Hasil untuk "Anesthesiology"

J. Soar, J. Nolan, B. Böttiger et al.

N. O’grady, M. Alexander, L. Burns et al.

Jishi Ye, Jishi Ye, Yu Liu et al.

BackgroundHigh trans-fatty acid (TFA) intake is a major modifiable risk factor for cardiovascular disease (CVD), especially in older adults. This study aimed to assess global trends and health inequalities in CVD burden attributable to high TFA intake from 1990 to 2021 and project future patterns through 2036.MethodsUsing data from the Global Burden of Disease (GBD) Study 2021, we analyzed age-standardized mortality rates (ASMR), disability-adjusted life years (ASDR), and inequality indicators across 204 countries and territories. Age-Period-Cohort (APC) models and Bayesian projections were applied to estimate future trends.ResultsGlobally, ASMR and ASDR attributable to high TFA intake declined by 69 and 68%, respectively, from 1990 to 2021. The most significant reductions were observed in high-SDI regions, where comprehensive TFA bans and public health policies were implemented. In contrast, the absolute burden remains high in low- and middle-SDI countries due to limited policy enforcement and dietary interventions. Socioeconomic inequalities narrowed over time, but vulnerable populations still face elevated risks. Projections indicate a continued global decline in CVD burden attributable to TFA through 2036, though widening uncertainties reflect demographic and policy challenges.ConclusionWhile global progress in reducing TFA-related CVD burden is evident, persistent disparities and emerging risks in low-resource settings underscore the need for global elimination of industrial TFA, strengthened health systems, and targeted strategies to protect high-risk groups.

Hangeul Park, Woojin Kim, Jungbo Sim et al.

Objective Motor-evoked potential (MEP) loss during intramedullary (IM) spinal cord tumor surgery impairs the ability to monitor further neural injury. Direct wave (D-wave) monitoring may allow continued assessment of corticospinal tract integrity after MEP loss. This study evaluates the role of D-wave-guided surgery in preserving function and enabling safe resection after MEP loss. Methods A retrospective study was conducted in adult patients with ependymoma (EPN), cavernous angioma (CA) or subependymoma who experienced MEP loss during IM tumor resection between January 2012 and May 2025. Patients who underwent continued resection under D-wave guidance after MEP loss were compared with those who did not. Results Among 37 eligible patients, 9 underwent D-wave-guided surgery and 28 did not. Functional improvement at the last follow-up was more frequent in the D-wave-guided surgery group (66.7% vs. 17.9%, p=0.011). This trend remained significant in EPN patients (74.4% vs. 9.1%, p=0.003), but not in CA patients. Immediate postoperative motor grade ≤3 was more common in the D-wave-guided surgery group (66.7% vs. 39.3%), although this difference was not statistically significant (p=0.251). By last follow-up, the proportions of patients self-ambulatory without external aids (88.9% vs. 89.3%, p=1.000) were similar between groups. Extent of resection, complications, and recurrence rates showed no significant differences. Conclusion D-wave-guided surgery may enable safe continuation of tumor resection after MEP loss without increasing morbidity. It offers a viable intraoperative strategy to preserve long-term motor function by extending monitoring beyond MEP limitations.

Liang-Gie Huang, Cheng-Chia Yu, Jia-You Fang et al.

Background/purpose: Individuals with diabetes mellitus (DM) are more susceptible to periodontitis, largely due to the accumulation of advanced glycation end-products (AGEs), which drive oxidative stress and inflammaging. Inflammaging is a state of chronic low-grade inflammation and accelerated cellular aging that contributes to periodontal degradation, mediated by AGEs-induced cellular senescence and senescence-associated secretory phenotype (SASP). 2-O-methylmagnolol (2-MG), a bioactive compound with antioxidant and anti-inflammatory properties, remains underexplored in DM-associated periodontal degeneration. This study investigated the effects of 2-MG on AGE-induced oxidative stress and inflammaging in human gingival epithelial cells (HGEs) and human gingival fibroblasts (HGFs). Materials and methods: The study assessed the effects of 2-MG on AGE-stimulated HGEs and HGFs by evaluating cell proliferation, wound healing capacity, reactive oxygen species (ROS) accumulation, cellular senescence markers, and the secretion of SASP factors, including interleukin (IL)-6 and IL-8. Additionally, Western blot analysis was performed to examine the protein expression of a senescence marker p16. Results: Treatment with 2-MG at concentrations up to 10 μM did not significantly affect HGEs and HGFs cell proliferation (P > 0.05). However, 2-MG effectively improved AGEs-induced wound healing impairment and significantly attenuated ROS production in a dose-dependent manner (P < 0.05). Furthermore, 2-MG reduced cellular senescence and suppressed the secretion of IL-6 and IL-8 (P < 0.05). Western blot analysis demonstrated that 2-MG inhibited AGEs-induced p16 expression (P < 0.05). Conclusion: The findings indicate that 2-MG mitigates AGEs-induced oxidative stress and inflammaging in HGEs and HGFs. These results suggest that 2-MG may have therapeutic potential in preventing or attenuating DM-associated periodontal degeneration.

Qi Gao, Bin Liu, Zhengjie Chen et al.

BackgroundPost-traumatic stress disorder (PTSD) is a prevalent and debilitating mental health condition that often develops after exposure to traumatic events. Stellate ganglion block (SGB) has been shown to alleviate PTSD symptoms, suggesting its potential as a preventive intervention, particularly in patients undergoing emergency ocular trauma surgery. However, the efficacy of SGB in preventing the onset of PTSD has not been clearly established.MethodsThis dual-center, randomized, double-blind, placebo-controlled trial will enroll 300 adult patients undergoing emergency ocular trauma surgery. Participants will be randomly assigned, in a 1:1 ratio and stratified by age (&lt;65 or ≥65 years), to either the SGB group or the placebo group (n = 150 per group). Each participant will receive either an active right stellate ganglion block or a sham procedure administered 15 min prior to the induction of anesthesia. The primary outcome is the difference in the incidence of PTSD at 1 month after surgery. Secondary outcomes include the severity of PTSD, delayed-onset PTSD, the four core symptom clusters (intrusive re-experiencing, avoidance, negative alterations in cognition or mood, and hyperarousal and reactivity), the severity of dissociative symptoms, Beck Anxiety Inventory (BAI) scores at 24, 48, and 72 h postoperatively; Visual Analog Scale (VAS) sleep scores at 24, 48, and 72 h postoperatively; Numerical Rating Scale (NRS) pain scores at 24, 48, and 72 h postoperatively; Heart Rate Variability (HRV) measured intraoperatively and at 24 and 48 h postoperatively; recovery time; extubation time; Richmond Agitation-Sedation Scale (RASS) scores; and length of hospital stay. Safety outcomes will include neck pain, dizziness, tinnitus, respiratory depression, anaphylaxis, sinus bradycardia (defined as heart rate &lt;50 beats/min), hematoma formation, infection, severe arrhythmia, pneumothorax, and complications related to general or spinal anesthesia. All data will be analyzed using a modified intention-to-treat (mITT) approach.DiscussionThis study aims to evaluate the efficacy and safety of SGB for the prevention of PTSD in patients undergoing emergency ocular trauma surgery.Clinical trial registrationChiCTR2500102717, www.chictr.org.cn/showproj.html?proj=270046.

Guo J, Li Y, Xie D et al.

Jixiang Guo,1,2 Yiwen Li,1,2 Dongxue Xie,1,2 Mingyang Zhang,1 Simao Fu3 1Department of Surgical Anesthesiology-Division 1, Zhongshan People’s Hospital, Zhongshan City, Guangdong Province, 528403, People’s Republic of China; 2School of Nursing and Health, Henan University, Kaifeng City, Henan Province, 475004, People’s Republic of China; 3Dean’s Office, Zhongshan People’s Hospital, Zhongshan City, Guangdong Province, 528403, People’s Republic of ChinaCorrespondence: Simao Fu, Dean’s Office, Zhongshan People’s Hospital, 2 Sun Wen East Road, Zhongshan City, Guangdong Province, People’s Republic of China, Email 2059202645@qq.comObjective: The aim of this study was to comprehensively summarize the best currently available evidence by reviewing and analyzing the relevant literature in the area of care and maintenance of tracheostomy patients in the ICU. The evidence covers a wide range of aspects of postoperative care, complication prevention and management, rehabilitation support, and multidisciplinary collaboration for tracheostomy patients.Methods: Using the “ 6S” evidence-based model, we searched multiple databases. The search focused on evidence related to the care of tracheostomy patients, including maintenance, nursing measures, multidisciplinary collaboration, and quality improvement, with the time frame ranging from the inception of the databases to March 14, 2025. Two researchers independently evaluated the quality of the literature, extracted data, and summarized evidence from publications meeting the inclusion criteria.Results: A total of 12 relevant documents were retrieved, including 6 guidelines, 2 expert consensus papers, 1 best clinical practice guideline, 3 Meta-analyses. Through summarization and induction, 49 best evidence pieces were obtained across three major themes: maintenance and protection, nursing measures, and multidisciplinary collaboration and quality improvement. These were further divided into 15 sub-themes, covering equipment management, environmental optimization, infection prevention, postoperative care, airway humidification, suctioning, tracheostomy tube management, skin care, rehabilitation exercises, complication prevention, and daily assessments.Conclusion: This research systematically compiles the optimal evidence regarding the care and management of tracheostomy patients, offering a comprehensive foundation for evidence-based clinical practice. It assists healthcare professionals in developing personalized care plans, improving patient safety, reducing complications, and promoting recovery. Future research should focus on optimizing multidisciplinary collaboration, exploring nurse-led interventions, and addressing cultural and resource limitations to further enhance the standardization and personalization of tracheostomy care.Keywords: tracheostomy, care management, multidisciplinary collaboration, evidence summary, quality improvement, best practices

Zhenyu Li, Ran Wei, Shunyu Yao et al.

Background: The incidence of cervical cancer ranks second among malignant tumors in women, exerting a significant impact on their quality of life and overall well-being. The hypoxic microenvironment plays a pivotal role in the initiation and progression of tumorigenesis. The present study aims to investigate the fundamental genes and pathways associated with the hypoxia-inducible factor (HIF-1A) in cervical cancer, aiming to identify potential downstream targets for diagnostic and therapeutic purposes. Methods: We obtained dataset GSE63514 from the Comprehensive Gene Expression Database (GEO). The dataset comprised of 24 patients in the normal group and 28 patients in the tumor group. Gene set difference analysis (GSVA) and gene set enrichment analysis (GSEA) were used to identify the genes related to HIF-1A expression and the specific signaling pathways involved.The association between HIF-1A and tumor immune infiltration was examined in the TCGA dataset. The WGCAN network was constructed to identify key genes within the blue module, and subsequent gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted to determine the pathways and functional annotations associated with HIF-1A. The protein interaction network of the HIF-1A gene was obtained from the STRING database and visualized using Cytoscape in the meantime.The function of HIF-1A and its related gene expression were verified in vivo. Results: HIF-1A was a risk factor in both univariate and multivariate Cox regression analysis of cervical cancer patients. A total of 344 genes significantly correlated with the expression of HIF-1A were identified through correlation analysis, and the genes exhibiting the strongest correlation were obtained. The major signaling pathways involved in HIF-1A encompass TNF-α/NF-κB, PI3K/AKT/MTOR, TGF-β, JAK-STAT, and various other signaling cascades. Reinforced by qRT-PCR, we identified Integrin beta-1 (ITGB1), C–C motif chemokine ligand 2 (CCL2), striatin 3 (STRN3), and endothelin-1 (EDN1) as pivotal downstream genes influenced by HIF-1A. HIF-1A is associated with immune infiltration of natural killer (NK) cells, mast cells, CD4+T cells, M0 macrophages, neutrophils, follicular helper T cells, CD8+T cells, and regulatory T cells (Treg). HIF-1A is associated with sensitivity to chemotherapy drugs. The identification of the HIF-1A pathway and its function primarily focuses on cytoplasmic translation, aerobic respiration, cellular respiration, oxidative phosphorylation, thermogenesis, among others. The results of in vivo experiments have confirmed that HIF-1A plays a crucial role in promoting the migration and invasion of cervical cancer cells. Moreover, the overexpression of HIF-1A led to an upregulation in the expressions of ITGB1, CCL2, STRN3, and EDN1. Conclusions: The role of HIF-1A in cervical cancer was determined through a combination of bioinformatics analysis and experimental validation. The genes potentially implicated in the tumorigenesis mechanism of HIF-1A were identified. These findings has the potential to enhance our comprehension of the progression of cervical cancer and offer promising therapeutic targets for its clinical management.

Tom C.R.V Van Zundert, Stephen P Gatt, André A.J van Zundert

Demand for anesthesia and analgesia for the frail elderly is continuously increasing as the likelihood of encountering very elderly, very vulnerable, and very compromised patients has, ever so subtly, increased over the last three decades. The anesthesiologist has, increasingly, been obliged to offer professional services to frail patients. Fortunately, there has been a dramatic improvement in medications, methods of drug delivery, critical monitoring, and anesthesia techniques. Specific methodologies peculiar to the frail are now taught and practiced across all anesthesia subspecialties. However, administering anesthesia for the frail elderly is vastly different to giving an anesthetic to the older patient. Frail patients are increasingly cared for in specialized units—geriatric intensive therapy units, post-acute care services, palliative, hospices, and supportive care and aged care facilities. Several medications (e.g., morphine-sparing analgesics) more suited to the frail have become universally available in most centers worldwide so that best-practice, evidence-based anesthesia combinations of drugs and techniques are now increasingly employed. Every anesthetic and pain management techniques in the frail elderly patient are going to be discussed in this review.

Saeyoung Kim, Hyun-Su Ri, Ji Hyun Kim et al.

Symptomatic extravasation of irrigation fluid is a rare complication of hip arthroscopy. However, depending on the amount of fluid, intra-abdominal hypertension (IAH) may occur and even develop into abdominal compartment syndrome, which can seriously alter hemodynamic circulation. Therefore, it is important for anesthesiologists to promptly recognize the abnormal signs of IAH for early diagnosis and better clinical outcomes. Nevertheless, these signs are difficult to detect because they are usually obscured when the patient is under anesthesia and masked by surgical drapes. We report a case of IAH under general anesthesia during hip arthroscopy to highlight possible symptoms and signs.

Baris Arslan, Tayfun Sugur, Osman Ciloglu et al.

Introduction: There are many possible sources of medical information; however, the quality of the information varies. Poor quality or inaccurate resources may be harmful if they are trusted by providers. This study aimed to analyze the quality of coronavirus disease 2019 (COVID-19)-related intubation videos on YouTube. Methods: The term “COVID-19 intubation” was searched on YouTube. The top 100 videos retrieved were sorted by relevance and 37 videos were included. The video demographics were recorded. The quality of the videos was analyzed using an 18-point checklist, which was designed for evaluating COVID-19 intubation. Videos were also evaluated using general video quality scores and the modified Journal of the American Medical Association score. Results: The educational quality was graded as good for eight (21.6%) videos, moderate for 13 (35.1%) videos, and poor for 16 (43.2%) videos. The median safe COVID-19 intubation score (SCIS) was 11 (IQR = 5–13). The SCISs indicated that videos prepared in an intensive care unit were higher in quality than videos from other sources (p < 0.05). The length of the video was predictive of quality (area under the curve = 0.802, 95% CI = 0.658–0.945, p = 0.10). Conclusions: The quality of YouTube videos for COVID-19 intubation is substandard. Poor quality videos may provide inaccurate knowledge to viewers and potentially cause harm.

Olof Hjorth, Andreas Frick, Malin Gingnell et al.

Abstract Selective serotonin reuptake inhibitors (SSRIs) and internet-based cognitive behavioral therapy (ICBT) are recommended treatments of social anxiety disorder (SAD), and often combined, but their effects on monoaminergic signaling are not well understood. In this multi-tracer positron emission tomography (PET) study, 24 patients with SAD were randomized to treatment with escitalopram+ICBT or placebo+ICBT under double-blind conditions. Before and after 9 weeks of treatment, patients were examined with positron emission tomography and the radioligands [11C]DASB and [11C]PE2I, probing the serotonin (SERT) and dopamine (DAT) transporter proteins respectively. Both treatment combinations resulted in significant improvement as measured by the Liebowitz Social Anxiety Scale (LSAS). At baseline, SERT-DAT co-expression was high and, in the putamen and thalamus, co-expression showed positive associations with symptom severity. SERT-DAT co-expression was also predictive of treatment success, but predictor-outcome associations differed in direction between the treatments. After treatment, average SERT occupancy in the SSRI + ICBT group was >80%, with positive associations between symptom improvement and occupancy in the nucleus accumbens, putamen and anterior cingulate cortex. Following placebo+ICBT, SERT binding increased in the raphe nuclei. DAT binding increased in both groups in limbic and striatal areas, but relations with symptom improvement differed, being negative for SSRI + ICBT and positive for placebo + ICBT. Thus, serotonin-dopamine transporter co-expression exerts influence on symptom severity and remission rate in the treatment of social anxiety disorder. However, the monoamine transporters are modulated in dissimilar ways when cognitive-behavioral treatment is given concomitantly with either SSRI-medication or pill placebo.

Marc Pfefferlé, Giada Ingoglia, Christian A. Schaer et al.

Clearance of red blood cells and hemoproteins is a key metabolic function of macrophages during hemolytic disorders and following tissue injury. Through this archetypical phagocytic function, heme is detoxified and iron is recycled to support erythropoiesis. Reciprocal interaction of heme metabolism and inflammatory macrophage functions may modify disease outcomes in a broad range of clinical conditions. We hypothesized that acute hemolysis and heme induce acute anti-inflammatory signals in liver macrophages. Using a macrophage-driven model of sterile liver inflammation, we showed that phenylhydrazine (PHZ)-mediated acute erythrophagocytosis blocked the anti-CD40 antibody-induced pathway of macrophage activation. This process attenuated the inflammatory cytokine release syndrome and necrotizing hepatitis induced by anti-CD40 antibody treatment of mice. We further established that administration of heme-albumin complexes specifically delivered heme to liver macrophages and replicated the anti-inflammatory effect of hemolysis. The anti-inflammatory heme-signal was induced in macrophages by an increased intracellular concentration of the porphyrin independently of iron. Overall, our work suggests that induction of heme-signaling strongly suppresses inflammatory macrophage function, providing protection against sterile liver inflammation.

Catalina I. Dumitrascu, David A. Olsen, Katherine W. Arendt et al.

Antisynthetase syndrome is a rare multisystem autoimmune disorder which clinically manifests with myositis, arthritis, interstitial lung disease, Raynaud phenomenon, and skin hyperkeratosis. Lung involvement represents the most severe form of disease and has rarely been reported in pregnancy. We present the case of a 22-year-old woman with antisynthetase syndrome and severe restrictive pulmonary disease who experienced a successful pregnancy and delivery. We discuss anesthetic considerations and highlight the importance of a multidisciplinary team approach in caring for parturients with multifactorial medical conditions.

Maozhou Wang, Ruixin Fan, Tianxiang Gu et al.

Abstract Background To evaluate the early prognosis and management of acute coronary involvement (ACI) in type A aortic dissection (ATAAD) patients without myocardial ischemia (MI). Methods We conducted a retrospective cohort study on a multicenter database. A total of 931 ATAAD patients without MI underwent thoracic aortic surgery between 2018 and 2019 in the Acute Aortic Syndrome Cooperation Network (AASCN) and were enrolled in our study. Patients were divided into two groups: ACI group and non-ACI group. Results There were 139 ACI patients (14.9%) and 792 non-ACI patients (85.1%) in our cohort. ACI group had higher 30-day mortality after surgery than non-ACI group (log-rank test: P = 0.028,Cox regression: hazard ratio [HR], 2.3; 95% confidence interval [95% CI], 1.1–5.39; P = 0.047), especially in sub-group of advanced age (53–80 years; HR, 4.0; 95% CI, 1.3–12.8; P = 0.017), low diastolic blood pressure (29-69 mmHg, HR, 3.8; 95% CI, 1.3–11.2; P = 0.018), low systolic blood pressure (51–119 mmHg, HR, 3.6; 95% CI, 1.1–12.4; P = 0.040), high body mass index (BMI;27.25–47.52 kg/m2; HR, 3.7; 95% CI, 1.3–10.7; P = 0.015) and high hemoglobin (>145 g/L; HR, 4.3; 95% CI, 1.2–16.0; P = 0.030). Acute renal failure was significant more in ACI group than non-ACI group (24.5% vs. 15.9%; P = 0.014). Conclusions ACI increases the short-term postoperative mortality and acute renal failure in ATAAD patients without MI. ATAAD patients with ACI may need a narrower control range of blood pressure even if without myocardial ischemia. Trial registration ChiCTR1900022637 . Retrospectively registered 19 April 2019.

Nakul Kumar, MD, Mariya Geube, MD, FASE

Jie Wang, Jie Wang, Baofeng Yang et al.

BackgroundIn rodents, the period of increased vulnerability to the developmental effects of general anesthetics coincides with the period of age-specific organizing (masculinizing) effects of the major female sex hormone 17β-estradiol (E2) in the male brain and excitatory GABA type A receptor (GABAAR) signaling. We studied whether E2 synthesis and excitatory GABAAR signaling are involved in the mediation of the developmental effects of sevoflurane in male rats.MethodsMale Sprague-Dawley rats were pretreated with the inhibitors of E2 synthesis, formestane, or the Na+-K+-2Cl– (NKCC1) Cl– importer, bumetanide, prior to sevoflurane exposure for 6 h on postnatal (P) day 4, P5, or P6. We tested whether a subsequent exposure of these rats to sevoflurane on P∼10 would cause electroencephalography (EEG)-detectable seizures. We also evaluated their behavior during the elevated plus maze (EPM) test on P∼60, prepulse inhibition (PPI) of acoustic startle responses on P∼70, and corticosterone secretion to physical restraint on P∼80.ResultsThe rats neonatally exposed to sevoflurane responded to repeated exposure to sevoflurane with increased EEG-detectable seizures (F(3,24) = 7.445, P = 0.001) and exhibited deficiencies during the EPM (F(3,55) = 4.397, P = 0.008) and PPI (F(3,110) = 5.222, P = 0.003) tests. They also responded to physical restraint with heightened secretion of corticosterone (F(3,16) = 11.906, P &lt; 0.001). These parameters in the sevoflurane-exposed rats that were pretreated with formestane or bumetanide were not different from those in the control rats.ConclusionThese results, along with previously published data, suggest that sevoflurane-enhanced E2 synthesis and excitatory GABAAR signaling at the time of sevoflurane anesthesia are involved in the mediation of the neurodevelopmental effects of the anesthetic in male rats.

Mizuho Sumitani, Michihiro Osumi, Hiroaki Abe et al.

People perceive the mind in two dimensions: intellectual and affective. Advances in artificial intelligence enable people to perceive the intellectual mind of a robot through their semantic interactions. Conversely, it has been still controversial whether a robot has an affective mind of its own without any intellectual actions or semantic interactions. We investigated pain experiences when observing three different facial expressions of a virtual agent modeling affective minds (i.e., painful, unhappy, and neutral). The cold pain detection threshold of 19 healthy subjects was measured as they watched a black screen, then changes in their cold pain detection thresholds were evaluated as they watched the facial expressions. Subjects were asked to rate the pain intensity from the respective facial expressions. Changes of cold pain detection thresholds were compared and adjusted by the respective pain intensities. Only when watching the painful expression of a virtual agent did, the cold pain detection threshold increase significantly. By directly evaluating intuitive pain responses when observing facial expressions of a virtual agent, we found that we ‘share’ empathic neural responses, which can be intuitively emerge, according to observed pain intensity with a robot (a virtual agent).

JuliaK Bialek, Maike Voges, Gabor A. Dunay et al.

S. Rose, T. Long

BackgroundThe Accreditation Council for Graduate Medical Education (ACGME) requires an annual evaluation of all ACGME-accredited residency and fellowship programs to assess program quality. The results of this evaluation must be used to improve the program. This manuscript describes a metric to be used in conducting ACGME-mandated annual program review of ACGME-accredited anesthesiology residencies and fellowships.MethodsA variety of metrics to assess anesthesiology residency and fellowship programs are identified by the authors through literature review and considered for use in constructing a program "report card."ResultsMetrics used to assess program quality include success in achieving American Board of Anesthesiology (ABA) certification, performance on the annual ABA/American Society of Anesthesiology In-Training Examination, performance on mock oral ABA certification examinations, trainee scholarly activities (publications and presentations), accreditation site visit and internal review results, ACGME and alumni survey results, National Resident Matching Program (NRMP) results, exit interview feedback, diversity data and extensive program/rotation/faculty/curriculum evaluations by trainees and faculty. The results are used to construct a "report card" that provides a high-level review of program performance and can be used in a continuous quality improvement process.ConclusionsAn annual program review is required to assess all ACGME-accredited residency and fellowship programs to monitor and improve program quality. We describe an annual review process based on metrics that can be used to focus attention on areas for improvement and track program performance year-to-year. A "report card" format is described as a high-level tool to track educational outcomes.