Assuntos
COVID-19 , Pandemias , Competência Clínica , Ecocardiografia , Avaliação Educacional , Humanos , SARS-CoV-2Assuntos
Cardiologia/educação , Ecocardiografia/normas , Educação Médica Continuada , Educação de Pós-Graduação em Medicina , Competência Clínica , Consenso , Currículo , Avaliação Educacional/normas , Bolsas de Estudo , Humanos , Sociedades Médicas , Conselhos de Especialidade Profissional , Estados UnidosRESUMO
Intracardiac echocardiography has historically been used to guide a limited number of transcatheter cardiac interventions. However, the tremendous advances in structural heart disease interventions in the last decade led to a growing interest in intracardiac echocardiography as a potential alternative to transesophageal echocardiography that mitigates the need for endotracheal intubation. Nonetheless, the scarcity of data, the imperfection of the current probes, and the limited experience among operators prevented a wider adoption of this technology. This review summarizes the contemporary relevant evidence and provides the structural interventionalist with an illustrative guide on the use of intracardiac echocardiography to guide various structural heart interventions.
Assuntos
Cateterismo Cardíaco , Ecocardiografia , Cardiopatias/terapia , Ultrassonografia de Intervenção/métodos , Cateterismo Cardíaco/efeitos adversos , Ecocardiografia/efeitos adversos , Cardiopatias/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversosRESUMO
BACKGROUND: Professional societies have made efforts to curb overuse of cardiac imaging and decrease practice variation by publishing appropriate use criteria. However, little is known about the impact of physician-level determinants such as liability concerns and risk aversion on decisions to order testing. METHODS: A web-based survey was administered to cardiologists and general practice physicians affiliated with two academic institutions. The survey consisted of four clinical scenarios in which appropriate use criteria rated echocardiography or stress testing as "may be appropriate." Respondents' degree of liability concerns and risk aversion were measured using validated tools. The primary outcome variable was tendency to order imaging, calculated as the average likelihood to order an imaging test across the clinical scenarios (1 = very unlikely, 6 = very likely). Linear regression models were used to evaluate the association between tendency to order imaging and physician characteristics. RESULTS: From 420 physicians invited to participate, 108 complete responses were obtained (26% response rate, 54% cardiologists). There was no difference in tendency to order imaging between cardiologists and general practice physicians (3.46 [95% CI, 3.12-3.81] vs 3.15 [95% CI, 2.79-3.51], P = .22). On multivariate analysis, a higher degree of liability concerns was the only significant predictor of decisions to order imaging (mean difference in tendency to order imaging, 0.36; 95% CI, 0.09-0.62; P = .01). CONCLUSION: In clinical situations in which performance of cardiac imaging is rated as "may be appropriate" by appropriate use criteria, physicians with higher liability concerns ordered significantly more testing than physicians with lower concerns.
Assuntos
Atitude do Pessoal de Saúde , Cardiologistas/estatística & dados numéricos , Ecocardiografia sob Estresse/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Responsabilidade Legal , Uso Excessivo dos Serviços de Saúde/legislação & jurisprudência , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Cardiologistas/legislação & jurisprudência , Tomada de Decisão Clínica , Clínicos Gerais/legislação & jurisprudência , Pesquisas sobre Atenção à Saúde , Massachusetts , Pennsylvania , Encaminhamento e Consulta/legislação & jurisprudência , Encaminhamento e Consulta/estatística & dados numéricos , Estados UnidosAssuntos
Ecocardiografia , Objetivos Organizacionais , Sociedades Médicas , Humanos , Estados UnidosAssuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Monitoramento de Medicamentos/tendências , Ecocardiografia/tendências , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico por imagem , Antineoplásicos/uso terapêutico , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico por imagem , Feminino , Cardiopatias/prevenção & controle , Humanos , Melhoria de QualidadeAssuntos
Cardiologia/educação , Cardiologia/normas , Competência Clínica/normas , Currículo/normas , Ecocardiografia/normas , Educação de Pós-Graduação em Medicina/normas , Comitês Consultivos/normas , Ecocardiografia/métodos , Educação de Pós-Graduação em Medicina/métodos , Guias como Assunto , Humanos , Sociedades Médicas/normasRESUMO
Academic medical centers are faced with increasing budgetary constraints due to a flat National Institutes of Health budget, lower reimbursements for clinical services, higher costs of technology including informatics and a changing competitive landscape. As such, institutional stakeholders are increasingly asking whether resources are allocated appropriately and whether there are objective methods for measuring faculty contributions and engagement. The complexities of translational research can be particularly challenging when trying to assess faculty contributions because of team science. For over a decade, we have used an objective scoring system called the Matrix to assess faculty productivity and engagement in four areas: research, education, scholarship, and administration or services. The Matrix was developed to be dynamic, quantitative, and able to insure that a fully engaged educator would have a Matrix score that was comparable to a fully engaged investigator. In this report, we present the Matrix in its current form in order to provide a well-tested objective system of performance evaluation for nonclinical faculty to help academic leaders in decision making.