Journal of Clinical Anesthesia最新文献

{"title":"The utility of the Ascertain Dementia Eight-item Questionnaire (AD8) and Mini-Cog in detecting cognitive impairment in older surgical patients – The Detect CI study","authors":"Ellene Yan HBSc ,&nbsp;Yasmin Alhamdah MSc ,&nbsp;Sinead Campbell MB BCh BAO FCAI ,&nbsp;David He MD PhD ,&nbsp;Leif Erik Lovblom PhD ,&nbsp;David F. Tang-Wai MD CM ,&nbsp;Aparna Saripella MSc ,&nbsp;Jean Wong MD ,&nbsp;Frances Chung MD","doi":"10.1016/j.jclinane.2025.111940","DOIUrl":"10.1016/j.jclinane.2025.111940","url":null,"abstract":"<div><h3>Background</h3><div>Brain health is often overlooked before surgery, missing an opportunity to identify at-risk patients. This study aimed to (1) examine the diagnostic performance of two ultra-rapid cognitive screening tools, the Ascertain Dementia Eight-item Questionnaire (AD8) and Mini-Cog, against a tool validated in surgical populations, the Montreal Cognitive Assessment (MoCA); and (2) compare preoperative patient-centered assessments and postoperative outcomes between those with and without cognitive impairment (CI).</div></div><div><h3>Methods</h3><div>CI was classified by scoring ≥2 on the AD8, ≤2 on the Mini-Cog, and/or ≤25 on the MoCA in non-cardiac patients ≥65 years old.</div></div><div><h3>Results</h3><div>Of 394 participants, 35 % had preoperative CI on the MoCA, 15 % on the AD8, and 12 % on the Mini-Cog. Both the AD8 and Mini-Cog demonstrated moderate area under the curve, with superior specificity over sensitivity. In contrast to the Mini-Cog, participants with CI on the MoCA and AD8 reported poorer preoperative patient-centered assessments than those without. Specifically, the AD8 was associated with poorer functional disability, frailty, anxiety and/or depression, pain level, sleep quality, and quality of life. Contrary to the MoCA and Mini-Cog, CI on the AD8 was associated with higher all-cause complications (15.1 % <em>vs.</em> 3.7 %, <em>P</em> = 0.003), emergency department visits (11.3 % <em>vs.</em> 2.5 %, <em>P</em> = 0.007), and composite adverse outcomes (15.1 % <em>vs.</em> 4.6 %, <em>P</em> = 0.008) at 90 days.</div></div><div><h3>Conclusions</h3><div>Although the AD8 and Mini-Cog demonstrated comparable diagnostic accuracy for CI, the AD8 provided additional insights into preoperative patient-centered assessments and 90-day adverse outcomes. Our study emphasizes the importance of preoperative screening for CI, highlighting the AD8 as a valuable tool.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111940"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-free anesthesia protocol based on thoracic paravertebral block enhances postoperative recovery after breast cancer surgery: Are there more lessons to be learnt?","authors":"Rafail Ioannidis ,&nbsp;Pelagia-Paraskevi Chloropoulou ,&nbsp;Despoina Sarridou","doi":"10.1016/j.jclinane.2025.111938","DOIUrl":"10.1016/j.jclinane.2025.111938","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111938"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to “Concerns regarding methodology in the Publication “Flow-Controlled versus PressureControlled Ventilation in Thoracic Surgery with One-Lung Ventilation – A Randomized Controlled Trial” by Thoma et al","authors":"P. Spraider,&nbsp;J. Abram,&nbsp;J. Martini","doi":"10.1016/j.jclinane.2025.111937","DOIUrl":"10.1016/j.jclinane.2025.111937","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111937"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroencephalographic changes related to cortico-subcortical decoupling during propofol-induced loss of consciousness: A secondary analysis of a prospective observational study","authors":"Juan L. Fernández-Candil ,&nbsp;Rachel Nuttall ,&nbsp;Lluís Gallart ,&nbsp;Gerhard Schneider ,&nbsp;Laura Blanco-Hinojo ,&nbsp;Gerard Martínez-Vilavella ,&nbsp;Jesus Pujol ,&nbsp;Irina Adalid ,&nbsp;Sebastian Berger ,&nbsp;Daniel Bujosa ,&nbsp;Joan Deus ,&nbsp;Pedro Luis Gambús ,&nbsp;Sebastian Jaramillo ,&nbsp;Luis Moltó ,&nbsp;Juan Felipe Ortega ,&nbsp;Susana Pacreu ,&nbsp;Víctor Pérez-Sola ,&nbsp;Esther Vilà","doi":"10.1016/j.jclinane.2025.111926","DOIUrl":"10.1016/j.jclinane.2025.111926","url":null,"abstract":"<div><h3>Background</h3><div>Cortico-subcortical decoupling has been observed in functional magnetic resonance imaging (fMRI) during slow propofol-induced loss of consciousness (LOC). However, corresponding electroencephalography (EEG) free of the cardioballistic and fMRI artifacts is essential for translating decoupling observations to clinical monitoring.</div></div><div><h3>Objective</h3><div>To describe artifact-corrected EEG changes corresponding to cortico-subcortical decoupling at LOC.</div></div><div><h3>Design</h3><div>Secondary analysis of a prospective observational study.</div></div><div><h3>Setting</h3><div>Tertiary-care hospital, data collection from June 2017 to January 2019.</div></div><div><h3>Participants</h3><div>Nineteen healthy volunteers receiving a targeted propofol infusion.</div></div><div><h3>Interventions</h3><div>Frontal EEG was recorded synchronously with clinical signs and fMRI. Gradient artifact correction was based on iterative peak detection. Cardioballistic artifact correction was accomplished with a recently described algorithmic method based on peak detection combined with temporal constraints.</div></div><div><h3>Main outcome measures</h3><div>The qCON index and frontal EEG before and after decoupling at LOC.</div></div><div><h3>Results</h3><div>Algorithm-filtered EEG tracings were suitable for analysis in 16 subjects. Propofol-induced LOC was achieved at a median (IQR) target plasma concentration of 4.5 (3.91 to 4.61) μg/mL and an effect-site concentration of 4.0 (2.94 to 4.31) μg/mL. The qCON index remained over 80 before decoupling and gradually decreased to values below 60 afterwards. Frontal alpha band power increased significantly from a median of 0.07 (0.03 to 0.15) 30 s before decoupling to 0.48 (0.08 to 0.58) 30 s after decoupling (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Cortico-subcortical decoupling related to propofol-induced LOC coincides with a gradual decrease in the qCON index and an increase in frontal alpha power. These results help translate fMRI findings to bedside settings.</div><div><strong>Registered</strong> at EudraCT (reference 2016–004833-25). Principal Investigator: Juan L. Fernández-Candil. Date of registration: January 4, 2017. Start Date: June 13, 2017.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111926"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overdiagnosis of catheter-related thrombosis: When intensive screening detects clinically irrelevant findings","authors":"Hui-Ting Yuan ,&nbsp;Nan Qin ,&nbsp;Ying Zhou","doi":"10.1016/j.jclinane.2025.111920","DOIUrl":"10.1016/j.jclinane.2025.111920","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111920"},"PeriodicalIF":5.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of dexamethasone and lidocaine combination on incidence of post-operative sore throat: A meta-analysis and trial sequential analysis","authors":"Jibran Ikram ,&nbsp;Aizaz Ali ,&nbsp;Abdul Moeez ,&nbsp;Muhammad Momin Khan ,&nbsp;Ubaidullah ,&nbsp;Aafeen Mujeeb ,&nbsp;Muhammad Abdullah Ali ,&nbsp;Sana Tanveer ,&nbsp;Malik W.Z. Khan ,&nbsp;Bushra Zaman ,&nbsp;Aamer Syed ,&nbsp;Muhammad Ahmad Nadeem ,&nbsp;Ayesha Zahid ,&nbsp;Mohammad Khudirat ,&nbsp;Sawaira ,&nbsp;Steven Minear ,&nbsp;Sabry Ayad","doi":"10.1016/j.jclinane.2025.111924","DOIUrl":"10.1016/j.jclinane.2025.111924","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative sore throat (POST) is a common complication after endotracheal intubation, occurring in 30–50 % of patients. While lidocaine (local anesthetic) and dexamethasone (anti-inflammatory) are used individually to prevent POST, their combined efficacy remains unclear. This meta-analysis synthesizes evidence from randomized controlled trials to determine whether Intravenous dexamethasone-lidocaine combination is more effective than dexamethasone alone in reducing POST incidence.</div></div><div><h3>Methods</h3><div>A systematic search was conducted across PubMed, Embase, and Web of Science to identify studies comparing the effect of dexamethasone with and without lidocaine on the incidence of POST, cough, and hoarseness. Statistical analysis was performed on RevMan. Data were pooled using a random-effects model (Mantel-Haenszel method), with results reported as risk ratios (RR) and 95 % confidence intervals (CIs); heterogeneity was assessed using the I² statistic. A <em>p</em>-value less than 0.05 was considered statistically significant. We use Gradpro GDT and Trial sequential analysis to assess the certainty and reliability of evidence, respectively.</div></div><div><h3>Results</h3><div>Our search retrieved 116 articles, of which 31 were duplicates. At the end of the selection process based on prespecified eligibility criteria, three randomized controlled trials were included in the final meta-analysis. Dexamethasone-lidocaine significantly reduces the incidence of POST compared to dexamethasone alone, with a (RR: 0.53; 95 % CI: 0.37–0.75; <em>P</em> = 0.0003, I² = 0 %). The meta-analysis showed no statistically significant difference in postoperative cough (RR: 0.81; 95 % CI: 0.41–1.61; <em>P</em> = 0.55, I² = 24 %) and hoarseness (RR: 0.60; 95 % CI: 0.29–1.22; <em>P</em> = 0.16, I² = 24 %) between the dexamethasone-lidocaine combination and dexamethasone alone. Non-significance doesn't prove groups are comparable; wide confidence intervals suggest a potentially meaningful difference in cough incidence. GRADE assessment analysis showed high evidence for POST and cough but showed moderate evidence for hoarseness and cough. Trial sequential analysis showed insufficient evidence to conclude that Dexamethasone-lidocaine reduces the incidence of POST.</div></div><div><h3>Conclusion</h3><div>The dexamethasone-lidocaine combination suggests a clinically meaningful reduction in POST compared to dexamethasone alone, with consistent effects across studies. While not impacting hoarseness and cough, these robust findings support adopting this readily available, cost-effective strategy to enhance recovery after intubation. The combination's benefit on the most common postoperative complications justifies its inclusion in airway management protocols. Further trials are needed to support and enhance the reliability of this current evidence.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111924"},"PeriodicalIF":5.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response of letter to the editor regarding “effects of neuromuscular block reversal with neostigmine/glycopyrrolate versus sugammadex on bowel motility recovery after laparoscopic colorectal surgery: A randomized controlled trial”","authors":"Jin-Woo Park MD, PhD","doi":"10.1016/j.jclinane.2025.111923","DOIUrl":"10.1016/j.jclinane.2025.111923","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111923"},"PeriodicalIF":5.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between race, ethnicity, and surgical case cancellations: A retrospective study in a cohort of patients undergoing oncological surgeries","authors":"Juan P. Cata MD ,&nbsp;Pascal Owusu-Agyemang MD ,&nbsp;Taiwo Adesoye MD ,&nbsp;Lei Feng MS","doi":"10.1016/j.jclinane.2025.111925","DOIUrl":"10.1016/j.jclinane.2025.111925","url":null,"abstract":"<div><h3>Background</h3><div>Surgical delays and cancellations have been shown to occur more frequently in racial and ethnic minority patients. We hypothesized that race and ethnicity are independent risk factors for surgical cancellations in patients with cancer.</div></div><div><h3>Methods</h3><div>This retrospective study reviewed surgical procedures in a large tertiary cancer center. The primary outcome was surgical cancellation before or on the intended surgery date. The primary exposure variable was a patient's self-reported race and ethnicity. A multivariable logistic regression model was fitted to estimate the effects of covariates on the status of case cancellation. A <em>p</em>-value &lt;0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Of 109,400 surgical cases, the overall rate of cancellation was 4.45 %. The highest rate was among patients in the head and neck service (15.04 %). Overall, changes in treatment were a frequent cause of cancellations (54.9 %). Black patients had the highest rate of cancellations among all ethnicities (5.4 %), with the breast surgical oncology service having the highest rate of cancellations among Black patients (16.6 %). After only including unique first clinical encounters of each patient (<em>N</em> = 78,227) and with adjustment of gender, age-adjusted CCI and primary surgery type in a mixed effects model which treated surgery date as a cluster variable, patients identified as NH-Asian (OR, 99.8 % CI: 0.56, 0.40–0.79), and NH-White (OR, 99.8 % CI: 0.64, 0.53–0.78) had statistically significant lower odds of surgical cancellation compared to NH-Black patients. Those identified as NHPIA (OR, 99.8 % CI: 0.57, 0.22–1.51), Hispanic or Latino (OR, 99.8 %: 0.82, 0.65–1.03), and Other (OR, 95 % CI: 0.76, 0.46–1.26) did not have significant lower odds of surgical cancellation compared to NH-Black patients.</div></div><div><h3>Conclusions</h3><div>Our work suggests that in the context of cancer care, Black or African-American patients have an increased risk of surgical cancellations.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111925"},"PeriodicalIF":5.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The usefulness of the modified steep ramp test as a practical exercise test for preoperative risk assessment in patients scheduled for pancreatic surgery","authors":"Heleen Driessens ,&nbsp;Lis S.M. Hoeijmakers ,&nbsp;Olav D.J. Zwerver ,&nbsp;Allard G. Wijma ,&nbsp;Nicole D. Hildebrand ,&nbsp;Remy R.Y.C. Queisen ,&nbsp;Mayella Kuikhoven ,&nbsp;Marcel den Dulk ,&nbsp;Steven W.M. Olde Damink ,&nbsp;Joost M. Klaase ,&nbsp;Bart C. Bongers","doi":"10.1016/j.jclinane.2025.111916","DOIUrl":"10.1016/j.jclinane.2025.111916","url":null,"abstract":"<div><h3>Background</h3><div>The widespread implementation of a preoperative assessment of aerobic capacity requires a practical field test. This study investigated the validity of the modified steep ramp test (SRT) for evaluating preoperative aerobic capacity and to evaluate its usefulness for preoperative risk assessment in patients planned for pancreatic surgery.</div></div><div><h3>Methods</h3><div>Patients scheduled for pancreatic surgery who preoperatively performed cardiopulmonary exercise testing (CPET) and the modified SRT within 14 days were included. To assess its criterion validity, the correlation between the achieved work rate at peak exercise (WR_peak) at the modified SRT and oxygen uptake (VO₂) at peak exercise (VO_2peak) during CPET was determined. To evaluate the ability of the modified SRT to correctly classify patients as fit or unfit, receiver operating characteristic (ROC) analyses were performed based on the CPET VO_2peak cutoff 18.0 ml.kg⁻¹.min⁻¹ and VO₂ at the ventilatory anaerobic threshold (VAT) cutoff 11.0 ml.kg⁻¹.min⁻¹.</div></div><div><h3>Results</h3><div>Forty-eight patients (21 females) aged 68.7 ± 7.6 years were included. Modified SRT WR_peak (W/kg) demonstrated a very strong correlation with CPET VO_2peak (<em>ρ</em> = 0.865, <em>r</em> = 0.926). The modified SRT WR_peak cutoff to most accurately classify patients as fit or unfit was 2.095 W/kg for the CPET VO_2peak cutoff (area under the curve (AUC) of 0.948) and the CPET VO₂ at the VAT cutoff (AUC of 0.814).</div></div><div><h3>Conclusions</h3><div>The modified SRT is a valid short-term practical exercise test to preoperatively assess aerobic capacity in patients undergoing pancreatic surgery. A modified SRT performance below 2.1 W/kg seems clinically most suitable to select candidates for further preoperative CPET evaluation and/or prehabilitation, given its positive and negative predictive value.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111916"},"PeriodicalIF":5.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144548828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and utility of anesthesiology entrustable professional activities assessed with a mobile web application","authors":"Pedro Tanaka M.D., Ph.D. (Medicine), M.A.C.M., Ph.D. (Education) ,&nbsp;Yoon Soo Park Ph.D ,&nbsp;Jonathan Chen MD PhD ,&nbsp;Alex Macario M.D., M.B.A","doi":"10.1016/j.jclinane.2025.111922","DOIUrl":"10.1016/j.jclinane.2025.111922","url":null,"abstract":"<div><h3>Background</h3><div>A prior study developed and validated 14 Entrustable Professional Activities (EPA) for anesthesia residents for anesthesiology residency programs to use as the basis for workplace assessment.</div></div><div><h3>Objective</h3><div>The goals of this study were to: 1) measure the reliability of seven of those 14 EPAs using entrustment data collected via a mobile web application (Web App) and 2) examine implementation and utility of the EPA Web App.</div></div><div><h3>Methods</h3><div>Web App design prioritized a simple and efficient user interface, and incorporated revisions based on feedback. Assessments were completed during the 2020–2021 academic year. Generalizability theory was used to examine the distribution of EPA global scores. Qualitative interview data of Web App usage by participants focused on domains of the Consolidated Framework for Implementation Research.</div></div><div><h3>Results</h3><div>The Web App was used in a total of 1116 observations in 31 residents. Two EPAs were effective in discriminating differences in resident performance, whereas two were not. With 24 observations, one of the EPAs had a G coefficient of 0.68 and phi coefficient of 0.66 approaching a level suitable for formative feedback, whereas the other EPAs did not reach the 0.7 threshold (for moderate reliability in formative assessment, not summative use) even with 24 observations. Several constructs were elicited from the interview data in the domains of intervention characteristics, individual characteristics, outer setting, and inner setting.</div></div><div><h3>Conclusion</h3><div>The utility of the Web App for EPA assessment was deemed positive for formative, low-stakes assessment. EPAs may not all necessarily be able to discriminate differences in resident performance. However, even a single EPA assessment may still be useful as one component of competency-based medical education via programmatic assessment.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111922"},"PeriodicalIF":5.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}