Milam, Adam J

Health care disparities, particularly among minoritized groups, pose significant challenges within health care systems, including the field of cardiac surgery. Limited English proficiency (LEP) is an often-overlooked factor contributing to these disparities. As key members of the preoperative evaluation, intraoperative management, and postoperative care of cardiac surgery patients, anesthesiologists have both ethical and economic responsibilities to understand, recognize, and address disparities to ensure equitable care for all patients. The objective of this scoping review is to summarize the literature on how LEP impacts the utilization of health services and outcomes after cardiac surgery. More specifically, the review will map how LEP is defined in the literature, summarize the patient populations that have been studied, and describe the health care outcomes in patients with LEP after cardiac surgery. A comprehensive literature search strategy was developed in collaboration with a medical librarian and was registered before conducting the search. Studies were eligible for inclusion in our current study if (i) the patient population was composed of adults (>or = 18), (ii) the study reported health care outcomes before or after cardiac surgery, and (iii) results were stratified by a patient’s English proficiency. All randomized control trials, systematic reviews, observational studies, and cross-sectional studies published in English were included in our study. If conference abstracts met the inclusion criteria, they were included for full-text review. Opinion articles and case reports were excluded. The search produced 2401 articles with 13 articles meeting the inclusion criteria. All studies were conducted in either North America or Australia/New Zealand. The number of patients included in each study ranged from 204 to 21,789, with 4 studies having less than 1500 patients and 2 studies having greater than 10,000 patients. Through a systematic review of the literature on this topic, we identified 3 overarching themes that were inferred from the collective body of studies. First, a significant barrier to studying this topic is the absence of a universal definition of LEP. Second, the heterogeneity in several aspects of the available studies makes it difficult to draw conclusions from the results. Finally, there is a general scarcity of research done on the impact of LEP on cardiac surgery outcomes. Ultimately, our scoping review reveals an area of health disparity research that requires more attention. If disparities are found, then health care leaders may begin investigating which interventions can help mitigate these disparities.

Purpose of the review Perioperative pain management continues to evolve as we see the pendulum of opioid use swinging back from highly restrictive administration towards more balanced intraoperative dosing strategies. Striking the optimal balance between nonopioid multimodal pain regimens and thoughtful opioid use has been at the forefront of cardiac surgical enhanced recovery protocols for several years. Herein, we review the history of methadone as a long-acting opioid and its resurgence with pleiotropic benefits in cardiac surgery patients. Recent findings Despite barriers to use and potential adverse effects, methadone is a proven agent for long-lasting analgesia, potentially reducing both short- and long-term opioid consumption. Multiple studies have demonstrated safety and efficacy in cardiac surgery. Dosing (0.1–0.3 mg/kg) and timing vary slightly in published studies and protocols; however, through standardization and clinical judgement regarding patient selection, methadone can safely be used to reduce opioid use and improve analgesia for cardiac surgery. Summary Further studies are needed to explore the mechanisms and ideal protocols for incorporating methadone into routine use as part of existing enhanced recover protocols. Long-term treatment effects extending beyond the immediate postoperative period, outcomes when included with adjuncts, and broader dose-response analysis are needed to guide future implementation.

Introduction Alcohol is consumed by an estimated 137.4 million people in the USA 12 years of age and older and, as a result, is estimated to have caused about 140 thousand deaths among people 20 to 64 years of age each year from 2015 up to and including 2019. Methods The proposed review of the evidence on alcohol’s impact on health aims to produce conclusions to inform the Dietary Guidelines for Americans, 2026–2030 . A multi-method approach will be utilised to formulate conclusions on (i) weekly (ie, average) thresholds to minimise long-term and short-term risks of morbidity and mortality, (ii) daily thresholds to minimise the short-term risk of injury or acute illness due to per occasion drinking, (iii) alcohol use among vulnerable populations (eg, pregnant women) and (iv) situations and circumstances that are hazardous for alcohol use. To inform expert decisions, this project will also include a systematic review of existing low-risk drinking guidelines, a systematic review of meta-analyses which examine alcohol’s impact on key attributable disease and mortality outcomes, and of estimates of the lifetime absolute risk of alcohol-attributable mortality and morbidity based on a person’s sex and average level of alcohol use. The systematic reviews were designed in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). The preliminary conclusions produced as a result of this project will undergo public consultation, and data from these consultations will be qualitatively analysed. The results of the public consultations will be used to further revise and refine the project’s conclusions. Ethics and registration The study was granted an ethics exemption as only secondary data sources and unidentifiable public consultation will be utilised. Systematic reviews are pre-registered with PROSPERO (registration numbers CRD42024584924 and CRD42024584948). Dissemination This project will establish a scientific consensus concerning alcohol’s impact on health. This consensus is imperative for informing the upcoming Dietary Guidelines for Americans, 2026–2030 , and for better informing individuals about the health risks associated with alcohol use.

The author feels himself to be an anomaly—both a full professor at age 38 at a nationally ranked medical center and a Black man from Baltimore with dreadlocks. He considered leaving academic medicine given the political changes occurring in the United States. The National Institutes of Health are terminating funded grants focused on health equity, and the Centers for Disease Control and Prevention are rolling back effective public health strategies specifically designed to mitigate health disparities. His main impetus for entering academic medicine—advancing health equity—as well as his identity as a Black male is being threatened. He is running out of positive coping mechanisms to counter these threats to remain in academic medicine. Addressing these challenges will require intentional efforts from faculty implementing health equity interventions, academic centers taking a stance, and foundations financially supporting health disparities research and interventions now abandoned by federal agencies.