Foundation For Anesthesia Education Research Articles

Incidence and between-center heterogeneity of anesthesia-related complications in pediatric populations documented in administrative data: A retrospective study.

Incidence and between-center heterogeneity of anesthesia-related complications in pediatric populations documented in administrative data: A retrospective study.

Quality of Life After Critical Illness.

1 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA. 2 Harvard Medical School, Boston, MA. 3 Ariadne Labs, Boston, MA. *See also p. 632. The views expressed in this article are those of the authors and do not necessarily represent the views of others. Support was provided solely from institutional sources. Dr. Arriaga is the recipient of: 1) a mentored research training grant from the Anesthesia Patient Safety Foundation (APSF) and the Foundation for Anesthesia Education and Research (FAER) and 2) a Career Development Award from the Center for Diversity and Inclusion of the Brigham and Women’s Hospital. He is also a member of the Patient Safety Editorial Board for the American Society of Anesthesiologists and Question Editor/Examiner for the American Board of Anesthesiology, where he receives a stipend for work that is otherwise done in a volunteer capacity. He received funding from the American Society of Anesthesiologists Patient Safety Editorial Board, the American Board of Anesthesiology, the Minority Faculty Career Development Award from the Center for Diversity and Inclusion of the Brigham and Women’s Hospital, the APSF, and the FAER. Dr. Allen has disclosed that he does not have any potential conflicts of interest.

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

Vivianne Tawfik, M.D., Ph.D., a Recipient of the 2022 James E. Cottrell, M.D., Presidential Scholar Award

Vivianne Tawfik, M.D., Ph.D., a Recipient of the 2022 James E. Cottrell, M.D., Presidential Scholar Award

A Call to Action: A Specialty-Specific Course to Support the Next Generation of Clinician Scientists in Anesthesiology.

Clinical production pressure is a significant problem for faculty of anesthesiology departments who seek to remain involved in research. Lack of protected time to dedicate to research and insufficient external funding add to this long-standing issue. Recent trends in funding to the departments of anesthesiology and their academic output validate these concerns. A 2022 study examining National Institutes of Health (NIH) grant recipients associated with anesthesiology departments across 10 years (2011-2020) outlines total awarded funds at $1,676,482,440, with most of the funds awarded to only 10 departments in the United States. Of note, the total 1-year NIH funding in 2021 for academic internal medicine departments was 3 times higher than the 10-year funding of anesthesiology departments. Additionally, American Board of Anesthesiology (ABA) diplomats represent a minority (37%) of the anesthesiology researchers obtaining grant funding, with a small number of faculty members receiving a prevalence of monies. Overall, the number of publications per academic anesthesiologist across the United States remains modest as does the impact of the scholarly work. Improving environments in which academic anesthesiologists thrive may be paramount to successful academic productivity. In fact, adding to the lack of academic time is the limited bandwidth of senior academic physicians to mentor and support aspiring physician scientists. Given then the challenges for individual departments and notable successes of specialty-specific collaborative efforts (eg, Foundation for Anesthesia Education and Research [FAER]), additional pooled-resource approaches may be necessary to successfully support and develop clinician scientists. It is in this spirit that the leadership of Anesthesia & Analgesia and The Journal of Education in Perioperative Medicine, unified with the Association of University Anesthesiologists, aim to sponsor the Introduction to Clinical Research for Academic Anesthesiologists (ICRAA) Course. Directed toward early career academic anesthesiologists who wish to gain competency specifically in the fundamentals of clinical research and receive mentorship to develop an investigative project, the yearlong course will provide participants with the skills necessary to design research initiatives, ethically direct research teams, successfully communicate ideas with data analysts, and write and submit scientific articles. Additionally, the course, articulated in a series of interactive lectures, mentored activities, and workshops, will teach participants to review articles submitted for publication to medical journals and to critically appraise evidence in published research. It is our hope that this initiative will be of interest to junior faculty of academic anesthesiology departments nationally and internationally.

A Call to Action: A Specialty-Specific Course to Support the Next Generation of Clinician Scientists in Anesthesiology.

Clinical production pressure is a significant problem for faculty of anesthesiology departments who seek to remain involved in research. Lack of protected time to dedicate to research and insufficient external funding add to this long-standing issue. Recent trends in funding to the departments of anesthesiology and their academic output validate these concerns. A 2022 study examining National Institutes of Health (NIH) grant recipients associated with anesthesiology departments across 10 years (2011-2020) outlines total awarded funds at $1,676,482,440, with most of the funds awarded to only 10 departments in the United States. Of note, the total 1-year NIH funding in 2021 for academic internal medicine departments was 3 times higher than the 10-year funding of anesthesiology departments. Additionally, American Board of Anesthesiology (ABA) diplomats represent a minority (37%) of the anesthesiology researchers obtaining grant funding, with a small number of faculty members receiving a prevalence of monies. Overall, the number of publications per academic anesthesiologist across the United States remains modest as does the impact of the scholarly work. Improving environments in which academic anesthesiologists thrive may be paramount to successful academic productivity. In fact, adding to the lack of academic time is the limited bandwidth of senior academic physicians to mentor and support aspiring physician scientists. Given then the challenges for individual departments and notable successes of specialty-specific collaborative efforts (eg Foundation for Anesthesia Education and Research [FAER]), additional pooled-resource approaches may be necessary to successfully support and develop clinician scientists. It is in this spirit that the leadership of Anesthesia and Analgesia and the Journal of Education in Perioperative Medicine, unified with the Association of University Anesthesiologists, aim to sponsor the Introduction to Clinical Research for Academic Anesthesiologists (ICRAA) Course. Directed toward early career academic anesthesiologists who wish to gain competency specifically in the fundamentals of clinical research and receive mentorship to develop an investigative project, the yearlong course will provide participants with the skills necessary to design research initiatives, ethically direct research teams, successfully communicate ideas with data analysts, and write and submit scientific articles. Additionally, the course, articulated in a series of interactive lectures, mentored activities, and workshops, will teach participants to review articles submitted for publication to medical journals and to critically appraise evidence in published research. It is our hope that this initiative will be of interest to junior faculty of academic anesthesiology departments nationally and internationally.

Clinically Applicable Approach for Predicting Future Mechanical Ventilation in Patients with COVID-19 Infection

Background: COVID-19 patients requiring mechanical ventilation have a high mortality and resource utilization. The ability to predict which patients may require mechanical ventilation, prior to clinical decompensation, allows increased acuity of care and targeted interventions to potentially mitigate deterioration. Methods: We included COVID-19 positive hospitalized patients in this single-center retrospective observational study. Our primary outcome was mechanical ventilation or death within the subsequent 24-hours prediction window. As clinical decompensation is likely more recognizable, but less modifiable, as the prediction window shrinks, we also assessed 4-hour and 12-hour, and, for more notice, 48-hour prediction window. General classes of model features included demographic information, laboratory results, comorbidities, medication administration, and vital signs. We created a Random Forest model and assessed performance using 10-fold cross validation. The model was then compared to models derived from generalized estimating equations using discrimination.Findings: Ninety-three (23%) of the 398 COVID-19 positive patients meeting our inclusion criteria required mechanical ventilation or died within 14-days of admission. The Random Forest model predicts pending mechanical ventilation with good discrimination (c-statistic = 0.858, 95% confidence interval 0.841 to 0.874), which is comparable to the discrimination of the generalized estimating equation regression. Vitals sign data including SpO 2 /FiO 2 ratio (Z-score = 8.56), respiratory rate (5.97), and heart rate (5.87) had the highest predictive utility in our algorithm. In our highest risk cohort, the number of patients needed to identify (NNI) a single new case of mechanical ventilation was 3.2 and for our second risk quintile, NNI was 5.0. Interpretation: Machine learning techniques can be leveraged to improve the ability to predict which COVID-19 patients are likely to require mechanical ventilation, identifying unrecognized bellwethers and providing insight into the constellation of accompanying signs of respiratory failure in COVID-19.Funding : National Institutes of Health and the Foundation for Anesthesia Education and ResearchFunding: MRM reports grants from the National Institutes of Health (K01-HL141701). NJD reports a grant from the Foundation for Anesthesia Education and Research. All other author declare no funding. Declaration of Interest: CBD is paid consultant for Thrive Earlier Detection. He is also an inventor on various technologies unrelated to the work described in this manuscript. Some of the licenses are or will be associated with equity or royalty payments. The terms of all these arrangements are being managed by Johns Hopkins University in accordance with its conflict of interest policies. All other authors declare no competing interests.Ethical Approval Statement: For this retrospective observational study performed at our academic quaternary care center, we obtained Institutional Review Board approval (Ann Arbor, MI; HUM00052066). As no patient care interventions were made through conducting the study, patient consent was waived. This manuscript follows multidisciplinary guidelines for reporting machine learning predictive models in biomedical research.14 Study outcomes, data collection, and statistical analyses were established a priori and presented at a multidisciplinary peer-review forum on May 20, 2020 prior to data access.

(373) Muscarinic M4 Positive Allosteric Modulators are Antinociceptive in Mouse Inflammatory Pain Models

The chronic pain and opioid epidemics have created an urgent need for effective, non-opioid analgesics. There is considerable evidence that the cholinergic system could be a promising target for novel drugs. Cholinesterase inhibitors and nonspecific muscarinic acetylcholine receptor (mAChR) agonists are clearly antinociceptive in humans and animal models, but adverse parasympathetic side effects limit clinical utility. The mAChR family includes five subtypes (M1-M5) with different physiologic roles. Prior studies indicate that the M2 and M4 subtypes mediate analgesia, while the M2 and M3 subtypes mediate most deleterious side effects. Therefore, an M4-selective compound might provide analgesia without prohibitive side effects. An M4 PAM, VU0467154, significantly reduced nocifensive behavior in both phases of the formalin assay in mice. However, dose-dependent motor impairment was evident in the open field and rotarod assays. A peripherally-restricted derivative of VU0467154 reduced nocifensive behavior in the second phase of the formalin assay by approximately 50% but did not cause motor impairment. These data suggest that both peripheral and central M4 mAChRs are potential targets for novel analgesics. Further studies are needed to determine the anatomic location and downstream effectors of M4 receptors involved in pain modulation. This project was supported by a grant from Foundation for Anesthesia Education and Research (to KNG)

Demographics and Scholarly Productivity of American Board of Anesthesiology Volunteers: Results of an Internet-Based Bibliometric Analysis.

The American Board of Anesthesiology (ABA) has been responsible for certification of anesthesiologists since 1938. Selected ABA diplomates provide their expertise to write the ABA's written and oral examinations and to administer the oral examination required for primary certification. The demographics, administrative and educational duties, and scholarly productivity of ABA volunteers and their dependence on subspecialty certification, transesophageal echocardiography (TEE) credentials, and grant funding are unknown. Observational study. Internet analysis. ABA volunteers who participated in the 2015 primary certification examinations identified from the 2016 issue of ABA News. None. The 2016 issue of ABA News was downloaded from the public ABA website and was used to identify all volunteers who participated in any aspect of the 2015 primary certification process. Each individual's practice type, faculty rank if applicable, and affiliation were identified using Google with the keyword "anesthesiology." The practice location, time, and interval after original ABA certification; additional ABA subspecialty certification; the number of publications and citations; publication rate; citations per publication; and the H-, M-, and i-10 indices were obtained using the ABA and Scopus databases. Credentials in TEE were identified for each individual using the National Board of Echocardiography database. National Institutes of Health (NIH) and Foundation for Anesthesia Education and Research (FAER) funding for each volunteer was evaluated using NIH Research Portfolio Online Reporting Tools and the FAER alumni databases, respectively. Three hundred ninety-three ABA volunteers were identified and analyzed. Three hundred ten individuals currently hold academic appointments (83.5%), whereas 83 (16.5%) hold private practice or military positions. Sixty-seven volunteers have major administrative roles (eg, dean, chief executive officer, associate or assistant dean, chair, vice chair). Thirty-five individuals are program directors of anesthesiology residencies or fellowships. Volunteers published 10,072 manuscripts that have been cited 194,835 times. Volunteers also received 51 NIH grants and 36 FAER grants. The median H-, M-, and i10-indices of volunteers were 4, 0, and 3, respectively. Scholarly productivity was dependent on academic rank, career duration, additional degrees, and extramural funding, but not on practice location, subspecialty certification, TEE credentials, or sex. These results indicated that ABA volunteers are leaders in anesthesiology with established records of administrative, educational, and scholarly accomplishment.

Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery

BackgroundRoutine preoperative testing is not recommended for patients undergoing cataract surgery, because testing neither decreases adverse events nor improves outcomes. We sought to assess adherence to this guideline, estimate expenditures from potentially unnecessary testing, and identify patient and health care system characteristics associated with potentially unnecessary testing.MethodsUsing an observational cohort of Medicare beneficiaries undergoing cataract surgery in 2011, we determined the prevalence and cost of preoperative testing in the month before surgery. We compared the prevalence of preoperative testing and office visits with the mean percentage of beneficiaries who underwent tests and had office visits during the preceding 11 months. Using multivariate hierarchical analyses, we examined the relationship between preoperative testing and characteristics of patients, health system characteristics, surgical setting, care team, and occurrence of a preoperative office visit.ResultsOf 440,857 patients, 53% had at least one preoperative test in the month before surgery. Expenditures on testing during that month were $4.8 million higher and expenditures on office visits $12.4 million higher (42% and 78% higher, respectively) than the mean monthly expenditures during the preceding 11 months. Testing varied widely among ophthalmologists; 36% of ophthalmologists ordered preoperative tests for more than 75% of their patients. A patient’s probability of undergoing testing was associated mainly with the ophthalmologist who managed the preoperative evaluation.ConclusionsPreoperative testing before cataract surgery occurred frequently and was more strongly associated with provider practice patterns than with patient characteristics. (Funded by the Foundation for Anesthesia Education and Research and the Grove Foundation.)

Nominations Sought for the 2014 FAER Mentoring Excellence in Research Award

The Foundation for Anesthesia Education and Research is accepting nominations for the 2014 FAER Mentoring Excellence in Research Award. The award recognizes an outstanding mentor in anesthesiology and the value of mentorship in the specialty. Each year, the FAER Academy of Research Mentors in Anesthesiology presents the award at the ASA annual meeting during the Celebration of Research.The nomination deadline for the FAER Mentoring Excellence in Research Award is March 31, 2014.Anesthesiologists who are actively engaged in anesthesiology mentorship and have a sustained record of mentoring anesthesiologists over time are eligible for the award. The award is based on the training experiences and successes of the nominee’s mentees, not on the mentor’s personal career achievements.Anyone who is a mentee or a colleague of a successful anesthesiology mentor may submit a nomination. Nominators must have personal knowledge of the nominee’s mentoring efforts. Mentees should be actively involved in research, teaching, mentoring, or other leadership activities.The recipient of the 2013 FAER Mentoring Excellence in Research award was Harriet W. Hopf, M.D., Professor and Vice Chair of Anesthesiology, and Associate Dean of Academic Affairs at the University of Utah.Please submit a nomination form, three letters of recommendation, the nominee’s curriculum vitae, and a completed mentor table. Nomination forms and more information about the nomination process are available at FAER.org/mentor-award.If you have questions about award nominations, contact Jody Clikeman, Program Coordinator, at 507-538-7884 or JodyClikeman@faer.org.

2014 Annual Journal Symposium

2014 Annual Journal Symposium

2014 Annual Journal Symposium

2014 Annual Journal Symposium

Perioperative frailty.

*Department of Anesthesiology, The Icahn School of Medicine at Mount Sinai, New York, New York †Departments of Anesthesiology, Neurosurgery, and Geriatrics, The Icahn School of Medicine at Mount Sinai, New York, New York Supported by NIH GEMSSTAR1 R03 AG040624-01, NIH P50 AG005138, NIH R01 AG029656-01A1, the American Geriatrics Society Jahnigan Scholar Program, and the Foundation for Anesthesia Education and Research (FAER). The authors have no conflicts of interest to disclose. Reprints: Stacie Deiner, MD, MS, Department of Anesthesiology, The Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, P.O. Box #1010, New York, NY 10029-6574. E-mail: [email protected]

Anesthesia Scholarship, Research, and Publication

Anesthesia Scholarship, Research, and Publication

Alveolar Recruitment and Lung Injury

Department of Anesthesiology and Critical Care Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA Department of Radiology Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA * See also p. e423. Dr. Cereda and his institution received grant support from the Foundation for Anesthesia Education and Research (Mentored Research Training Grant–Basic Science) and the Society of Critical Care Anesthesiologists. Mr. Xin has disclosed that he does not have any potential conflicts of interest.

Announcement and Call for Abstracts

Announcement and Call for Abstracts

ANNOUNCEMENT AND CALL FOR ABSTRACTS

NOVEMBER 12, 2012 — The Foundation for Anesthesia Education and Research is accepting nominations for the 2013 FAER Mentoring Excellence in Research Award. The award recognizes an outstanding mentor in anesthesiology and the value of mentorship in the specialty. Each year, the FAER Academy of Research Mentors in Anesthesiology presents the award at the ASA annual meeting during the Celebration of Research.The nomination deadline for the FAER Mentoring Excellence in Research Award is March 31, 2013.Anesthesiologists who are actively engaged in anesthesiology mentorship and have a sustained record of mentoring anesthesiologists over time are eligible for the award. The award is based on the training experiences and successes of the nominee’s mentees, not on the mentor’s personal career achievements.Anyone who is a mentee or a colleague of a successful anesthesiology mentor may submit a nomination. Nominators must have personal knowledge of the nominee’s mentoring efforts. Mentees should be actively involved in research, teaching, mentoring, or other leadership activities.The recipient of the 2012 FAER Mentoring Excellence in Research award was Roderic G. Eckenhoff, M.D., Austin Lamont Professor of Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania.Please submit a nomination form, three letters of recommendation, the nominee’s curriculum vitae, and a completed mentor table. Nomination forms and more information about the nomination process are available at FAER.org/mentor-award.If you have questions about award nominations, contact Mary Schrandt, Associate Director, at 507-538-7883 or MarySchrandt@faer.org.To learn more about FAER, visit FAER.org/about.

FAER Announces Pilot Healthcare Services Research Grant, Seeks Applications for 2013 Grant Cycle, All Grant Types

NOVEMBER 12, 2012 — With the urgency to transform healthcare along the triple aim of improving health for the individual, improving health for the population, and reducing costs, it is critical to train anesthesiologists in the science of healthcare services research. The Foundation for Anesthesia Education and Research and the Anesthesia Quality Institute are partnering to offer a pilot mentored grant for early-career investigators in the field of healthcare services research.The Mentored Research Training Grant – Healthcare Services Research (MRTG-HSR) is a 2-year $175,000 grant that provides funding for research and training in healthcare services research to faculty members who are within 10 years of having completed an anesthesiology residency or fellowship program. Year one is funded up to $75,000. Year two is funded up to $100,000. The MRTG-HSR requires 75 percent research time. There is dedicated funding for the MRTG-HSR to start in July 2013.The MRTG-HSR joins the other FAER grants that are offered on an annual basis. The application deadline for the MRTG-HSR and all FAER research grants is February 15, 2013. Eligibility requirements and application information can be found online at FAER.org/research-grants .ADDITIONAL FAER GRANT OPPORTUNITIES— Apply by February 15 If you have questions about the Mentored Research Grant in Healthcare Services Research or about applying for a FAER research grant, contact Carol Demulling, Associate Director, 507-538-7879 or CarolDemulling@faer.org.To learn more about FAER, visit FAER.org/about.

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Introduction: Ischemic preconditioning is a promising strategy to prevent acute kidney injury causd by ischemia/reperfusion injury. We set out to determine if ischemic preconditioning protects glomerular endothelial cell (GenC) monolayers from a model of ischemia/reperfusion injury (IRI) and whether prolonged hyperglycemia alters the effects of ischemic preconditioning. Hypothesis: We hypothesized that ischemic preconditioning would protect GenC integrity in an in vitro model of IRI, and that this effect would be unchanged in the setting of prolonged hyperglycemia. Methods: GenC were cultured on transwells in normoxia and either normoglycemic (5.5 mM glucose) or hyperglycemic (25.5 mM glucose) conditions. After 5 days of culture, GenC were subjected to either 60 minutes ischemic preconditioning (oxygen-glucose deprivation, OGD) or sham. GenC were returned to normoxia/normoglycemia for 18h. Both preconditioned and control groups of GENC were then exposed to OGD for 6 hours followed by 18 hours of reoxygenation/glucose repletion. Transendothelial electrical resistance (TEER) was used as a measure of GenC monolayer integrity, and was assessed prior to OGD and after reoxygenation/glucose repletion. Statistical analysis was performed using 2-tailed Student’s t-test. Results: The normoglycemic GenC monolayers exposed to ischemic preconditioning were more resistant to OGD than unconditioned gENC as measured by higher TEER values (p=0.02, n= 6). When GenC were cultured in hyperglycemia prior to experimentation, the effect of ischemic preconditioning was lost, and there was no significant difference in TEER values (p=0.68, n=3). Conclusions: These data suggest that ischemic preconditioning protects the integrity of healthy GenC monolayers in an in vitro model of ischemia reperfusion. However, it appears that the protective effect of ischemic preconditioning is lost in cells that are cultured in hyperglycemic conditions. Supported by awards from the Foundation for Anesthesia Education and Research (KJS), Collins Medical Trust (KJS), and K08DK090754-01 (MPH).