ABSTRACT
BACKGROUND AND OBJECTIVES: Transesophageal echocardiography (TEE) is considered an indispensable tool for perioperative evaluation in mitral valve (MV) surgery. TEE is routinely performed by anesthesiologists competent in TEE; however, in certain situations, the expertise of a senior cardiologist specializing in TEE is required, which incurs additional costs. The purpose of this study is to determine the indications for specialized perioperative TEE based on its utility and the correlation between intraoperative TEE diagnoses and surgical findings, compared with routine TEE performed by an anesthesiologist. MATERIALS AND METHODS: We conducted a three-year prospective study involving 499 patients with MV disease undergoing cardiac surgery. Patients underwent intraoperative and early postoperative TEE and at least one other perioperative echocardiographic evaluation. A computer application was dedicated to calculating the utility of each type of specialized TEE indication depending on the type of MV disease and surgical intervention. RESULTS: The indications for performing specialized perioperative TEE identified in our study can be categorized into three groups: standard, relative, and uncertain. Standard indications for specialized intraoperative TEE included establishing the mechanism and severity of MR (mitral regurgitation), guiding MV valvuloplasty, diagnosing associated valvular lesions post MVR (mitral valve replacement), routine evaluations in triple-valve replacements, and identifying the causes of acute, intraoperative, life-threatening hemodynamic dysfunction. Early postoperative specialized TEE in the intensive care unit (ICU) is indicated for the suspicion of pericardial or pleural effusions, establishing the etiology of acute hemodynamic dysfunction, and assessing the severity of residual MR post valvuloplasty. CONCLUSIONS: Perioperative TEE in MV surgery can generally be performed by a trained anesthesiologist for standard measurements and evaluations. In certain cases, however, a specialized TEE examination by a trained senior cardiologist is necessary, as it is indirectly associated with a decrease in postoperative complications and early postoperative mortality rates, as well as an improvement in immediate and long-term prognoses. Also, for standard indications, the correlation between surgical and TEE diagnoses was superior when specialized TEE was used.
ABSTRACT
The Covid-19 pandemic has made a strong mark on the education system globally. Universities have been compelled to take urgent measures to provide young people with access to education, leading them to invest significant resources in building their own e-learning platforms. Because they were created and implemented in a relatively short time, certain e-learning platforms presented several issues, underscoring the need for improvement. This paper aims to identify students' perceptions of how e-learning platforms should be refined in order to increase the quality of online educational services. The research involved a sample of 114 students enrolled in the University of Medicine and Pharmacy Carol Davila in Bucharest. Data collection was conducted using an online questionnaire, and data analysis was performed using the IBM SPSS software. The results indicated that there is room for improvement in the quality of the services offered. To achieve this, further steps should focus on the interface of the online platforms, optimizing the presentation of educational materials, and refining the communication between teachers and students. Furthermore, other online tools (e.g., blogs, forums, or mobile applications) should be incorporated within these platforms, in order to facilitate the integrative distribution of information.
