翻译：钮阳 徐州医科大学2024级硕士研究生
审校：赵林林 徐医附院麻醉科
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《Anesthesia & Analgesia》2024年10月刊，第139卷第4卷
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《Anesthesia & Analgesia》2024年7月刊，第139卷第1卷
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《Anesthesia & Analgesia》2024年11月刊，第139卷第5卷1.Perioperative Health Care Disparities: Identifying Problems Versus Solutions2.Key Diversity, Equity, and Inclusion Considerations When Using Big Data to Study Networks利用大数据研究网络时的关键多样性、公平性和包容性考量3.An Ironclad Case for Patient Blood Management: Iron Is More Than Hemoglobin1.Lost in Translation: Cognitive Screening and Outcomes2.Anesthesiology Residency Matching - A DEI Perspective麻醉学住院医匹配——从多元化、公平性和包容性（DEI）的角度看待Original Laboratory Research Report1.A Prospective Observational Cohort Study of Language Preference and Preoperative Cognitive Screening in Older Adults: Do Language Disparities Exist in Cognitive Screening and Does the Association Between Test Results and Postoperative Delirium Differ Based on Language Preference?语言偏好与老年人术前认知筛查的前瞻性观察队列研究：认知筛查中存在语言差异吗？基于语言偏好，测试结果与术后谵妄之间是否存在关联？A greater percentage of surgical procedures are being performed each year on patients 65 years of age or older. Concurrently, a growing proportion of patients in English-speaking countries such as the United States, United Kingdom, Australia, and Canada have a language other than English (LOE) preference. We aimed to measure whether patients with LOE underwent cognitive screening at the same rates as their English-speaking counterparts when routine screening was instituted. We also aimed to measure the association between preoperative Mini-Cog and postoperative delirium (POD) in both English-speaking and LOE patients.背景：每年对65岁或以上的患者进行外科手术的比例较大。同时，在美国、英国、澳大利亚和加拿大等英语国家，越来越多的患者偏爱英语以外的语言（LOE）。我们的目的是测量在进行常规筛查时，LOE患者接受认知筛查的比率是否与说英语的患者相同。我们还旨在测量英语和LOE患者术前Mini-Cog和术后谵妄（POD）之间的关系。We conducted a single-center, observational cohort study in patients 65 years old or older, scheduled for surgery and evaluated in the preoperative clinic. Cognitive screening of older adults was recommended as an institutional program for all patients 65 and older presenting to the preoperative clinic. We measured program adherence for cognitive screening. We also assessed the association of preoperative impairment on Mini-Cog and POD in both Englishspeaking and LOE patients, and whether the association differed for the 2 groups. A MiniCog score ≤2 was considered impaired. Postoperatively, patients were assessed for POD using the Confusion Assessment Method (CAM) and by systematic chart review.方法：我们对65岁及以上、计划手术并在术前临床评估的患者进行了一项单中心、观察性队列研究。老年人认知筛查被推荐为所有65岁及以上患者术前门诊的制度性项目。我们测量了认知筛查的依从性。我们还评估了英语和LOE患者术前Mini-Cog和POD损伤的相关性，以及两组患者的相关性是否不同。MiniCog评分≤2分为受损。术后，采用混淆评估法（CAM）和系统的图表回顾对患者进行POD评估。Over a 3-year period (February 2019–January 2022), 2446 patients 65 years old or older were assessed in the preoperative clinic prior. Of those 1956 patients underwent cognitive screening. Eighty-nine percent of English-speaking patients underwent preoperative cognitive screening, compared to 58% of LOE patients. The odds of having a Mini-Cog assessment were 5.6 times higher (95% confidence interval [CI], 4.6–7.0) P < .001 for Englishspeaking patients compared to LOE patients. In English-speaking patients with a positive Mini-Cog screen, the odds of having postop delirium were 3.5 times higher (95% CI, 2.6–4.8) P < .001 when compared to negative Mini-Cog. In LOE patients, the odds of having postop delirium were 3.9 times higher (95% CI, 2.1–7.3) P < .001 for those with a positive Mini-Cog compared to a negative Mini-Cog. The difference between these 2 odds ratios was not significant ( P = .753).结果：在3年期间（2019年2月- 2022年1月），2446名65岁及以上的患者在术前临床进行了评估。1956名患者接受了认知筛查。89%说英语的患者接受了术前认知筛查，而LOE患者的这一比例为58%。与LOE患者相比，英语患者进行Mini-Cog评估的几率高5.6倍（95%置信区间[CI]， 4.6-7.0） P < 0.001。在Mini-Cog筛查阳性的英语患者中，与Mini-Cog阴性患者相比，停药后谵妄的几率高3.5倍（95% CI, 2.6-4.8） P < 0.001。在LOE患者中，与Mini-Cog阴性患者相比，Mini-Cog阳性患者出现停药后谵妄的几率是后者的3.9倍（95% CI, 2.1-7.3） P < 0.001。两种比值比差异无统计学意义（P = .753）。We observed a disparity in the rates LOE patients were cognitively screened before surgery, despite the Mini-Cog being associated with POD in both English-speaking and LOE patients.Efforts should be made to identify barriers to cognitive screening in limited English-proficient older adults.结论：尽管Mini-Cog在英语和LOE患者中与POD相关，但我们观察到LOE患者在手术前认知筛查率存在差异。应努力找出在英语能力有限的老年人中进行认知筛查的障碍。2.Diversity, Equity, and Inclusion in US Anesthesiology Residency MatchingThis retrospective observational study identified 47,117 anesthesiology applicants among the 546,298 residency applicants in the Electronic Residency Application Service (ERAS) system between 2011 and 2022 and stratified applicants by self-reported gender, race, and ethnicity.The demographics of anesthesiology trainees reported in the 2014 to 2015, 2018 to 2019, and 2022 to 2023 Accreditation Counsel of Graduate Medical Education (ACGME) Data Resource Books were used as surrogates for matched applicants as demographics are not reported by the National Residency Match Program. To facilitate comparisons, ERAS applicants were grouped into 4-year epochs to align with consolidated ACGME reports corresponding to the application years. Odds ratios (OR); 95% confidence interval of applying to and matching into anesthesiology were analyzed.方法：这项回顾性观察性研究从2011年至2022年电子住院申请服务（ERAS）系统的546,298名住院申请人中筛选出47,117名麻醉科申请人，并根据自我报告的性别、种族和民族对申请人进行分层。2014 - 2015年、2018 - 2019年和2022 - 2023年研究生医学教育认证顾问（ACGME）数据资源书中报告的麻醉学培训生的人口统计数据被用作匹配申请人的替代，因为国家住院医师匹配计划没有报告人口统计数据。为了便于比较，ERAS申请人被分为4年一组，以与申请年度对应的综合ACGME报告保持一致。优势比（OR）；分析麻醉学应用与匹配的95%置信区间。Women had lower odds of applying to anesthesiology compared to men overall (OR, 0.55; 95% CI, 0.54–0.56, P < .0001) and maintained significantly lowered odds of applying within each epoch. Women had similar odds of matching into anesthesiology residency compared to men (OR, 1.10; 95% CI, 1.06–1.14, P < .0001). Black, Hispanic or Latino, Asian and NH-PI, and AI-AN applicants had similar odds to White applicants of applying to anesthesiology but odds of matching were significantly lower overall ( P < .0001) for Asian and NH-PI (OR, 0.66; 95% CI, 0.63–0.70), Black (OR, 0.49; 95% CI, 0.45–0.53), Hispanic or Latino (OR, 0.50; 95% CI, 0.46–0.54), and AI-AN (OR, 0.20; 95% CI, 0.15–0.28) applicants. The odds of matching among some minoritized applicants increased in the ACGME 2022 to 2023 report year.结果：总体而言，女性申请麻醉学的几率低于男性(OR, 0.55；95% CI, 0.54-0.56, P < 0.0001)，并且在每个epoch内保持显著降低的应用几率。与男性相比，女性与麻醉科住院医师匹配的几率相似(OR, 1.10；95% ci, 1.06-1.14, p < 0.0001)。黑人、西班牙裔或拉丁裔、亚洲人、NH-PI和AI-AN申请人申请麻醉学的几率与白人申请人相似，但亚洲人和NH-PI申请人的匹配几率总体上显着降低（P < 0.0001） (or, 0.66；95% CI, 0.63-0.70)，黑色(OR, 0.49；95% CI, 0.45-0.53)，西班牙裔或拉丁裔(or, 0.50；95% CI, 0.46-0.54)和AI-AN (OR, 0.20；95% CI, 0.15-0.28)。在ACGME 2022年至2023年的报告年度，一些少数族裔申请人的匹配几率有所增加。 From 2011 to 2022, women had lower odds of applying to anesthesiology residency than men yet had similar odds of matching. Racial and ethnic minoritized groups had significantly lower odds of matching compared to White applicants despite similar odds of applying. These findings highlight disparities in the anesthesiology match and may help identify opportunities to promote workforce diversity within the field. More detailed reporting of gender, race, and ethnicity in annual match data may better define barriers to entry and identify opportunities for improvement.结论：从2011年到2022年，女性申请麻醉学住院医师的几率低于男性，但匹配几率相似。尽管申请的几率相似，但与白人申请人相比，少数种族和少数民族申请人的匹配几率明显较低。这些发现突出了麻醉学匹配的差异，可能有助于确定促进该领域劳动力多样性的机会。在年度比赛数据中更详细地报告性别、种族和民族，可以更好地确定进入的障碍，并确定改进的机会。1.Gadolinium-Based Contrast Agents: Rationale for Use in Patients with Iodine Contrast or Shellfish Allergy?钆基造影剂：在碘造影剂或贝类过敏患者中的使用理由？2.More Than a 100 Years After Flexner: Are We Achieving Expertise Through Medical Education?弗莱克斯纳报告后一百多年：我们是否通过医学教育实现了专业化？3.Exploring the Potential of Evidence-Based Practice on Mitigating Health Care Disparities4.Introducing and Studying the Materials and Methods of Anesthesia and Analgesia in Ancient IranResponse Letter to the Editor
