Alyssa Burgart (she/her)

All Publications

• Physician Unionization: Opportunities and Challenges for Anesthesiologists in the United States. Anesthesia and analgesia Hendrix, J. M., Burgart, A. M., Baker, E. B., Wolman, R. L., Kras, J. F. 2023

  Abstract

  Physician unionization is gaining traction in the United States, with <10% of practicing physicians now members, up from historically weak support. Factors that drive interest in unions include a decreased number of independent practitioners, an increase in workloads, and the erosion of autonomy. Approximately 56% of anesthesiologists are considered employees and may be eligible for union membership. Physician unions may provide higher wages, better working conditions, and legal protection. However, they also raise concerns about patient care and professionalism. This article discusses the legal and regulatory framework governing the unionization of physicians, benefits, challenges, and potential future developments. Continued analysis and debate are necessary to determine the optimal role of physician unions in the health care industry.

  View details for DOI 10.1213/ANE.0000000000006852

  View details for PubMedID 38091478

• Recommendations for the use of pediatric data in artificial intelligence and machine learning ACCEPT-AI. NPJ digital medicine Muralidharan, V., Burgart, A., Daneshjou, R., Rose, S. 2023; 6 (1): 166

  Abstract

  ACCEPT-AI is a framework of recommendations for the safe inclusion of pediatric data in artificial intelligence and machine learning (AI/ML) research. It has been built on fundamental ethical principles of pediatric and AI research and incorporates age, consent, assent, communication, equity, protection of data, and technological considerations. ACCEPT-AI has been designed to guide researchers, clinicians, regulators, and policymakers and can be utilized as an independent tool, or adjunctively to existing AI/ML guidelines.

  View details for DOI 10.1038/s41746-023-00898-5

  View details for PubMedID 37673925

  View details for PubMedCentralID PMC10482936

• Violence in the pain clinic: the hidden pandemic. Regional anesthesia and pain medicine Fawzy, Y., Siddiqui, Z., Narouze, S., Potru, S., Burgart, A. M., Udoji, M. A. 2023

  Abstract

  Workplace violence is any physical assault, threatening behavior or other verbal abuse directed toward persons at work or in the workplace. The incidence of workplace violence in healthcare settings in general and more specifically the pain clinic is thought to be underestimated due to hesitancy to report, lack of support from management and healthcare systems, and lack of institutional policies as it relates to violence from patients against healthcare workers. In the following article, we explore risk factors that place clinicians at risk of workplace violence, the cost and impact of workplace violence, how to build a violence prevention program and lastly how to recover from violence in the practice setting.

  View details for DOI 10.1136/rapm-2022-104308

  View details for PubMedID 36754543

• Loss of access to legal abortion in America: history, implications, and action items for anesthesiologists. Anaesthesia, critical care & pain medicine Landau, R., Burgart, A. M., Sutton, C. D. 2022: 101125

  View details for DOI 10.1016/j.accpm.2022.101125

  View details for PubMedID 35803575

• Physician Sexual Assault: The Moral Imperative for Gender Equity in Medicine AMERICAN JOURNAL OF BIOETHICS Burgart, A. M. 2019; 19 (1): 4–6

  View details for DOI 10.1080/15265161.2018.1552036

  View details for Web of Science ID 000456689000003

• Chemical Restraints for Obstetric Violence: Anesthesiology Professionals, Moral Courage, and the Prevention of Forced and Coerced Surgeries. The American journal of bioethics : AJOB Burgart, A., Sutton, C. 2024; 24 (2): 4-7

  View details for DOI 10.1080/15265161.2024.2299629

  View details for PubMedID 38295250

• Resuscitate but not Intubate? Partial Codes in Pediatrics. Pediatrics Silverman, A., Batten, J., Berkman, E., Fitzgerald, H., Epstein, B., Shearer, E., Diekema, D., Burgart, A. 2023

  Abstract

  The use of partial code status in pediatric medicine presents clinicians with unique ethical challenges. The clinical vignette describes the presentation of a pulseless infant with a limited life expectancy. The infant's parents instruct the emergency medicine providers to resuscitate but not to intubate. In an emergency, without a clear understanding of parents' goals, complying with their request risks an ineffective resuscitation. The first commentary focuses on parental grief and how, in certain circumstances, a partial code best serves their needs. Its authors argue that providers are sometimes obligated to endure moral distress. The second commentary focuses on the healthcare team's moral distress and highlights the implications of a relational ethics framework for the case. The commentators emphasize the importance of honest communication and pain management. The final commentary explores the systems-level and how the design of hospital code status orders may contribute to requests for partial codes. They argue systems should discourage partial codes and prohibit resuscitation without intubation.

  View details for DOI 10.1542/peds.2022-058931

  View details for PubMedID 37435669

• Keeping an Open Mind About Open Notes: Sharing Anesthesia Records With Patients. Anesthesia and analgesia Ramaswamy, P., Xie, J., Marsiglio, A. M., Burgart, A. M., Schmiesing, C. A., Cohen, N. H., Robinowitz, D. L., Wang, E. 2022; 135 (4): 697-703

  Abstract

  ADDENDUM: Please note that in the interim since this paper was accepted for publication, new governmental regulations, pertinent to the topic, have been approved for implementation. The reader is thus directed to this online addendum for additional relevant information: http://links.lww.com/AA/E44.

  View details for DOI 10.1213/ANE.0000000000005800

  View details for PubMedID 36108183

• Pilot Evaluation of a Multidisciplinary Strategy for Laparoscopic Sleeve Gastrectomy in Adolescents and Young Adults with Obesity and Intellectual Disabilities. Obesity surgery Jones, R. E., Wood, L. S., Matheson, B. E., Pratt, J. S., Burgart, A. M., Garza, D., Shepard, W. E., Bruzoni, M. 2021

  View details for DOI 10.1007/s11695-021-05393-y

  View details for PubMedID 33797732

• Poorly conducted science is unprofessional. Journal of vascular surgery Burgart, A. M., Pendergrast, T. 2020

  View details for DOI 10.1016/j.jvs.2020.07.080

  View details for PubMedID 32958318

• Elective Surgery and COVID-19: A Framework for the Untested Patient. Annals of surgery Lu, A. C., Burgart, A. M. 2020

  View details for DOI 10.1097/SLA.0000000000004474

  View details for PubMedID 32889879

• Parents Demand and Teenager Refuses Epidural Anesthesia. Pediatrics Berkowitz, I., Burgart, A., Truog, R. D., Mancuso, T. J., Char, D., Lantos, J. D. 2020

  Abstract

  A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.

  View details for DOI 10.1542/peds.2019-3295

  View details for PubMedID 32398328

• Donor heart selection during the COVID-19 pandemic: A case study JOURNAL OF HEART AND LUNG TRANSPLANTATION Chen, C., Chen, S. F., Hollander, S. A., Rosenthal, D., Maeda, K., Burgart, A., Almond, C. S., Chen, S. 2020; 39 (5): 497–98

  View details for Web of Science ID 000535430200015

• Machine Learning Implementation in Clinical Anesthesia: Opportunities and Challenges. Anesthesia and analgesia Char, D. S., Burgart, A. n. 2020

  View details for DOI 10.1213/ANE.0000000000004656

  View details for PubMedID 31922996

• How Anesthesiologists Experience and Negotiate Ethical Challenges from Drug Shortages. AJOB empirical bioethics Sinow, C. n., Burgart, A. n., Char, D. S. 2020: 1–8

  Abstract

  In the face of ongoing drug shortages, anesthesiologists have been described as having to become "Iron Chefs, challenged to create safe patient outcomes with missing ingredients. Unfortunately, developing responsive ethical guidance for how anesthesiologists should best handle ethical concerns with ongoing and mutable drug shortages is limited by the dearth of studies examining how bedside clinicians actually experience drug shortages and what ethical challenges they encounter. In order to better understand what ethical concerns individual anesthesiologists experience around drug shortages and how they negotiate them, we undertook this qualitative interview study. Methods: We conducted semi-structured interviews with anesthesiologists at three field sites: an academic tertiary care adult hospital that performs approximately 46,000 anesthetics annually comprising cases ranging across all surgical disciplines; the affiliated veteran's affairs hospital that performs 12,000 anesthetics annually; and, the affiliated children's hospital that performs 20,500 anesthetics annually. Results: 29 anesthesiologists were interviewed (17 adult and 12 pediatric anesthesiologists), representing a spectrum of practice areas in clinical anesthesia: general, pediatric, regional, pain, critical care, obstetrics, liver transplant, and palliative medicine. Three themes emerged: (1) uncertainty about responsibility for clinical decisions made in consequence to a shortage; (2) creativity, and its limits, in choosing anesthetic plans; and, (3) disclosure of concerns about shortages (to patients and colleagues). Conclusions: Our data suggests anesthesiologists have unmet needs for ethical guidance on how to approach drug shortages. First is managing responsibility for decisions stemming from a drug shortage. Second, interviewees struggled with disclosure of their concerns, both to patients and to surgical colleagues. A formal shared decision making approach may present the best solution, since the act of structuring a shared decision making conversation or creating a decision making tool will have to incorporate the views of all stakeholders around shortages and their potential clinical consequences.

  View details for DOI 10.1080/23294515.2020.1839596

  View details for PubMedID 33124970

• Resource Allocation in COVID-19 Research: Which Trials? Which Patients? The American journal of bioethics : AJOB Wieten, S. n., Burgart, A. n., Cho, M. n. 2020; 20 (7): 86–88

  View details for DOI 10.1080/15265161.2020.1779392

  View details for PubMedID 32716767

• The opioid crisis should lead pediatric anesthesiologists to a broader vision of opioid stewardship. Paediatric anaesthesia Burgart, A. M., Char, D. 2019; 29 (11): 1078–80

  View details for DOI 10.1111/pan.13730

  View details for PubMedID 31677337

• Scarlet A (Book Review) AMERICAN JOURNAL OF BIOETHICS Book Review Authored by: Burgart, A. M. 2019; 19 (10): W3–W4

  View details for DOI 10.1080/15265161.2019.1655956

  View details for Web of Science ID 000487986000003

• Compassionate deactivation of ventricular assist devices in children: A survey of pediatric ventricular assist device clinicians' perspectives and practices PEDIATRIC TRANSPLANTATION Kaufman, B. D., Hollander, S. A., Zhang, Y., Chen, S., Bernstein, D., Rosenthal, D. N., Almond, C. S., Murray, J. M., Burgart, A. M., Cohen, H. J., Kirkpatrick, J. N., Blume, E. D. 2019; 23 (3)

  View details for DOI 10.1111/petr.13359

  View details for Web of Science ID 000476931300005

• Ethical Challenges Confronted When Providing Nusinersen Treatment for Spinal Muscular Atrophy. JAMA pediatrics Burgart, A. M., Magnus, D. n., Tabor, H. K., Paquette, E. D., Frader, J. n., Glover, J. J., Jackson, B. M., Harrison, C. H., Urion, D. K., Graham, R. J., Brandsema, J. F., Feudtner, C. n. 2018; 172 (2): 188–92

  Abstract

  The US Food and Drug Administration's December 2016 approval of nusinersen for the treatment of patients with all subtypes of spinal muscular atrophy ushered in a new era for patients with spinal muscular atrophy, their families, and all those involved in their care. The extreme cost of the medication and the complicated logistical requirements for administering nusinersen via lumbar puncture have created practical challenges that raise important ethical considerations. We discuss 6 challenges faced at the institutional level in the United States: cost, limited evidence, informed consent, treatment allocation, fair distribution of responsibilities, and transparency with stakeholders. These challenges must be understood to ensure that patients with spinal muscular atrophy benefit from treatment, are protected from harm, and are treated fairly.

  View details for PubMedID 29228163

• Managing Expectations: Delivering the Worst News in the Best Way? The American journal of bioethics : AJOB Burgart, A. M., Magnus, D. n. 2018; 18 (1): 1–2

  View details for PubMedID 29313792

• Ethical Controversy About Hysterectomy for a Minor. Pediatrics Burgart, A. M., Strickland, J., Davis, D., Baratz, A. B., Karkazis, K., Lantos, J. D. 2017

  Abstract

  One of the most complicated ethical issues that arises in children's hospitals today is the issue of whether it is ever permissible to perform a procedure for a minor that will result in permanent sterilization. In most cases, the answer is no. The availability of good, safe, long-acting contraception allows surgical options to be postponed when the primary goal of such surgical options is to prevent pregnancy. But what if a minor has congenital urogenital anomalies or other medical conditions for which the best treatment is a hysterectomy? In those cases, the primary goal of therapy is not to prevent pregnancy. Instead, sterility is an unfortunate side effect of a medically indicated treatment. Should that side effect preclude the provision of a therapy that is otherwise medically appropriate? We present a case that raises these issues, and asked experts in law, bioethics, community advocacy, and gynecology to respond. They discuss whether the best option is to proceed with the surgery or to cautiously delay making a decision to give the teenager more time to carefully consider all of the options.

  View details for DOI 10.1542/peds.2016-3992

  View details for PubMedID 28562274

• Compassionate Deactivation of Ventricular Assist Devices in Children: A Survey of Pediatric VAD Clinicians' Perspectives and Practices Kaufman, B. D., Hollander, S. A., Chen, S. H., Bernstein, D., Rosenthal, D. N., Almond, C., Murray, J. M., Burgart, A. M., Cohen, H. J., Kirkpatrick, J. N., Blume, E. D. ELSEVIER SCIENCE INC. 2017: S37–S38

  View details for Web of Science ID 000398839800075

• Fairness and Transparency in an Expanded Access Program: Allocation of the Only Treatment for SMA1. The American journal of bioethics : AJOB Burgart, A. M., Collier, J. n., Cho, M. K. 2017; 17 (10): 71–73

  View details for PubMedID 29020542

• Moral Distress in Clinical Ethics: Expanding the Concept AMERICAN JOURNAL OF BIOETHICS Burgart, A. M., Kruse, K. E. 2016; 16 (12): 1-1

  View details for DOI 10.1080/15265161.2016.1253963

  View details for Web of Science ID 000390115900008

  View details for PubMedID 27901425

• Randomized n-of-1 Trials: Quality Improvement, Research, or Both? Pediatrics Samuel, J. P., Burgart, A., Wootton, S. H., Magnus, D., Lantos, J. D., Tyson, J. E. 2016; 138 (2)

  Abstract

  The regulatory demarcations between clinical research and quality improvement (QI) are ambiguous and controversial. Some projects that were undertaken as a form of QI were deemed by regulatory agencies to be research and thus to require institutional review board approval. In the era of personalized medicine, some physicians may ask some patients to participate in n-of-1 trials in an effort to personalize and optimize each patient's medical treatment. Should such activities be considered research, QI, or just excellent personalized medicine? Experts in research, research regulation, and bioethics analyze these issues.

  View details for DOI 10.1542/peds.2016-1103

  View details for PubMedID 27385811

• Current Use of Pelvic Organ Prolapse Quantification by AUGS and ICS Members FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY Pham, T., Burgart, A., Kenton, K., Mueller, E. R., Brubaker, L. 2011; 17 (2): 67-69

  Abstract

  : To determine the current use of the pelvic organ prolapse quantification (POP-Q) by members of the American Urogynecologic Society (AUGS) and the International Continence Society (ICS).: Surgically active members of AUGS and ICS completed a Web-based questionnaire about their use of the POP-Q and included queries regarding respondent's clinical training, surgical experience, and practice setting. Users of POP-Q described their POP-Q use including patient's position, tools used to measure or assist with exposure, use of strain, and bladder volume. Strengths and weaknesses of the POP-Q system were also assessed.: The 308 respondents had a median of 8 years (range, 0-35 years) of independent performance of POP surgery. Most were from the United States (70%), in a shared practice (64%), with at least 2 years of fellowship training (61%), and had trainees participating in patient care (81%). Of the respondents, 76% reported using the POP-Q; however, the technique of POP-Q varied. Of the 24% not using the POP-Q, two-thirds reported past POP-Q use. For these individuals, prolapse description was done using Baden-Walker (57%), descriptive words (38%), or other grades (7%). More than 50% of nonusers reported that the POP-Q is "too time-consuming" or that their "colleagues do not use it.": Although most surveyed members of AUGS and ICS are using the POP-Q, we detected variability in the day-to-day practice of POP-Q use. To further advance the communication benefits of the POP-Q, a revision that provides evidence-based guidance may be a worthwhile refinement.

  View details for DOI 10.1097/SPV.0b013e318207c904

  View details for Web of Science ID 000209176100003

  View details for PubMedID 22453690