have employed to tackle these challenges. Working with interested students to manage workload, advocating for funded faculty positions, and integrating curricular materials in multiple formats are just a few of the approaches that have helped climate-health initiatives to achieve longevity and penetration in the curriculum. A better identification of the challenges and drivers for success in curricular efforts can provide a roadmap to more efficient implementation of climate-health topics within medical education.

Climate and health education: A critical review at one medical school.

Introduction: As medical schools continue to improve and refine their undergraduate curricula, they are also redefining the roadmap for preparing future generations of physicians. Climate change is a critical topic to integrate into medical education. This period of change for undergraduate medical education coincides with a surge in interest and design efforts for climate and health curricula in health professional education, but this nascent field has yet to be solidly institutionalized. To continue to grow the number of medical students who achieve competency in the effects of climate change on individual health and the health of the planet during their training, we must examine what has worked to date and continue to shift our approach as curricular changes are implemented for feasibility and relevancy. Objective and methods: In the present study, we assessed the "climate and health" content at one northeastern U.S. medical school that is undergoing an overhaul of their entire curriculum to explore strategies to deliver more robust climate health education in the context of the educational redesign. We conducted 1) a retrospective review of the now four-year-old initiative to investigate the sustainability of the original content, and 2) semi-structured interviews with lecturers, course directors, and medical education coordinators involved in implementation, and with faculty tasked with developing the upcoming curricular redesign. Results and discussion: Of the original implementation plan, the content was still present in nine of the 14 lectures. Themes determined from our conversations with involved faculty included the need for 1) a shared vision throughout the content arc, 2) further professional development for faculty, and 3) involvement of summative assessment for students and the content itself to ensure longevity. The interviews also highlighted the importance of developing climate-specific resources that fit within the school's new curricular priorities. This critical review can serve as a case study in curriculum to inform other schools undergoing similar changes.