BACKGROUND:The representation of women among leaders in the field of anesthesia continues to trail that of their male counterparts. This qualitative study was conducted to understand the pathway of leadership acquisition among women in the field of anesthesiology. METHODS: Using constructivist grounded theory, we sought to determine whether there were specific internal or external factors that were common to women in leadership in the specialty field of anesthesiology, and specifically, how they obtained leadership positions. Semistructured interviews were conducted for data collection. A total of 26 women in leadership positions in anesthesiology participated in this study. RESULTS: The analysis of these interviews resulted in the development of 4 common themes related to career pathways for these women in leadership. Each theme was examined in depth to determine the qualities necessary for individuals to advance in the field and the pathway to obtaining leadership positions. The findings of this study showed that early-career, high-value mentorship and sponsorship were important factors in leadership acquisition. Most participants (n = 20; 76%) had early mentors. Of those with early mentorship, 13 (65%) had high-value mentors, who we define as someone with power or authority. Sponsorship was the leading factor contributing to leadership acquisition. CONCLUSIONS: The results of this qualitative study may serve as a guide for encouraging female anesthesiologists with leadership aspirations. We suggest that the specialty field of anesthesiology institute targeted measures to help increase the percentage of women leadership with formal sponsorship programs at the local and national levels. (Anesth Analg 2023;136:6-12) KEY POINTS• Question: How do female anesthesiologists close the gender leadership gap in anesthesiology? • Findings: Early-career, high-value mentors may be advantageous, and sponsorship is crucial to acquiring leadership positions for women in anesthesiology. • Meanings: Opportunities exist in the specialty field of anesthesiology to reduce the gender gap in leadership with formalized mentorship and sponsorship programs at the local and national levels.

Glycosylated Haemoglobin and Red Blood Cells in Diabetes Glycosylated haemoglobin has an increased affinity for oxygen [1], and in diabetics the number of red blood cells has been found to correlate with glycohaemoglobin (GHb) level [2]. If confirmed, this could indicate compensatory polycythaemia resulting from chronic hypoxaemia. We have reviewed in this respect our data relating to 79 adult diabetic males and 48 postmenopausal women, all of them living in the coastal area, non-smokers and suffering from no known heart, lung or blood diseases. No differences were found between patients treated by diet alone, oral drugs or insulin. Blood count was done in the Coulter counter, and GHb was determined by the Biorex 70 column method [3]. Results are presented in the table and show statistically significant but very weak correlation for GHb positively with of red blood cells (p = 0.04), and negatively with mean corpuscular volume (p = 0.034) in males only.

BackgroundRapid diagnostic tests (RDTs), such as Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF), have been shown to improve time to effective therapy and positively impact patient outcomes when used along with antimicrobial stewardship team (AST) intervention in treating bloodstream infections (BSIs). The purpose of this study was to assess the impact of MALDI-TOF (implemented May 25, 2016) and AST intervention on management of BSIs at a smaller, resource-limited institution.MethodsIRB-approved, single-center, pre-post quasi-experiment including all patients treated for BSI at the University of Toledo Medical Center from November 1, 2015-November 30, 2016. Patients transferred with documented BSI, expired prior to organism identification, or had blood culture positive for Mycobacterium, Nocardia, anaerobes, or molds were excluded. Primary endpoint: time to effective therapy. Secondary endpoints: time to optimal therapy, hospital length of stay (LOS), recurrent bacteremia, and 30-day readmission and all-cause mortality.Results593 blood cultures screened, 261 included; 131 pre- and 130 post-MALDI-TOF implementation. Baseline characteristics similar between groups. Median (IQR) time to effective therapy was 6.1 h (2.3–20.0) pre-MALDI-TOF and 6.4 hours (2.2–23.7) post-MALDI-TOF, P = 0.609. Median (IQR) time to optimal therapy was 67.3 (48.6–93.2) pre-MALDI-TOF and 67.2 (44.3–94.0) post-MALDI-TOF, P = 0.520. Secondary endpoints shown in Table 1. In a subset of cultures defined as contaminants, reduction was seen in time to discontinuation of therapy, however not statistically significant (93.8 hours (61.8–131.4) vs. 71.1 hours (57.5–106.3); P = 0.180).ConclusionImplementation of MALDI-TOF and AST intervention did not significantly improve an already prompt time to effective therapy in patients with BSIs at our institution. Time to optimal therapy was also similar, highlighting the need for more rapid susceptibility tests in order to support earlier de-escalation of therapy.Table 1.Clinically Evaluable EndpointsPre-MALDI-TOF (n = 108)Post-MALDI-TOF (n = 104)P-valueHospital LOS (days)9.1 (6.2–15.6)10.0 (6.3–15.7)0.823Recurrent bacteremia6 (5.6)4 (3.8)0.74830-day readmission24 (22.2)18 (17.3)0.36930-day, all-cause mortality16 (14.8)19 (18.3)0.498Values reported as median (IQR) or n(%).Disclosures All authors: No reported disclosures.

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BackgroundAlmost half of urine cultures (UCs) obtained are in asymptomatic patients, which may lead to misdiagnosis of urinary tract infection (UTI) and unnecessary treatment. To decrease misdiagnosis of UTI, changes were made to the order entry and urine culture process at our institution in April 2018. This included removal of a standalone UC from the electronic order entry system and development of a more stringent criterian for urinalysis with reflex culture (UAC). We evaluated the impact of these ordering changes on the total number of UCs performed.MethodsThis was a pre-post retrospective study comparing the hospital UAC rate per 1,000 patient-days and ED UAC rate per 1,000 visits in the pre-intervention period from April 2017 to March 2018 to the intervention period from May 2018 to March 2019 in a 319-bed teaching hospital in northwest Ohio. In April 2018, urine microscopy and UAC were the only available options. Furthermore, UC would only be performed if the following criteria were met: 10 white blood cells (WBC)/HFP. Standalone UC was available for the following patients who were excluded: immunosuppressed patients, pregnant women and patients undergoing invasive urologic procedures. These changes were accompanied by provider education, and providers were given the option to override UAC rules by calling the microbiology lab within 24 hours to request UC.ResultsAfter incorporating these changes, we observed an increase in the use of UAC compared with UC-only in both the ED (80% pre-vs. 94% post-implementation) and inpatient setting (59% pre-vs. 92% post-implementation). This was accompanied by a reduction in the overall UCs performed in both the ED (49.17 per 1,000 visits to 23.53 per 1,000 visits [P < 0.001]) and inpatient units (23.31 per 1,000 patient-days to 9.31 per 1,000 patient-days [P < 0.001]). Chart review of cases where providers overrode UAC criteria and requested UC have demonstrated no false negatives to date; cultures either had no growth or were consistent with contamination by polymicrobial urogenital flora.ConclusionRestricted access to standalone UC, implementation of UAC with more stringent criteria and provider education reduced the number of urine cultures performed without sacrificing sensitivity for detecting UTI and potential antimicrobial use.Disclosures All authors: No reported disclosures.