scholarly journals A Survey on Teaching Ultrasound-Guided Chronic Pain Procedures in Pain Medicine Fellowship Programs

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. E681-E689
Author(s):  
Bassem O. Asaad
Keyword(s):  
Chronic Pain ◽  
Ultrasound Guidance ◽  
Response Rate ◽  
Program Directors ◽  
Fellowship Training ◽  
Pain Medicine ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Fellowship Programs ◽  
Ultrasound Technology

Background: Over the last decade ultrasound guidance (USG) has been utilized very successfully in acute pain procedures to confirm nerves’ anatomic location and obtain live images. Not only the utilization, but the teaching, of USG has become an essential part of anesthesiology residency training. Prior to the introduction of USG, chronic pain procedures were always done either under fluoroscopy or blindly. USG offers advantages over fluoroscopy for completion of chronic pain procedures. USG decreases radiation exposure and the expenses associated with operating a fluoroscopy machine and allows live visualization of soft tissues and blood flow, a feature that fluoroscopy does not directly offer. Even today, the utilization and teaching of the technique for chronic pain procedures has not been as widely accepted as in acute pain management. Objectives: To understand the current practices and the factors affecting the teaching of ultrasound guided chronic pain procedures in chronic pain fellowship programs throughout the United States. Study Design: Survey conducted by internet and mail. The survey was distributed to program directors of ACGME-accredited pain medicine fellowships. When the survey was distributed there were 92 accredited pain medicine fellowships. Methods: REDCap survey software was used for designing the questionnaire and sending email invitations. Also, paper questionnaires were sent to those who did not respond electronically. Additional copies of the survey were mailed or faxed upon request. We received 43 responses (a response rate of 46.7%). Statistical analyses included frequencies, crosstabs, and nonparametric Spearman rank-order correlations. Results: The majority of stellate ganglion blocks, occipital nerve blocks, and peripheral nerve blocks are currently being done under ultrasound guidance. Although interest among trainees is very high, only 48.8% of the fellowship programs require fellows to learn the technique before graduation and 32.6% of the program directors agree that teaching of USG should be an ACGME requirement for pain medicine fellowship training. Faculty training is considered to be the most important factor for teaching the technique by 62.8% of directors. In the opinion of the majority of program directors, the greatest factor that stands against teaching the technique is the fact that it is time consuming. Nearly half (44.2%) of program directors believe that the technique will never replace fluoroscopy; but one quarter (25.6%) think that the new 3D ultrasound technology, when available, will replace fluoroscopy. Limitations: A moderate response rate (46.7%) may limit the generalizability of the findings. However, our survey respondents seem to represent the study population quite well, although there was a bias towards the university-based programs. Training programs located at community-based hospitals and U.S. government installations were not as well represented. Conclusion: The teaching of ultrasound guided chronic pain procedures varies significantly between individual programs. Though many program directors do require that fellows demonstrate competency in the technique before graduation, as of today there is no ACGME guideline regarding this. The advancement in ultrasound technology and the increase in number of trained faculty may significantly impact the use of USG in training fellows to perform chronic pain procedures. Key words: Ultrasound guidance, fluoroscopy, chronic pain procedures, regional nerve blocks, musculoskeletal procedures, implantable devices, pain medicine, fellowship training, anesthesia residency training

scholarly journals Do Pain Medicine Fellowship Programs Provide Education in Practice Management? A Survey of Pain Medicine Fellowship Programs

2018 ◽  
Vol 1 (21;1) ◽  
pp. E43-E48 ◽  
Author(s):  
Rene Przkora
Keyword(s):  
Pain Management ◽  
Business Education ◽  
Management Training ◽  
Program Directors ◽  
Fellowship Training ◽  
Practice Management ◽  
Pain Medicine ◽  
Financial Reports ◽  
Education Practice ◽  
Fellowship Programs

Background: We hypothesized that there is a gap between expectations and actual training in practice management for pain medicine fellows. Our impression is that many fellowships rely on residency training to provide exposure to business education. Unfortunately, pain management and anesthesiology business education are very different, as the practice settings are largely officeversus hospital-based, respectively. Objective: Because it is unclear whether pain management fellowships are providing practice management education and, if they do, whether the topics covered match the expectations of their fellows, we surveyed pain medicine program directors and fellows regarding their expectations and training in business management. Study Design: A survey. Setting: Academic pain medicine fellowship programs. Methods: After an exemption was obtained from the University of Texas Medical Branch Institutional Review Board (#13-030), an email survey was sent to members of the Association of Pain Program Directors to be forwarded to their fellows. Directors were contacted 3 times to maximize the response rate. The anonymous survey for fellows contained 21 questions (questions are shown in the results). Results: Fifty-nine of 84 program directors responded and forwarded the survey to their fellows. Sixty fellows responded, with 56 answering the survey questions. Limitations: The responder rate is a limitation, although similar rates have been reported in similar studies. Conclusions: The majority of pain medicine fellows receive some practice management training, mainly on billing documentation and preauthorization processes, while most do not receive business education (e.g., human resources, contracts, accounting/financial reports). More than 70% of fellows reported that they receive more business education from industry than from their fellowships, a result that may raise concerns about the independence of our future physicians from the industry. Our findings support the need for enhanced and structured business education during pain fellowship. Key words: Business education, practice management, fellowship training, curriculum development, knowledge gaps, private practice

Regional anaesthesia of the upper limb

2017 ◽  
Author(s):  
Colin J. L. McCartney ◽  
Alan J. R. Macfarlane
Keyword(s):  
Peripheral Nerve ◽  
Upper Limb ◽  
Regional Anaesthesia ◽  
Ultrasound Guidance ◽  
Nerve Supply ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Traditional Approaches ◽  
Indications And Complications

Peripheral nerve blocks of the upper limb can provide excellent anaesthesia and postoperative analgesia. A variety of well-established traditional approaches to the brachial plexus exist, namely interscalene, supraclavicular, infraclavicular, and axillary techniques. Individual terminal nerves such as the median, radial, ulnar, and other smaller nerves can also be blocked more distally. The traditional and ultrasound-guided approach to each of these nerve blocks is discussed in turn in this chapter, along with specific indications and complications. The introduction of ultrasound guidance has generated significant excitement in this field in the last 10 years and has been demonstrated to improve efficacy and reduce complications. However, a sound knowledge of anatomy of the nerve supply to the upper limb remains essential during any upper limb regional anaesthesia technique.

scholarly journals Diversity, Equity, and Inclusion in Hematology and Oncology Fellowship Programs

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2977-2977
Author(s):  
Michael Mankbadi ◽  
Lidet Alemu ◽  
Afiya Bey ◽  
Nathan T. Connell ◽  
Lisa Fanning ◽  
...  
Keyword(s):  
Interim Analysis ◽  
Response Rate ◽  
Medical Oncology ◽  
Selection Process ◽  
Program Directors ◽  
Program Director ◽  
Fellowship Program ◽  
Medical Specialties ◽  
Fellowship Programs ◽  
Equity And Inclusion

Abstract Background The National Institutes of Health define African Americans or Blacks, American Indians, Alaska Natives, Hispanics or Latinos, Native Hawaiians, and other Pacific Islanders as being underrepresented in medicine. A number of studies have demonstrated that improving diversity of such underrepresented demographics within the medical profession improves patient outcomes, medical education and reduces health disparities in patients from vulnerable racial or socioeconomic groups. Despite this recognition, significant underrepresentation of various racial, ethnic, and sexual identities still exists within nearly all medical specialties. Aims The purpose of this study was to a gain a greater understanding of the current state of diversity, equity, and inclusion (DEI) efforts among U.S. hematology and medical oncology fellowship training programs. We explored the perspectives of adult and pediatric fellowship program directors regarding current recruitment strategies and suggestions for improvement to help mitigate the effects of implicit and explicit bias. Here, we present an interim analysis of the data using descriptive statistics. Methods: We convened a multi-institutional collaboration of fellowship program directors, teaching faculty, and staff members of the American Society of Hematology to develop a survey examining perceptions of DEI efforts among hematology and medical oncology fellowship program directors. The survey was pilot tested in a small group of program directors representing 6 different academic programs (5 adult, 1 pediatric). The final online survey was distributed via email to 224 fellowship program directors at U.S. adult and pediatric hematology and medical oncology fellowship programs. The survey included 29 questions regarding perspectives on bias within the fellowship selection process, current DEI initiatives, and current faculty and fellow demographics. Survey respondents were asked to rate the importance of numerous factors in determining which applicants to invite utilizing a scale of 0-10, with 0 and 10 representing lowest and highest importance, respectively. To measure program director perceptions of certain applicant groups, survey respondents were asked to rate applicant demographics as being advantaged/disadvantaged based on survey options ranging from 0-5, with 0 and 5 representing very disadvantaged and very advantaged, respectively. Results: At interim analysis, 41 of 224 program directors completed the survey for an interim response rate of 21%, including 25 adult program directors and 16 pediatric program directors, with representation from university and community programs. Of the program directors surveyed, 28 (68%) reported having access to a dedicated diversity committee or DEI policies in place to improve recruitment of underrepresented applicants. In determining which applicants to invite, respondents placed highest value on the applicant's program director letter (mean score ± standard deviation: 7.44±1.93), caliber of the applicant's residency program (7.28±2.06) and letters of recommendations (7.15±2.23). Survey respondents viewed white and male applicants as representing the most advantaged demographic group, while LGBTQI, age>40, and U.S. citizen and non-citizen international medical graduates were the most disadvantaged (Table 1). Suggestions regarding improving DEI in the fellowship selection process included implementing bias training, identifying potentially disadvantaged applicants in ERAS, increasing faculty diversity, and pairing underrepresented applicants with interviewers based on applicant preference. Conclusion: While the majority of hematology and medical oncology fellowship program directors report having DEI programs or policies to improve recruitment of underrepresented applicants, perceptions of advantaged/disadvantaged groups may extend beyond demographics traditionally viewed as being underrepresented in medicine. As our survey is ongoing, we plan to reanalyze our data when the survey has been finalized with a higher response rate utilizing multivariable regression to identify themes that may further improve DEI efforts within the fellowship selection process. Figure 1 Figure 1. Disclosures LaCasce: Bristol-Myers Squibb Company.: Other: Data Safetly and Monitoring. Murphy: North American Thrombosis Foundation: Honoraria. Naik: Rigel: Research Funding. Podoltsev: Pfizer: Honoraria; Blueprint Medicines: Honoraria; Incyte: Honoraria; Novartis: Honoraria; Celgene: Honoraria; PharmaEssentia: Honoraria; Bristol-Myers Squib: Honoraria; CTI BioPharma: Honoraria.

scholarly journals New peripheral nerve blocks: are they worth the hype?

2020 ◽  
pp. S1-S3
Author(s):  
AT Bösenberg ◽  
E Holland
Keyword(s):  
Peripheral Nerve ◽  
Ultrasound Guidance ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Portable Ultrasound ◽  
Spinal Nerves ◽  
Ultrasound Technology ◽  
Innovative Approaches

The advent of portable ultrasound technology has revolutionised our ability to place peripheral nerve blocks within tissue planes. Ultrasound guidance has facilitated the introduction of new innovative approaches to deeper nerves not previously attempted using landmark-based techniques. The majority of these truncal blocks involve the branches of the spinal nerves.

scholarly journals Status of global health fellowship training in the United States and Canada

2019 ◽  
Vol 10 (4) ◽  
pp. e80-e95
Author(s):  
Ann Evensen ◽  
Sean Duffy ◽  
Russell Dawe ◽  
Andrea Pike ◽  
Brett Nelson
Keyword(s):  
Global Health ◽  
Program Directors ◽  
The United States ◽  
Fellowship Training ◽  
Web Based ◽  
Training Requirements ◽  
Median Size ◽  
Fellowship Programs ◽  
Program Characteristics ◽  
Clear Objective

Background: Increasing numbers of residency graduates desire global health (GH) fellowship training. However, the full extent of training options is not clear. Objective: To identify clinical GH fellowships in all specialties in the U.S. and Canada and to describe their demographics, innovative features, and challenges. Methods: The authors surveyed program directors or designees from GH fellowships with a web-based tool in 2017. Program directors reported demographics and program characteristics. Results: The authors identified 85 potential programs. Fifty-four programs (63.5%) responded confirming 50 fellowships. The number of U.S. GH fellowship programs increased by 89.7% since 2010. One-third of fellowships accepted graduates from more than one specialty. The most common single-specialty programs were Emergency Medicine or Family Medicine. Fellowship duration was most commonly 24 months. Median size was one fellow per year. Funding and lack of qualified applicants were significant challenges. Most programs were funded through fellow billing for patient care or other means of self-support.   Conclusions: The number of U.S. and Canadian GH fellowship programs has nearly doubled since 2010. Programs reported lack of funding and qualified applicants as their most significant challenges. Consensus amongst stakeholders regarding training requirements may improve outcomes for future fellows, their employers, and the patients they serve.

scholarly journals Education Research: Multiple sclerosis and neuroimmunology fellowship training status in the United States

Neurology ◽  
2020 ◽  
Vol 94 (11) ◽  
pp. 495-500 ◽  
Author(s):  
Ahmed Z. Obeidat ◽  
Yasir N. Jassam ◽  
Le H. Hua ◽  
Gary Cutter ◽  
Corey C. Ford ◽  
...  
Keyword(s):  
United States ◽  
Multiple Sclerosis ◽  
Program Directors ◽  
The United States ◽  
Fellowship Training ◽  
Current Status ◽  
Application Process ◽  
Shared Resources ◽  
Fellowship Programs ◽  
Internal Funding

ObjectiveTo investigate the current status of postgraduate training in neuroimmunology and multiple sclerosis (NI/MS) in the United States.MethodsWe developed a questionnaire to collect information on fellowship training focus, duration of training, number of fellows, funding application process, rotations, visa sponsorship, and an open-ended question about challenges facing training in NI/MS. We identified target programs and sent the questionnaires electronically to fellowship program directors.ResultsWe identified and sent the questionnaire to 69 NI/MS fellowship programs. We successfully obtained data from 64 programs. Most programs were small, matriculating 1–2 fellows per year, and incorporated both NI and MS training into the curriculum. Most programs were flexible in their duration, typically lasting 1–2 years, and offered opportunities for research during training. Only 56% reported the ability to sponsor nonimmigrant visas. Most institutions reported having some internal funding, although the availability of these funds varied from year to year. Several program directors identified funding availability and the current absence of national subspecialty certification as major challenges facing NI/MS training.ConclusionOur study is the first to describe the current status of NI/MS training in the United States. We found many similarities across programs. We anticipate that these data will serve as a first step towards developing a standard NI/MS curriculum and help identify areas where shared resources could enhance trainee education despite differences in training environments. We identified funding availability, certification status, and nonimmigrant visa sponsorship as potential barriers to future growth in the field.

Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for chronic pain after inguinal hernia repair

Hernia ◽  
2012 ◽  
Vol 17 (3) ◽  
pp. 329-332 ◽  
Author(s):  
I. Thomassen ◽  
J. A. van Suijlekom ◽  
A. van de Gaag ◽  
J. E. H. Ponten ◽  
S. W. Nienhuijs
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Ultrasound Guided ◽  
Nerve Blocks

Refining the rat sciatic nerve block: a novel ultrasound-guided technique

2021 ◽  
pp. 002367722110346
Author(s):  
Scott Hughey ◽  
Donald Campbell ◽  
Kamala Rapp-Santos ◽  
Jacob Cole ◽  
Gregory Booth ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Ultrasound Guidance ◽  
Sciatic Nerve Block ◽  
Sprague Dawley ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Translational Studies ◽  
Translational Models ◽  
Nerve Staining

Murine translational models are an important tool to understand pain pathophysiology. One procedure used frequently in murine research is the sciatic nerve block. This study sought to demonstrate the use of ultrasound-guided sciatic nerve block in a cadaveric murine model. A total of 40 injections were performed in 20 Sprague–Dawley male 18-month-old rat cadavers. Necropsy was performed to identify staining of the sciatic nerve. Staining with methylene blue occurred in 40 of 40 ultrasound-guided injections. The extremely accurate nature of this block under ultrasound guidance is favorable for future translational studies in rats undergoing sciatic nerve blocks. This method may represent a significant improvement in current methods.

scholarly journals Mental Nerve Neuropathy Following Dental Extraction

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E375-E380 ◽  
Author(s):  
Foad Elahi
Keyword(s):  
Chronic Pain ◽  
Early Recognition ◽  
Early Stage ◽  
Nerve Tissue ◽  
Pain Clinic ◽  
Dental Extraction ◽  
Pain Medicine ◽  
Mental Nerve ◽  
Accurate Identification ◽  
Nerve Blocks

Mental nerve neuropathy (MNN), colloquially referred to as numb chin syndrome, is an uncommon neurologic condition that may arise secondary to multiple local and systemic etiologies, and may mimic other pain conditions affecting the mandible. Early recognition of mental nerve neuropathy in conjunction with accurate etiologic identification is crucial, as early pain management may prevent the transition from an acute to a chronic pain condition. In this article, we will describe the clinical courses of 2 patients who presented to the pain clinic with chronic painful numbness in the mental nerve sensory distribution following dental extraction. After a period of failed conservative medical management and repetitive successful nerve blocks at the mental foramen, we decided to proceed with radiofrequency nerve ablation. In both cases, performance of radiofrequency nerve ablation demonstrated a significant decrease in pain. Within interventional pain medicine, nerve blocks are often utilized to assist with pain generator identification, and resultantly also play an integral role in treatment planning. For instance, nerve blocks are often utilized to establish accurate identification of nerve tissue viability, a preliminary role essential for the determination of whether to proceed with an ablative peripheral nerve procedure. In this article, we will additionally review these important usages of nerve blocks within interventional pain medicine. The objective of our article is to help clinicians identify and properly manage early stage mental nerve neuropathy. Moreover, we aim to advance general medical knowledge of this important pain medicine topic. During the process of preparing this article we reviewed all existing pertinent medical literature related to MNN. Key words: Mental nerve, neuropathy, radiofrequency, nerve ablation, chronic pain

scholarly journals A review of the anatomy and a step-by-step visual guide to performing an ultrasound-guided infraclavicular brachial plexus block

2020 ◽  
pp. 17-22
Author(s):  
S Govender ◽  
D Möhr ◽  
ZN Tshabalala ◽  
AN van Schoor
Keyword(s):  
Brachial Plexus ◽  
Ultrasound Guidance ◽  
Brachial Plexus Block ◽  
Transverse Plane ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Block Methods ◽  
Infraclavicular Brachial Plexus Block ◽  
Vascular Structures ◽  
Plexus Block

Background: The aim of this description is to provide step-by-step guidelines for performing an ultrasound guided infraclavicular brachial plexus nerve block. Methods: The brachial plexus in the infraclavicular fossa of sixty healthy volunteers was scanned in the horizontal/transverse plane. The relevant regional anatomy was studied to identify the muscular and vascular structures seen on the ultrasound screen. Results: The entire process was documented and a standard, step-by-step guide to performing ultrasound guided vertical infraclavicular brachial plexus blocks was developed. Conclusion: The development of high-resolution ultrasound guidance has allowed for the direct visualisation of the brachial plexus when performing nerve blocks. Ultrasound-guided infraclavicular brachial plexus nerve blocks are becoming more popular. This description aimed to provide step-by-step guidelines on how to perform this block safely and efficiently.

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