Harbell, Monica W.

Objective: To evaluate and compare parental leave policies from the top United States (US) hospitals with a focus on inclusivity of all types of parents. Methods: In September and October of 2021, the parental leave policies of the top 20 US hospitals, ranked by the 2021 US News & World report, were evaluated. Parental leave policies were obtained and reviewed through the hospitals' public websites. Hospitals' Human Relations (HR) departments were contacted to confirm the policies. Hospital policies were scored against a rubric created by the authors. Results: Among the top US hospitals (21 total hospitals), 17 (81%) had publicly available policies, and one policy was obtained by contacting HR. Fourteen of the 18 hospitals (77.8%) had a parental leave policy distinctive from short-term disability and offered paid paternity or partner leave. Thirteen hospitals (72.2%) offered parental leave for parents whose children were carried through surrogacy. Fourteen hospitals (77.8%) included adoptive parents; however, only five hospitals (27.8%) specifically included foster parents. The average paid leave for birthing mothers was 7.9 weeks compared to 6.6 weeks for nonbirthing parents. Only three hospitals offered the same leave for birthing and nonbirthing parents. Conclusion: While a few of the top 20 hospitals have paid parental leave policies that are inclusive and equivalent to all parents, many do not and represent an area for improvement. As healthcare industry leaders, these hospitals should strive for inclusive parental leave policies that care for their employees with the same high standards they set for caring for patients.

BACKGROUND: Although the number of women in medicine has increased, women remain underrepresented in leadership positions, specifically in medical societies. Specialty societies in medicine are influential in networking, career advancement, research and education opportunities, and providing awards and recognition. The goals of this study are to examine the representation of women in leadership positions in anesthesiology societies compared to women society members and women anesthesiologists and to analyze the trend in women society presidents over time. METHODS: A list of anesthesiology societies was obtained from the American Society of Anesthesiology (ASA) website. Society leadership positions were obtained via the societies’ websites. Gender was determined by images on the society website and images or pronouns on hospital websites and research databases. The percentage of women presidents, vice presidents/presidents-elect, secretaries/treasurers, board of directors/council members, and committee chairs was calculated. The percentage of women in society leadership positions was compared to the percentage of women society members when available, and the percentage of women anesthesiologists in the workforce (26%) using binomial difference of unpaired proportions tests. The trend of women presidents from 1980 to 2020 was analyzed using a Cochran-Armitage trend test. RESULTS: A total of 13 societies were included in this study. Overall, women held 32.6% (189/580) of leadership positions. 38.5% (5/13) of presidents, 17.6% (3/17) of presidents-elect/vice presidents, and 45% (9/20) of secretaries/treasurers were women. In addition, 30.0% (91/303) of board of directors/council members and 34.2% (90/263) of committee chairs were women. The percentage of women holding society leadership positions was significantly greater than the percentage of women anesthesiologists in the workforce ( P < .001), as was the percentage of women as committee chairs ( P = .003). The percentage of women society members was available for 9 of 13 societies (69%), and the percentage of women leaders was similar to the percentage of women society members ( P = .10). There was a significant difference in the percentage of women leaders between society size categories. Small societies had 32.9% (49/149) women leaders, medium had 39.4% (74/188) women leaders, and the single large society had 27.2% (66/243) ( P = .03). There were also significantly more women leaders in the Society of Cardiovascular Anesthesiologists (SCA) than there are women members ( P = .02). CONCLUSIONS: This study suggests that anesthesia societies may be more inclusive of women in leadership positions compared to other specialty societies. Although in anesthesiology, women remain underrepresented in academic leadership roles, there is a higher proportion of women in leadership roles in anesthesiology societies than proportion of women in the anesthesia workforce.

Background and objectives Studies show variable spread with thoracic erector spinae plane (ESP) injections. Injection sites vary from lateral end of the transverse process (TP) to 3 cm from the spinous process, with many not describing the precise site of injection. This human cadaveric study examined dye spread of ultrasound-guided thoracic ESP block at two needle locations. Methods Ultrasound-guided ESP blocks were performed on unembalmed cadavers. Methylene blue (20 mL, 0.1%) was injected in the ESP at the medial TP at level T5 (medial transverse process injection (MED), n=7) and the lateral end of the TP between T4 and T5 (injection between transverse processes (BTWN), n=7). The back muscles were dissected, and the cephalocaudal and medial-lateral dye spread documented. Results Dye spread cephalocaudally from C4-T12 in the MED group and C5-T11 in the BTWN group, and laterally to the iliocostalis muscle in five MED injections and all BTWN injections. One MED injection reached serratus anterior. Dorsal rami were dyed in five MED and all BTWN injections. Dye spread to the dorsal root ganglion and dorsal root in most injections, though more extensively in the BTWN group. The ventral root was dyed in 4 MED and 6 BTWN injections. Epidural spread in BTWN injections ranged from 3 to 12 levels (median: 5 levels), with contralateral spread in two cases and intrathecal spread in five injections. Epidural spread in MED injections was less extensive (median (range): 1 (0–3) levels); two MED injections did not enter the epidural space. Conclusion An ESP injection administered between TPs exhibits more extensive spread than a medial TP injection in a human cadaveric model.

AbstractDiabetes insipidus is characterized by polyuria due to an inability to auto‐regulate water balance resulting in dangerous metabolic derangements. Intraoperative anesthetics have been increasingly identified as a cause of diabetes insipidus in adult patients; however, it is rare in pediatrics. We present a case of a 16‐year‐old male undergoing resection of a recurrent left juvenile nasopharyngeal angiofibroma who experienced intraoperative polyuria concerning diabetes insipidus. Urine output drastically decreased following discontinuation of dexmedetomidine with complete resolution within 24 h. We conclude that this case of transient diabetes insipidus was associated with dexmedetomidine administration.

AbstractExtended‐release liposomal bupivacaine is frequently used in surgical infiltration for postoperative pain control. The manufacturer recommends against subsequent local anesthetics within 96 hours. We administered epidural bupivacaine one day after local liposomal bupivacaine infiltration for staged hemipelvectomy without symptoms of LAST. Further pharmacokinetic and clinical safety studies are needed.

Large group lectures, which are widely used in continuing medical education, are susceptible to pitfalls that can negatively impact their effectiveness. In this article, we describe evidence-based best practices from the educational literature that can revive the medical lecture as an effective educational tool. We provide practical tips for both developing and delivering lectures, emphasizing the key role that learning objectives can and should have in the development of lectures, the importance of organization, effective use of visuals and application of restraint in slide design. Pause techniques to authentically engage the audience are described. We also provide practical tips for promoting attention in virtual presentations.