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https://www.readbyqxmd.com/read/27935778/anesthesia-involvement-in-palliative-care
#1
Amanda C Faircloth
Palliative care teams require multidisciplinary support. While this is an emerging area in anesthesia practice, there are many avenues for certified registered nurse anesthetists (CRNAs) to share their unrivaled clinical knowledge. CRNAs may become involved with or consult on palliative sedation, medical management, interventional pain management, terminal wean/extubation, and organ donation. Additionally, CRNAs need to understand the unique needs of this patient population so that they can appropriately care for palliative care patients presenting to the operating room for palliative surgery...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27935772/anesthetic-implications-of-obesity-and-obstructive-sleep-apnea
#2
Jennifer Greenwood
The incidence of morbid obesity has tripled within the past 25 years in developed countries, with the highest rate of growth noted among people with body mass index (BMI) greater than 50. The physiologic derangements that accompany obesity affect almost every organ system leading to a vast array of comorbid conditions including obstructive sleep apnea (OSA). This review focuses on the unique perioperative management considerations that the nurse anesthetist must address when caring for these patients as well as the impact of obesity and OSA on postoperative complications and mortality rates...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27935771/preparing-anesthetists-to-manage-cannot-intubate-cannot-ventilate-situations
#3
Kenneth A Wofford
Cannot intubate/cannot ventilate (CICV) situations during anesthesia are rare, potentially catastrophic to the patient, and difficult to predict. Widely adopted practice guidelines advocate an algorithmic approach to CICV situations in which the anesthetist: (a) recognizes the CICV situation, (b) calls for help, (c) steadily progresses through a variety of methods to ventilate the patient and secure the airway, (d) restores ventilation via an infraglottic airway if the patient cannot be safely awakened prior to becoming moribund...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27918405/certified-registered-nurse-anesthetist-perceptions-of-factors-impacting-patient-safety
#4
Susan P McMullan, Charlotte Thomas-Hawkins, Maria R Shirey
Certified registered nurse anesthetists (CRNAs) provide more than 40 million anesthetics each year in the United States. This article describes a study that investigates relationships among CRNA organizational structures (CRNA practice models, work setting, workload, level of education, work experience), CRNA ratings of patient safety culture, and CRNA adverse anesthesia-related event (ARE) reporting. This is a cross-sectional survey study of 336 CRNAs randomly selected from American Association of Nurse Anesthetists database...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27917532/do-women-have-a-choice-care-providers-and-decision-makers-perspectives-on-barriers-to-access-of-health-services-for-birth-after-a-previous-cesarean
#5
Sarah Munro, Jude Kornelsen, Kitty Corbett, Elizabeth Wilcox, Nick Bansback, Patricia Janssen
BACKGROUND: Repeat cesarean delivery is the single largest contributor to the escalating cesarean rate worldwide. Approximately 80 percent of women with a past cesarean are candidates for vaginal birth after a cesarean (VBAC), but in Canada less than one-third plan VBAC. Emerging evidence suggests that these trends may be due in part to nonclinical factors, including care provider practice patterns and delays in access to surgical and anesthesia services. This study sought to explore maternity care providers' and decision makers' attitudes toward and experiences with providing and planning services for women with a previous cesarean...
December 5, 2016: Birth
https://www.readbyqxmd.com/read/27871514/cost-impact-of-unexpected-disposition-after-orthopedic-ambulatory-surgery-associated-with-category-of-anesthesia-provider
#6
Robert L Ohsfeldt, Thomas R Miller, John E Schneider, Cara M Scheibling
STUDY OBJECTIVE: To provide estimates of the costs and health outcomes implications of the excess risk of unexpected disposition for nurse anesthetist (NA) procedures. DESIGN: A projection model was used to apply estimates of costs and health outcomes associated with the excess risk of unexpected disposition for NAs reported in a recent study. SETTING: Ambulatory and inpatient surgery. PATIENTS: Base-case model parameters were based on estimates taken from peer-reviewed publications when available, or from other sources including data for all hospital stays in the United States in 2013 from the Healthcare Cost and Utilization Project Web site...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27730795/do-legal-issues-deserve-space-in-specialty-medical-journals
#7
Neeraj Nagpal
Physicians and Internists in India have tended to brush under the carpet legal issues affecting their profession. Of concern to all Physicians is the judgment in a recent case where the NCDRC has stated that if MD Medicine Physicians write Physician & Cardiologist on their letterhead it is Quackery. What is MD Medicine degree holder in India qualified and trained to treat ? These are issues which need debate and that can only be initiated once we recognize that there is a problem. Either an MD Medicine is a cardiologist or he is not...
February 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27716690/the-myocardial-protective-effect-of-dexmedetomidine-in-high-risk-patients-undergoing-aortic-vascular-surgery
#8
Rabie Soliman, Gomaa Zohry
OBJECTIVE: The aim of the study was to assess the effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery. DESIGN: A randomized prospective study. SETTING: Cairo University, Egypt. MATERIALS AND METHODS: The study included 150 patients undergoing aortic vascular surgery. INTERVENTION: The patients were classified into two groups (n = 75). Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0...
October 2016: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/27705982/the-impact-of-team-based-learning-tbl-on-physician-assistant-students-academic-performance-in-gross-anatomy
#9
Jonathan A Isbell, Valeria Makeeva, Kara Caruthers, William S Brooks
PURPOSE: Changes in medical education have prevented students from conducting full cadaveric dissections in gross anatomy. The efficacy of alternative educational methods is being explored to augment traditional dissection. METHODS: Team-based learning was integrated into the 2014 gross anatomy laboratory for physician assistants (PA) and nurse anesthetists. Deidentified data from the 2013 and 2014 courses were used to assess with t-tests the effect of this addition on student academic performance...
September 2016: Journal of Physician Assistant Education
https://www.readbyqxmd.com/read/27705012/how-patient-controlled-sedation-is-adopted-in-clinical-practice-of-sedation-for-endoscopic-retrograde-cholangiopancreatography-a-prospective-study-of-1196-cases
#10
Jarno Jokelainen, Marianne Udd, Leena Kylänpää, Harri Mustonen, Jorma Halttunen, Outi Lindström, Reino Pöyhiä
OBJECTIVE: Patient controlled sedation (PCS) has been shown to be a valid choice for sedation during endoscopic retrograde cholangiopancreatography (ERCP) in randomized studies. However, large scale studies are lacking. MATERIAL AND METHODS: A single center, prospective observational study to determine how sedation for ERCP is administered in clinical setting. All 956 patients undergoing 1196 ERCPs in the endoscopy unit of Helsinki University Central Hospital 2012-2013, methods of sedation and adverse events associated with different sedations were recorded...
October 5, 2016: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/27687466/assessing-electronic-interruptions-experienced-by-an-anesthesiology-clinical-director
#11
Thomas E Schulte, Ellen K Roberts, Kristina Birch, Steven J Lisco
STUDY OBJECTIVE: The purpose of this study was to assess the workflow interruptions on an anesthesiology clinical director (CD). By assessing the interruptions on the CD, we hypothesize that these frequent interruptions would prohibit the CD from medical direction of residents or certified nurse anesthetists in operating rooms. DESIGN: Cellular phone data were obtained from Verizon Wireless statements over 10 months, August 2012 through May 2013. These data were from a single cellular phone carried by the anesthesia CD and subsequent overnight anesthesiologist 24 hours a day...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27667347/how-the-nurse-anesthetist-decides-to-manage-perioperative-fluid-status
#12
Honey Calebrant, Marie Sandh, Inger Jansson
PURPOSE: To determine the factors that affect how nurse anesthetists in a county in Sweden decide how to manage perioperative fluid status. DESIGN: A cross-sectional qualitative study was conducted at two surgical wards in a county hospital. METHODS: Sixteen nurse anesthetists were interviewed to explore how nurse anesthetists assess patients' intraoperative fluid requirements and the subsequent measures adopted. FINDING: Three categories emerged through content analysis: clinical criteria and the thought process that drives decision making, interdependence in decision making, and uncertainty in decision making...
October 2016: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/27646394/-knowledge-and-implementation-of-the-s3-guideline-on-delirium-management-in-germany
#13
T Saller, V V Dossow, K Hofmann-Kiefer
BACKGROUND: Delirium is a common complication in critical care. The syndrome is often underestimated due to its potentially no less dangerous course as a hypoactive delirium. Therefore, current guidelines ask for a structured, regular and routine screening in all intensive care units. If delirium is diagnosed, symptomatic therapy should be initiated promptly. OBJECTIVES: The aim of the current study was to evaluate recent German anesthetists' strategies regarding delirium care compared to the German guidelines for sedation and delirium in intensive care...
October 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27637819/using-focus-groups-to-identify-characteristics-of-an-ideal-work-environment-for-advanced-practice-clinicians
#14
Robert J Motley, Richard J Mazzaccaro, David B Burmeister, Samuel D Land, Richard M Boulay, Heiwon Chung, Lynn Deitrick, Andrew D Sumner
Advanced Practice Clinicians (APCs) in collaborative practice represent a diverse and valuable group of health care professionals, including nurse practitioners, physician assistants, nurse anesthetists, and nurse midwives. Because these healthcare professionals have been identified as part of the solution to physician shortages, it is critical for health networks to examine and address issues affecting collaborative relationships. We invited our network APCs to participate in focus group sessions to determine both attributes and barriers to an ideal work environment...
September 2016: Healthcare
https://www.readbyqxmd.com/read/27614787/evaluation-of-a-ketamine-based-anesthesia-package-for-use-in-emergency-cesarean-delivery-or-emergency-laparotomy-when-no-anesthetist-is-available
#15
Thomas F Burke, Brett D Nelson, Taylor Kandler, Zaid Altawil, Khama Rogo, Javan Imbamba, Stella Odenyo, Leeya Pinder, Svjetlana Lozo, Moytrayee Guha, Melody J Eckardt
OBJECTIVE: To assess the safety of a ketamine-based rescue anesthesia package to support emergency cesarean delivery and emergency laparotomy when no anesthetist was available. METHODS: A prospective case-series study was conducted at seven sub-county hospitals in western Kenya between December 10, 2013, and January 20, 2016. Non-anesthetist clinicians underwent 5days of training in the Every Second Matters-Ketamine (ESM-Ketamine) program. A database captured preoperative, intraoperative, and postoperative details of all surgeries in which ESM-Ketamine was used...
December 2016: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/27596281/interprofessional-work-in-operating-rooms-a-qualitative-study-from-sri-lanka
#16
Vathsala Jayasuriya-Illesinghe, Sepali Guruge, Bawantha Gamage, Sherry Espin
BACKGROUND: A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons' perception of teamwork, team members' roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. METHODS: Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork...
September 5, 2016: BMC Surgery
https://www.readbyqxmd.com/read/27580196/the-evolution-of-a-peer-assistance-network-for-nurse-anesthetists-substance-use-disorder
#17
Linda Stone, Diana Quinlan, Julie A Rice, Elizabeth Laura Wright
The American Association of Nurse Anesthetists has a long history of providing peer support for its members with substance use disorder (SUD). The American Association of Nurse Anesthetists' Peer Assistance Advisors Committee (PAAC) is a group of certified registered nurse anesthetist volunteers who strive to promote the awareness of SUD through education and research and provide support to certified registered nurse anesthetists and students with this disease. During the committee's 33-year history, educational outreach to nurse anesthesia educational programs and anesthesia workplaces has expanded, the peer support network has been strengthened, resources and guidelines have been developed, and research related to SUD has been conducted in an effort to accomplish these goals...
July 2016: Journal of Addictions Nursing
https://www.readbyqxmd.com/read/27542098/precautionary-practices-for-administering-anesthetic-gases-a-survey-of-physician-anesthesiologists-nurse-anesthetists-and-anesthesiologist-assistants
#18
James M Boiano, Andrea L Steege
Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants...
October 2, 2016: Journal of Occupational and Environmental Hygiene
https://www.readbyqxmd.com/read/27541267/one-stop-multidisciplinary-pain-clinic-for-survivors-of-torture
#19
Bianca M Kuehler, Susan R Childs
Bianca Kuehler and Susan Childs speak to Jade Parker, Commissioning Editor: Dr Bianca Kuehler initially qualified in Germany as an anesthetist in 1993 and is on the specialist register in the UK. After moving to the UK she obtained a Diploma in Occupational Health to supplement the understanding and implication of chronic pain on the work environment. She is very interested in multidisciplinary approaches in treatment of chronic and acute pain patients and, therefore, working closely with Dr Childs opened a plethora of opportunities to develop new services including a fibromyalgia clinic and a specialist clinic for patients who are survivors of torture...
October 2016: Pain Management
https://www.readbyqxmd.com/read/27501656/tranexamic-acid-in-anesthetic-management-of-surgical-procedures
#20
Jessica Mayeux, Kathy Alwon, Shawn Collins, Ian Hewer
Blood loss during surgical procedures poses a grave risk to the patient, but transfusion is costly and associated with adverse outcomes. Antifibrinolytics, however, offer an economical and effective means of decreasing blood loss associated with surgical procedures. Tranexamic acid (TXA) is an antifibrinolytic that blocks lysine-binding sites of fibrinogen and fibrin, preventing the breakdown of existing clots. This journal course reviews extensive research demonstrating that antifibrinolytics such as TXA decrease blood loss and in some studies reduce allogeneic transfusion requirements...
June 2016: AANA Journal
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