Virtual Interviews at Graduate Medical Education Training Programs: Determining Evidence-Based Best Practices.

The COVID-19 pandemic has had a profound impact on the nation's health care system, including on graduate medical education (GME) training programs. Traditionally, residency and fellowship training program applications involve in-person interviews conducted on-site, with only a minority of programs offering interviews remotely via a virtual platform. However, in light of the COVID-19 pandemic, it is anticipated that most interviews will be conducted virtually for the 2021 application cycle and possibly beyond. Therefore, GME training programs need to prepare for the transition to virtual interviews using evidence-based practices. At the University of California, San Francisco, a multidisciplinary task force was convened to review existing literature about virtual interviews and determine best practices. This article summarizes these findings, first discussing the advantages and disadvantages of the virtual interview format and then providing evidence-based best practices for GME training programs. Specifically, the authors make the following recommendations: develop a detailed plan for the interview process, consider using standardized interview questions, recognize and respond to potential biases that may be amplified with the virtual interview format, prepare your own trainees for virtual interviews, develop electronic materials and virtual social events to approximate the interview day, and collect data about virtual interviews at your own institution. With adequate preparation, the virtual interview experience can be high yield, positive, and equitable for both applicants and GME training programs.

Acute kidney injury in the elderly: predisposition to chronic kidney disease and vice versa.

There have been considerable advances in the past few years in our understanding of how chronic kidney disease (CKD) predisposes to acute kidney injury (AKI) and vice versa. This review shows, however, that few studies have focused on the elderly or conducted stratified analysis by age. It does appear that elderly patients with estimated glomerular filtration rate (eGFR) 45-59 ml/min/1.73 m(2) are at higher risk for AKI compared with their counterparts with eGFR >60 ml/min/1.73 m(2). This is a similar relationship to that seen in younger patients, although effect size appears smaller. As the incidence of AKI has been increasing over the past several years, the proportion of elderly patients surviving after AKI has also been increasing. Since AKI heightens the risk for the development and acceleration of CKD, this implies significant public health concerns with regard to the absolute number of elderly persons developing incident CKD.

Atherosclerotic renal artery stenosis--diagnosis and treatment.

Renal artery stenosis (RAS) is characterized by a heterogeneous group of pathophysiologic entities, of which fibromuscular dysplasia and atherosclerotic RAS (ARAS) are the most common. Whether and which patients should undergo revascularization for ARAS is controversial. The general consensus is that all patients with ARAS should receive intensive medical treatment. The latest randomized clinical trials have increased confusion regarding recommendations for revascularization for ARAS. Although revascularization is not indicated in all patients with ARAS, experts agree that it should be considered in some patients, especially those with unstable angina, unexplained pulmonary edema, and hemodynamically significant ARAS with either worsening renal function or with difficult to control hypertension. A search of the literature was performed using PubMed and entering the search terms renal artery stenosis, atherosclerotic renal artery stenosis, and renal artery stenosis AND hypertension to retrieve the most recent publications on diagnosis and treatment of ARAS. In this review, we analyze the pathways related to hypertension in ARAS, the optimal invasive and noninvasive modalities for evaluating the renal arteries, and the available therapies for ARAS and assess future tools and algorithms that may prove useful in evaluating patients for renal revascularization therapy.

Survival by dialysis modality in critically ill patients with acute kidney injury.

Among critically ill patients, acute kidney injury (AKI) requiring dialysis is associated with mortality rates generally in excess of 50%. Continuous renal replacement therapies (CRRT) often are recommended and widely used, although data to support its superiority over intermittent hemodialysis (IHD) are lacking. Data from the Program to Improve Care in Acute Renal Disease (PICARD), a multicenter observational study of AKI, were analyzed. Among 398 patients who required dialysis, the risk for death within 60 d was examined by assigned initial dialysis modality (CRRT [n = 206] versus IHD [n = 192]) using standard Kaplan-Meier product limit estimates, proportional hazards ("Cox") regression methods, and a propensity score approach to account for selection effects. Crude survival rates were lower for patients who were treated with CRRT than IHD (survival at 30 d 45 versus 58%; P = 0.006). Adjusted for age, hepatic failure, sepsis, thrombocytopenia, blood urea nitrogen, and serum creatinine and stratified by site, the relative risk for death associated with CRRT was 1.82 (95% confidence interval 1.26 to 2.62). Further adjustment for the propensity score did not materially alter the association (relative risk 1.92; 95% confidence interval 1.28 to 2.89). Among critically ill patients with AKI, CRRT was associated with increased mortality. Although the results could reflect residual confounding by severity of illness, these data provide no evidence for a survival benefit afforded by CRRT. Larger, prospective, randomized clinical trials to compare CRRT and IHD in severe AKI are needed.