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https://www.readbyqxmd.com/read/28106610/-opt-out-and-access-to-anesthesia-care-for-elective-and-urgent-surgeries-among-u-s-medicare-beneficiaries
#1
Eric C Sun, Franklin Dexter, Thomas R Miller, Laurence C Baker
BACKGROUND: In 2001, the Centers for Medicare and Medicaid Services issued a rule allowing U.S. states to "opt out" of the regulations requiring physician supervision of nurse anesthetists in an effort to increase access to anesthesia care. Whether "opt out" has successfully achieved this goal remains unknown. METHODS: Using Medicare administrative claims data, we examined whether "opt out" reduced the distance traveled by patients, a common measure of access, for patients undergoing total knee arthroplasty, total hip arthroplasty, cataract surgery, colonoscopy/sigmoidoscopy, esophagogastroduodenoscopy, appendectomy, or hip fracture repair...
January 19, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28098571/operating-room-anesthesia-subspecialization-is-not-associated-with-significantly-greater-quality-of-supervision-of-anesthesia-residents-and-nurse-anesthetists
#2
Franklin Dexter, Johannes Ledolter, Richard H Epstein, Bradley J Hindman
BACKGROUND: Supervision of anesthesia residents and nurse anesthetists is a major responsibility of faculty anesthesiologists. The quality of their supervision can be assessed quantitatively by the anesthesia residents and nurse anesthetists. Supervision scores are an independent measure of the contribution of the anesthesiologist to patient care. We evaluated the association between quality of supervision and level of specialization of anesthesiologists. METHODS: We used two 6-month periods, one with no feedback to anesthesiologists of the residents' and nurse anesthetists' evaluations, and the other with feedback...
November 2, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28097305/enhanced-recovery-after-surgery-a-review
#3
Olle Ljungqvist, Michael Scott, Kenneth C Fearon
Importance: Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Observations: Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient...
January 11, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28091758/-deaths-from-propofol-abuse-survey-of-institutes-of-forensic-medicine-in-germany-austria-and-switzerland
#4
C Maier, J Iwunna, M Tsokos, F Mußhoff
Previous references suggesting a high mortality of propofol addiction in medical personnel were mostly based on surveys of the heads of medical departments or case reports; therefore, a questionnaire was sent to 48 forensic medicine departments in Germany, Austria and Switzerland concerning the number of autopsies carried out between 2002-2112 on medical personnel with the suspicion of abuse of propofol or other analgesics. The response rate was 67%. In 16 out of the 32 responding departments 39 deaths (27 males) were observed with previous connections to anesthesiology, intensive care or emergency departments of which 22 were physicians, 13 nurses, 2 other personnel and 2 were unknown...
January 13, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28068834/design-considerations-of-a-randomized-controlled-trial-of-sedation-level-during-hip-fracture-repair-surgery-a-strategy-to-reduce-the-incidence-of-postoperative-delirium-in-elderly-patients
#5
Tianjing Li, L Susan Wieland, Esther Oh, Karin J Neufeld, Nae-Yuh Wang, Kay Dickersin, Frederick E Sieber
Background Delirium is an acute change in mental status characterized by sudden onset, fluctuating course, inattention, disorganized thinking, and abnormal level of consciousness. The objective of the randomized controlled trial "A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" (STRIDE) is to assess the effectiveness of light versus heavy sedation on delirium and other outcomes in elderly patients undergoing hip fracture repair surgery. Our goal is to describe the design considerations and lessons learned in planning and implementing the STRIDE trial...
January 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/28066096/pain-on-propofol-injection-causes-and-remedies
#6
REVIEW
Kalindi Anil Desousa
Pain on propofol injection (POPI) is a minor problem that all anesthetists face every day. Introduction of several new formulations and hundreds of clinical trials have failed to find its remedy with just one intervention in all patients. This article highlights the causes of POPI and interventions that are used to eliminate this pain in current practice. Relevant articles from Medline and Embase databases were searched and included in this descriptive review with the following conclusions: (1) POPI is due to irritation of venous adventitia leading to release of mediators such as kininogen from kinin cascade...
November 2016: Indian Journal of Pharmacology
https://www.readbyqxmd.com/read/28064380/perioperative-factors-associated-with-hidden-blood-loss-in-intertrochanteric-fracture-patients
#7
Y Liu, Y Sun, L Fan, J Hao
BACKGROUND: The actual total blood loss after a hip fracture has been found to be considerably larger than that observed during surgery and collected in drainage postoperatively. However, no previous studies have offered reasonable explanations for the deficit between a large hemoglobin drop and a small intraoperative blood loss. The aim was to quantify blood loss associated with hip injuries and surgery, and to identify the relative risk factors for perioperative hidden blood loss. MATERIALS AND METHODS: Eighty-nine patients with a femoral intertrochanteric fracture were operated on between August 2012 and October 2013...
January 7, 2017: Musculoskeletal Surgery
https://www.readbyqxmd.com/read/28059836/neurally-mediated-syncope-during-cesarean-delivery-a-case-report
#8
Seiko Sato, Erisa Nakamori, Go Kusumoto, Kenji Shigematsu, Ken Yamaura
A 28-year-old woman with preeclampsia at 32 weeks of gestation underwent a cesarean delivery under spinal anesthesia. Administration of nitroglycerin at 200 μg to relax uterine smooth muscles and the application of fundal pressure led to severe bradycardia and loss of consciousness, followed by cardiac arrest. Delivery was completed immediately and recovery was achieved 10 seconds later following cardiopulmonary resuscitation. Neurally mediated syncope was considered the cause of cardiac arrest. Anesthetists should be aware of the potential risk during cesarean delivery following the administration of nitroglycerin, fundal pressure, regional anesthesia, and hypovolemia because of preeclampsia...
January 4, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28045884/a-study-of-interpersonal-conflict-among-operating-room-nurses
#9
Tsui-Fen Chang, Chung-Kuang Chen, Ming-Jia Chen
BACKGROUND: Team collaboration is an important factor that affects the performance of the operating room (OR). Therefore, the ability of OR nurses to adapt to and manage interpersonal conflict incidents properly is very important. PURPOSE: The aims of this study were to investigate the interpersonal conflict management capabilities of OR nursing staffs and to find the relationships among the demographics of OR nurses and the following: work-related variables, interpersonal conflict management style, and target of interpersonal conflict...
December 29, 2016: Journal of Nursing Research: JNR
https://www.readbyqxmd.com/read/28040234/-regulation-of-hypnosis-in-propofol-anesthesia-administration-based-on-non-linear-control-strategy
#10
Muhammad Ilyas, Ali Khaqan, Jamshed Iqbal, Raja Ali Riaz
Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi-tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed-loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter-patient variability. This paper proposes a closed-loop automated drug administration approach to control Depth Of Hypnosis in anesthesia...
December 28, 2016: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28034412/does-adoption-of-electronic-health-records-improve-organizational-performances-of-hospital-surgical-units-results-from-the-french-e-si-preps-sips-study
#11
Morgane Plantier, Nathalie Havet, Thierry Durand, Nicolas Caquot, Camille Amaz, Irène Philip, Pierre Biron, Lionel Perrier
BACKGROUND: Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances...
February 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28009653/teamwork-assessment-tools-in-obstetric-emergencies-a-systematic-review
#12
Desire N Onwochei, Stephen Halpern, Mrinalini Balki
INTRODUCTION: Team-based training and simulation can improve patient safety, by improving communication, decision making, and performance of team members. Currently, there is no general consensus on whether or not a specific assessment tool is better adapted to evaluate teamwork in obstetric emergencies. The purpose of this qualitative systematic review was to find the tools available to assess team effectiveness in obstetric emergencies. METHODS: We searched Embase, Medline, PubMed, Web of Science, PsycINFO, CINAHL, and Google Scholar for prospective studies that evaluated nontechnical skills in multidisciplinary teams involving obstetric emergencies...
December 22, 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/28009594/assessing-the-psychometric-properties-of-alternative-items-for-certification
#13
Mary Anne Krogh, Timothy Muckle
Alternative items were added as scored items to the National Certification Examination for Nurse Anesthetists (NCE) in 2010. A common concern related to the new items has been their measurement attributes. This study was undertaken to evaluate the psychometric impact of adding these items to the examination. Candidates had a significantly higher ability estimate in alternative items than in multiple choice questions and 6.7 percent of test candidates performed significantly differently in alternative item formats...
2016: Journal of Applied Measurement
https://www.readbyqxmd.com/read/28007030/ultrasound-anatomy-of-the-transversus-abdominis-plane-region-in-pregnant-women-before-and-after-cesarean-delivery
#14
Nicholas Kiefer, Stefanie Krahe, Ulrich Gembruch, Stefan Weber
BACKGROUND: After cesarean delivery, analgesia is often incomplete and a multimodal approach to analgesia is necessary. Transverse abdominal plane (TAP) block has been advocated in this setting, yet no systematic description of the ultrasound anatomy in pregnant women exists in the literature. Therefore, we aimed to describe the sonographical features of relevant structures in pregnant women before and after elective cesarean. METHODS: Sixty women at, or close to term scheduled for elective cesarean delivery underwent a standardized ultrasound examination before and after delivery...
December 22, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/28005805/mental-foramen-relation-to-mandibular-fracture
#15
Mohammad Waheed El-Anwar, Ahmed Hassan Sweed, Ghada Abdulmonaem
OBJECTIVE: To detect site of the mental nerve foramen in patients of mandibular fracture and study its relation to mandibular fracture site using radiology and operative findings during open reduction and internal fixation. PATIENTS AND METHODS: This study was carried out on 46 patients who had traumatic mandibular fractures. All patients were managed by open reduction and internal fixation during which mental foramen site and fracture site were reported and analyzed and compared to preoperative radiography...
November 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28001018/advanced-practice-registered-nurses-final-rule-with-comment-period
#16
(no author information available yet)
The Department of Veterans Affairs (VA) is amending its medical regulations to permit full practice authority of three roles of VA advanced practice registered nurses (APRN) when they are acting within the scope of their VA employment. Certified Registered Nurse Anesthetists (CRNA) will not be included in VA's full practice authority under this final rule, but comment is requested on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking...
14, 2016: Federal Register
https://www.readbyqxmd.com/read/27982268/utility-of-ultraportable-echocardiography-in-the-preoperative-evaluation-of-noncardiac-surgery
#17
Jean Allan Costa, Maria Lucia Pereira Almeida, Tereza Cristina Duque Estrada, Guilherme Lobosco Werneck, Alexandre Marins Rocha, Maria Luiza Garcia Rosa, Mario Luiz Ribeiro, Claudio Tinoco Mesquita
Background: The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives: To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods: A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study...
November 2016: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/27958191/wet-or-dry-a-review-of-intravenous-fluid-administration-in-anesthesia-practice
#18
Matthew D'Angelo, R Kyle Hodgen
Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27956916/h1n1-influenza-patient-saved-by-extracorporeal-membrane-oxygenation-first-report-from-iran
#19
Alireza Jahangirifard, Zargham Hossein Ahmadi, Majid Golestani Eraghi, Payam Tabarsi, Majid Marjani, Afshin Moniri, Seyed Ali Reza Nadji, Seyed Mohammad Reza Hashemian, Ali Akbar Velayati
Respiratory failure is a serious complication of H1N1 influenza that, if not properly managed, can cause death. When mechanical ventilation is not effective, the only way to save the patient's life is extracorporeal membrane oxygenation (ECMO). A prolonged type of cardiopulmonary bypass, ECMO is a high-cost management modality compared to other conventional types and its maintenance requires skilled personnel. Such staff usually comprises the members of open-heart surgical teams. Herein, we describe a patient with H1N1 influenza and severe respiratory failure not improved by mechanical ventilation who was admitted to Masih Daneshvari Medical Center in March 2015...
July 6, 2016: Journal of Tehran Heart Center
https://www.readbyqxmd.com/read/27941482/iatrogenic-cardiac-tamponade-during-endovascular-aortic-and-mesenteric-stent-grafting
#20
Ingrid Haller, Wolfgang Lederer, Martina Stichlberger, Lydia Posch, Rafael Rehwald, Martin C Freund, Bernhard Glodny, Franz J Wiedermann
The authors report a case of left ventricular perforation and cardiac tamponade in a patient undergoing endovascular aortic and mesenteric stent grafting. During the procedure, the anesthetist noticed a sudden increase in central venous pressure and a decrease in blood pressure. Cardiac tamponade was suspected and confirmed by transesophageal echocardiography. Pericardiotomy resulted only in temporary stabilization. Emergency sternotomy revealed left ventricular perforation. Both anesthetists and radiologists have to be aware of such rare but severe complications of interventional procedures...
December 9, 2016: A & A Case Reports
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