Identification, Characterization, and Ranking of Candidate Metrics for Selection to Anesthesiology Residency: An Iterative Survey of Program Directors.

Background: The primary aim of this study was to identify and stratify candidate metrics used by anesthesiology residency program directors (PDs) to develop their residency rank lists through the National Resident Matching Program. Methods: Sixteen PDs comprised the participants, selected for diversity in geography and program size. We used a 3-round iterative survey to identify and stratify candidate metrics. In the first round, participants listed metrics they planned to use to evaluate candidates. In the second round, metrics from the first round were ranked by importance, and criteria were solicited to define an exceptional, strong, average, marginal, and uncompetitive candidate for each metric. In the third round, aggregated results were presented and participants refined their rankings. Results: Of the 16 PDs selected, 15 participated in the first and second survey rounds, and 10 in the third. Eighteen candidate metrics were indicated by 8 or more PDs for residency selection. All 10 PDs from the final round identified passing Step 1 of the United States Medical Licensing Exam (USMLE) and the absence of "red flags" like a failed rotation as key selection metrics, both averaging an importance score of 4.9 out of 5. Other metrics identified by all PDs included clerkship evaluation comments, USMLE Step 2 scores, class rank, letters of recommendation, personal statement, and program and geographical signals. Conclusions: The study reveals key metrics anesthesiology residency PDs use for candidate ranking, which may offer candidates insights into their competitiveness for anesthesiology residency.

Oral Ketamine for Acute Pain Management After Amputation Surgery.

Objective: Intravenous ketamine has been shown to provide postoperative analgesia in many clinical trials, in particular to reduce opioid consumption. The primary objective of this pilot study is to determine if multiple dosing over a three-day perioperative period with oral ketamine is a safe treatment method for acute pain after amputation surgery. Methods: Three consented subjects (age 57-60 years) undergoing elective amputation of the lower extremity were included in the study (Institutional Review Board and Food and Drug Administration Investigational New Drug approved). An analgesic dose of oral ketamine (1.0 mg/kg) was administered one hour before surgery. Eight hours after the preoperative dose, a second dose was given. On the first postoperative day, subjects received oral ketamine (1.0 mg/kg) three times per day; and on the second postoperative day, this dose was reduced to 0.5 mg/kg three times per day. The primary outcome measure was the incidence of adverse events. Results: No serious and unexpected adverse events occurred; therefore, no subject required a dose reduction. The numerical rating score for postoperative pain of the body part adjacent to the amputation site ranged from 0.5-4.0. Morphine milligram equivalent opioid doses were in the range of 0-17.5 mg on the first postop day and 1.0-4.0 mg on the second postop day. Conclusions: Our pilot study suggests that oral ketamine is safe to use at 1 mg/kg three times per day, as well as convenient for hospital floor and potential home use. Future studies will determine if the perioperative oral ketamine also reduces the incidence of chronic stump or phantom limb pain.

Prevalence of treated hypothyroidism in the community: Analysis from general practices in North-East England with implications for the United Kingdom.

OBJECTIVE: Hypothyroidism is more frequently diagnosed in women and older individuals. It has been suggested that the prevalence of hypothyroidism and the number of prescriptions for thyroid hormones are increasing. However, despite hypothyroidism being a common medical condition, contemporary data on prevalence, particularly across the various age groups, is limited. DESIGN: Information regarding number of individuals diagnosed with treated hypothyroidism (defined as patients prescribed levothyroxine) across ten General Practices (total population of 66 843) in the North-East of England in 2016 was obtained in an anonymized manner. Total as well as age group-specific point prevalence rates were calculated. In addition, corresponding population data for the United Kingdom were acquired, and national total and age-specific hypothyroidism prevalence rates were estimated. RESULTS: The overall prevalence of hypothyroidism in this community sample was 4.5% (n = 3004). Prevalence increased across the age groups from 0.1% in children aged 0-10 years to 15.1% in those aged more than 90 years. After adjusting for demographic differences between the North-East England and UK populations, it is estimated that the total UK-wide prevalence of hypothyroidism in 2016 is 3.6%; affecting more than 2.3 million individuals including nearly 800 000 individuals aged >70 years. CONCLUSIONS: Hypothyroidism affects millions of individuals in the UK and is currently a prevalent diagnosis in more than 1 in 10 individuals aged above 70 years. As the population ages this number is likely to increase. The clinical and economic effects of current management strategies for hypothyroidism, particularly in the older population, need to be evaluated.