Surgeons' re-operative valve replacement practices in patients with endocarditis due to drug use.

BACKGROUND: This study discerns surgeons' attitudes and practices in the determination of heart valve replacement for patients with infectious endocarditis (IE) due to intravenous drug use (IVDU). We aimed to identify the factors contributing to surgeons' decision-making process for initial and recurrent surgical heart valves and the availability of institutional guidance. METHODS: An IRB-approved, anonymous mixed-methods, open survey instrument was designed and validated with 24 questions. A convenience sample of cardiothoracic surgeons in the United States and globally resulted in a total of 220 study participants with 176 completing every question on the survey. RESULTS: A cluster analysis revealed that although surgeons can be divided into subgroups based on their previous experience with valve replacements, these groups are not perfectly homogenous, and the number of identified clusters is dependent on technique used. Analysis of variance revealed the variables that most clearly divided the surgeons into subgroups were, in order of importance, years of practice, number of valve replacements, and geography. CONCLUSIONS: Our analysis showed heterogeneity among cardiothoracic surgeons regarding how they make clinical decisions regarding re-operative valve replacement related to IE-IVDU. Therefore, an opportunity exists for interprofessional teams to develop comprehensive guidelines to decrease variability in surgical decision-making regarding valve replacement associated with IE-IVDU.

Summary of the First Annual Rocky Mountain Healthcare Symposium.

The Medical Center of Aurora, in Aurora, Colorado (USA), served as the host institution for the First Annual Rocky Mountain Healthcare Symposium. The objectives of the Symposium were to offer a series of lectures, provided by a group of internationally recognized leaders in clinical medical research on "How to conduct clinical medical research," and to allow medical residents from regional training programs to highlight their research. Twelve programs, from four US States, were represented. Oral presentations were given for selected abstracts with awards given for best posters and presentations. While the First Annual Symposium was generally viewed as successful based upon feedback metrics, survey results provided both subjective and quantitative foundation for improvements.