October 1, 2012
Registration Now Open for Advanced Pain Management Certificate Program
Applications are now being accepted for new term of the Hamline University Post-Master’s Certificate in Advanced Pain Management program, which has been created collaboratively by the AANA and Hamline University. Classes for the new term will begin in February 2013.
Designed to be completed in four semesters, this innovative program combines the convenience of online classes with hands-on clinical work under the guidance of experienced pain practitioners. Graduates will receive a Post-Master’s Certificate in Advanced Pain Management. Both didactic and clinical components are required to complete the program. The didactic content will include: Theoretical Foundation of Pain; Imaging and Radiation Safety; Assessment, Diagnosis and Referral; Pharmacology; Interventional Pain Practice; Spiritual Aspects of Health and Illness; and various non-allopathic aspects related to pain management. The clinical practica will include rotations through clinical sites and will provide a mentoring relationship between experienced pain practitioners and students seeking to expand their knowledge of advanced pain management. For further information, see http://www.hamline.edu/education/certificates/pain-management.html.
- USA Today's Chronic Pain Insert Features Nurse Anesthesia and the AANA
- U.S. State Department Warns Against Travel to Tunisia at this Time
- New AANA Position Statements Focus on Mobile Device Use, Fatigue, and Other Topics
- Coming in January: Business of Anesthesia Workshop
- AANALearn Course Provides 2 CE Pharmacology Credits
- Register Now for State Government Affairs Webinars!
- AANA Foundation Award Winners Honored at AANA Annual Meeting
- Announcing the AANA Foundation 2012-2013 Board of Trustees
- October Journal Course Focuses on Obstructive Sleep Apnea
- Stay Tuned for Updates on Contacting Congress Again about CRNA Pain Care
- Congress OKs Six-Month Stopgap Budget
- White House Lists Programs Facing Big Hits from Budget “Sequester” Starting Jan. 1
- ASA Comment on Pain Includes Unusual Take on Anesthesiologist Medical Direction Payment
- Comparative Effectiveness Research Panel Seeking Letters of Intent for Research by October 15
- Where Are the Presidential Candidates on Major Health Issues?
- FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
Healthcare HeadlinesHealthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.
Inside the Association
USA Today's Chronic Pain Insert Features Nurse Anesthesia and the AANA
The Chronic Pain Awareness insert in the Sept. 21, 2012 issue of USA Today
features a two-page spread on nurse anesthesia and the AANA. The AANA is also featured on the cover in a banner ad promoting “Certified Registered Nurse Anesthetists: Alleviating Pain for 150 Years.” For further information about the insert and why maintaining access to CRNA chronic pain management is so important, read more here.
State Department Warns Against Travel to Tunisia at this Time
On Sept. 15, 2012, the U.S. Department of State issued a warning to U.S. citizens against Travel to Tunisia
, the site of the 2014 World Congress of Nurse Anesthetists, at this time. The warning followed the attack on the U.S. Embassy in Tunis and the Sept. 14 order of the departure of all non-emergency U.S. government personnel from Tunisia. The AANA is monitoring the situation and will keep members informed of further developments. In the meantime, the Association suggests that members planning to attend the Congress delay making travel plans until further information is available. See the Department of State’s Country Specific Information for Tunisia
webpage for the latest information and advice.
The International Federation of Nurse Anesthetists (IFNA) officers and the Congress Planning Committee hope to have further information after their Nov. 29-Dec. 1 meeting. Members with questions are welcome to contact IFNA First Vice President and USA Country Representative Jackie Rowles, CRNA, MBA, MA, FAAPM, DPNAP, via email at firstname.lastname@example.org.
New AANA Position Statements Focus on Mobile Device Use, Fatigue, and Other Topics
The AANA Board of Directors recently approved three new position statements, including: Position Statement (PS) 1.12 "Patient-Centered Care: CRNAs and the Interprofessional Team," PS 2.17 "Patient Safety: Fatigue, Sleep, and Work Schedule Effects," and PS 2.18 "Mobile Device Use." The Board also approved the revision of PS 2.15 "Safe Surgery and Anesthesia." All CRNAs and student registered nurse anesthetists should become familiar with these position statements, which are available at http://www.aana.com/resources2/professionalpractice/Pages/AANA-Position-Statements,-Advisory-Opinions,-and-Considerations.aspx.
Additionally, the Board approved the archiving of PS 1.2 “Relationships Between Healthcare Professionals,” PS 1.3 “Opposition to Fixed Ratio of CRNAs to Anesthesiologists,” PS 1.9 “Nurse Anesthetists and Anesthesiologists Practicing Together” and Interim PS 1.11 “CRNA Attributes, Skills, and Requirements Essential for Professional Practice.” Also archived: Advisory Opinion 5.1 “Patient Safety: Fatigue, Stress, and Work Schedule Effects.”
Coming In January: Business of Anesthesia Workshop
The AANA’s first stand-alone Business of Anesthesia Conference will be held in Naples, Fla., on Jan. 26, 2013, in the Waldorf Astoria Naples. This popular educational offering, which premiered at the 2012 Mid-Year Assembly, will feature valuable insights from a team of experts on anesthesia as a discipline and a business, while taking a look at the economic, legal, and government policies that shape CRNA reimbursement and value to healthcare. Registration is now open. See http://www.aana.com/meetings/aanaworkshops/Pages/Business-of-Anesthesia.aspx
for additional information.
AANALearn® Pharmacology Course Provides 2 CE Credits
The newest AANALearn
® pharmacology course, “Perioperative Neuromuscular Blockade – Time for Another Look,” consists of two lectures presented and videotaped at the 2012 AANA Annual Meeting. AANA members may view the course content for free: Log in with your AANA username and password and click on the video link within the course description in the Sales Catalog. To earn continuing education credits, you may purchase the course examination and evaluation for a minimal fee and complete them within 90 days of purchase. Members always receive a discounted enrollment fee for AANALearn® courses. Visit www.aanalearn.com
and browse the catalogs now.
Register Now for State Government Affairs Webinars!
Structuring the Government Relations Committee
October 23, 2012 (7 p.m. CST)
APRN Consensus Model Implementation
November 8, 2012 (6 p.m. CST)
State Legislative and Regulatory Update for State Attorneys and Lobbyists
December 4, 2012 (3 p.m. CST)
State Legislative and Regulatory Process
January 16, 2013 (7 p.m. CST)
February 26, 2013 (7 p.m. CST)
AANA Foundation Award Winners Honored at the AANA Annual Meeting
The 2012 AANA Foundation honored the following CRNAs at the 79th AANA Annual Meeting in San Francisco.
John F. Garde Researcher of the Year: Bruce Schoneboom, CRNA, PhD, FAAN
A brilliant researcher, scholar, educator, leader, role model, and prominent military leader with an expansive array of scientific discovery and methodology whose contributions to the nurse anesthesia profession will have a lasting impact.
Advocate of the Year: Celeste Hinzmann, CRNA
A passionate supporter and role model who demonstrates the characteristics needed to support the activities of the Foundation and served as advocate for the state of Nebraska since the inception of the Advocate program through FY2011.
Rita L. LeBlanc Philanthropist of the Year: Goldie Brangman, CRNA
An AANA Foundation “Friends for Life” charter member who exemplifies the spirit of giving through a lifetime of financial support and as an educator, mentor and friend of the nurse anesthesia community.
Janice Drake CRNA, Humanitarian Award: Ronda L. Davis, CRNA, MSN
A dedicated volunteer, donating her services to Fresh Start which hosts surgery weekends and dental clinics that transform the lives of disadvantaged children suffering from physical deformities through the gift of reconstructive surgery and related healthcare services.
For a complete listing of AANA Foundation award recipients including fellowship and scholarship awardees, please view the AANA Foundation FY12 Annual Report by visiting www.aanafoundation.com.
Announcing the AANA Foundation 2012-2013 Board of Trustees
The AANA Foundation welcomes the Board of Trustees for the 2012-2013 year: Chair: John T. (Jack) Hitchens, CRNA, BA; Chair-Elect: Sandra K. Tunajek, CRNA, DNP; Co-Vice Chair Professional Development: Margaret Faut-Callahan, CRNA, PhD, FAAN; Co-Vice Chair Fundraising: Wilma Gillis, CRNA, BSN, APNP; Treasurer: James E. Jelinek, BS; Trustees: Dennis Bless, CRNA, MS; Normalynn Garrett, CRNA, PhD; Todd Herzog, CRNA; Amy Langan; Donna I. Vierthaler, CRNA, MHS; Bette M. Wildgust, CRNA, MS, MSN; Wanda O. Wilson, CRNA, PhD; and Student Position: Monica Masemer, RN, BSN.
The Foundation thanks outgoing Board Chair Bette Wildgust, CRNA, MS, MSN, for her leadership in FY12. Bette will remain on the Board of Trustees for this fiscal year to conclude her term as a Board of Trustees member.
The Foundation would also like to thank trustees Janice J. Izlar, CRNA, DNAP; Leo A. Le Bel CRNA, JD, MEd; and Rodney C. Lester, CRNA, PhD, MSN, MBA for sharing their time and talents over the past years. The AANA Foundation greatly appreciates their board participation and insights and looks forward to continuing to work together in other capacities.
October Journal Course Focuses on Obstructive Sleep Apnea
The October AANA Journal course, “Is That Snoring Something to Worry About? Anesthetic Implications for Obstructive Sleep Apnea,” details the Berlin Questionnaire and the STOP-BANG Questionnaire, which are useful tools to preoperatively identify patients at risk for surgical complications. Other featured articles include “Anesthetic Implications of Post-Polio Syndrome: New Concerns for an Old Disease” and “Ease of Intubation With the Parker Flex-Tip or a Standard Mallinckrodt Endotracheal Tube Using a Video Laryngoscope (GlideScope).” To view the AANA Journal, see www.aana.com/aanajournalonline.
Stay Tuned for Updates on Contacting Congress Again about CRNA Pain Care
Medicare agency officials state that they are scheduled to publish a final rule on CRNA chronic pain management services on or about Nov. 1, 2012, to take effect Jan. 1, 2013, though there are no guarantees until the final rule actually appears in the Federal Register. What to do until then?
Prepare to write your U.S. Representatives and Senators. Shortly, AANA members will be provided online tools to write Congress once again about protecting CRNA chronic pain management services. AANA members will be asked to urge their lawmakers to contact Medicare and support restoring direct reimbursement of CRNA chronic pain care services as part of their final rule. Members will also be asked to follow up a couple of weeks thereafter.
Know that the American Society of Anesthesiologists (ASA) is running its own grassroots campaign, having its members call U.S. Representatives and Senators against Medicare patient access to CRNA pain care.
In the meantime, the Medicare agency will be reviewing comments that the public has submitted on the 2013 physician fee schedule proposed rule, which included the proposal on Medicare CRNA pain management services. Favorable comments from legislators at this time are valuable.
With Congress headed for a post-election “lame duck” session, the AANA and its allies will also have to protect against having harmful anti-CRNA “poison pill” language included in end-of-year budget bills. Time that CRNAs have spent educating their lawmakers over the past year or so about this issue will be very important during the “lame duck” session.
Stay up to date for contacting Capitol Hill on CRNA pain care at www.protectmypaincare.com. And for further information, see the ASA's most recent campaign information.
Congress OKs Six-Month Stopgap Budget 2
The House and Senate a approved a stopgap budget package on a bipartisan 329-91 vote funding the U.S. government for six months beginning Oct. 1, 2012, initiating across-the-board cuts of 8 percent to domestic non-security discretionary programs including many healthcare programs. However, because the stopgap bill averts an Oct. 1 government shutdown, it also buys time for Congress to figure out how to avert the across-the-board cuts during its coming post-election “lame duck” session.
The across-the-board cut of 8 percent is a budget “sequestration” process ordered by the 2011 Budget Control Act, passed by Congress last year with the objective of driving lawmakers to develop a major budget agreement – and with provisions to cut spending overall if they failed, which they did. The cut takes effect Jan. 1, 2013, and affects healthcare programs of interest to CRNAs like Title 8, but imposes a smaller 2 percent cut to Medicare, and exempts Medicaid and Veterans health programs. The 2 percent Medicare cuts would cost 496,000 jobs by the end of 2013, and some 766,000 jobs by 2021, if they are allowed to take effect, says an analysis sponsored by the American Hospital Association (AHA). National security budgets are exposed to larger cuts than the rest of the government budget. Once the stopgap package is signed into law, agencies would have to report to Congress how they would make the cuts.
However, the impact of the stopgap funding measure (HJ Res 117) on Title 8 funding is not completely clear. The stopgap “continuing resolution” bill funds the government for six months, through March 31, 2013 – but the Health Resources and Services Administration usually issues Title 8 grant funds in the late summer of a federal fiscal year, after that March date. Thus, Title 8 funds in particular will be subject to whatever budget agreement the next Congress taking office in January will develop.
White House Lists Programs Facing Big Hits from Budget “Sequester” Starting Jan. 1
Health, education and national security programs will take major and sudden hits of up to 9.4 percent if Congress and the administration fail to reach agreement to avert over a trillion dollars worth of across-the-board budget cuts slated to take effect Jan. 1, 2013. Health, education and national security programs will take major and sudden hits of up to 9.4 percent if Congress and the Administration fail to reach agreement to avert over a trillion dollars worth of across-the-board budget cuts slated to take effect Jan. 1, 2013, according to a report released by the White House Office of Management and Budget Sept. 14. Some of the programs of interest to CRNAs identified in the report of sample “sequestration” cuts for FY 2013 included:
- Defense health programs, 9.4 percent or $3.2 billion;
- Centers for Disease Control nondefense portions, 8.2 percent or $464 million, and defense portions 10.0 percent or 6 million;
- Medicare program management, 8.2 percent or $38 million from discretionary accounts;
- Healthcare fraud and abuse control accounts, 8.2 percent or $25 million;
- Food and Drug Administration salaries and expenses, 8.2 percent or $318 million;
- Health Resources and Services including Title 8 programs, 8.2 percent or $509 million;
Indian Health Services, 8.2 percent or $317 million; and,
- National Institutes of Health, 8.2 percent or $2.518 billion.
The across-the-board “sequestration” cuts are a portion of what policymakers are terming a fiscal “cliff” facing the U.S. government budget, which also includes hundreds of billions of dollars worth of expiring tax provisions – and, of CRNA interest specifically, a 27.2 percent cut in Medicare Part B payments once the temporary relief of “sustainable growth rate” formula reductions expires. With Congress on recess until after the November elections, the work of addressing these items falls to the post-election “lame duck” session taking place in Washington later in November.
ASA Comment on Pain Includes Unusual Take on Anesthesiologist Medical Direction Payment
When an anesthesiologist is medically directing a CRNA, the American Society of Anesthesiologists (ASA) says anesthesiologists alone are performing the seven required medical direction steps, and CRNAs are not, according to the ASA's Sept. 4, 2012, comment letter
to Medicare predominantly focused against CRNA pain care. The Medicare agency did not propose making changes to Part B medical direction payments in its 2013 physician fee schedule proposed rule; rather, the ASA was commenting on Medicare estimates of volume and time data for calculating indirect practice expense. Read More.
When an anesthesiologist is medically directing a CRNA, the American Society of Anesthesiologists (ASA) says anesthesiologists alone are performing the seven required medical direction steps, and CRNAs are not, according to the ASA’s Sept. 4, 2012, comment letter to Medicare predominantly focused against CRNA pain care. The Medicare agency did not propose making changes to Part B medical direction payments in its 2013 physician fee schedule proposed rule; rather, the ASA was commenting on Medicare estimates of volume and time data for calculating indirect practice expense.
According to the ASA letter, “When anesthesia care is provided in the care team mode with an anesthesiologist medically directing nurse anesthetists or anesthesiologist assistants, the anesthesiologist must: Perform a pre-anesthetic examination and evaluation; Prescribe the anesthesia plan; Personally participate in the most demanding procedures in the anesthesia plan, including if applicable, induction and emergence; Ensure that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist; Monitor the course of anesthesia administration at frequent intervals; Remain physically present and available for immediate diagnosis and treatment of emergencies; and Provide indicated-post-anesthesia care. These activities are performed by the anesthesiologist – not by the medically directed nurse anesthetists or AA – and do not represent duplicative services. Furthermore, most of these services are performed outside the parameters of reported anesthesia time.”
The ASA’s statement contradicts, among other things, a recent article
(March 2012) stating that lapses in anesthesiologist supervision is common even when an anesthesiologist is supervising as few as two CRNAs, and AANA member survey data showing anesthesiologists rarely perform all seven medical direction steps.
The ASA concludes by stating, “(P)erhaps the payment split should be 50 percent of the full allowed amount to the anesthesiologist and an appropriate figure that may be <50 percent of the full amount to the nurse anesthetist.”
Comparative Effectiveness Research Panel Seeking Letters of Intent for Research by October 15
The Patient-Centered Outcomes Research Institute (PCORI) is seeking letters of intent for its second cycle of funding requests for up to $96 million in comparative clinical effectiveness research designed to help patients and those who care for them make better-informed health and health care decisions. PCORI was authorized by Congress to conduct research to provide information about the best available evidence to help patients and their healthcare providers make more informed decisions. PCORI’s research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options.
For further information see the PCORI press release and application center webpage.
Where Are the Presidential Candidates on Major Health Issues?
Kaiser Health News has published a helpful summary of President Obama's healthcare agenda and of Governor Romney's Healthcare Agenda.
FEC REQUIRED LEGAL DISCLAIMER FOR CRNA-PAC
Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use our best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. I am a U.S. Citizen.
Perioperative and Anaesthetic-Related Mortality in Developed and Developing Countries
To investigate patterns of perioperative and anesthetic-related mortality over the past half a century, Canadian researchers conducted a systematic review and analysis of 87 studies. Although the baseline risk of surgical patients magnified over the years, the team found that fewer patients died as a direct result of anesthesia. The anesthetic-related mortality rate during the 1990s-2000s was 34 per million, down substantially from 52 per million in the 1970s-1980s and from 357 per million prior to that. Similarly, total perioperative mortality fell from decade to decade, dipping from 10,603 per million in the pre-1970s period to 4,533 per million in the 1970s and 1980s and to 1,176 per million in the 1990s-2000s. The study, funded by the University of Western Ontario, also revealed that perioperative mortality has declined most in developed countries, whose best practices should be spread in order to reduce total perioperative mortality as well as anesthetic-related mortality on a global scale.
From "Perioperative and Anaesthetic-Related Mortality in Developed and Developing Countries"
The Lancet (09/22/2012) Vol. 380, P. 1075 Bainbridge, Daniel; Martin, Janet; Arango, Miguel; et al.
Peripheral NSAIDs Reduce Pain, Inflammation After Cesarean Delivery
SU.S. researchers believe that combining a low-dose nonsteroidal anti-inflammatory drug (NSAID) with a local anesthetic delivered directly into the wound following a Cesarean birth would hold down pain and inflammation levels while reducing the need for analgesia. In their double-blind, controlled trial, Stanford University investigators implanted a wound-instillation system under the skin just before closing up the Cesarean wounds of 60 women who had healthy deliveries. The mothers were randomly assigned to receive either bupivacaine alone; bupivacaine with hydromorphone; or bupivacaine with ketorolac, a NSAID, as part of the instillation therapy. Pain scores, use of an oral opioid, and cytokines from wound extractions at four, 24, and 48 hours after surgery were measured. The bupivacaine with ketorolac proved to lower pain and analgesic use the most as well as reduce inflammatory markets significantly. "This study suggests that peripheral administration of an NSAID like ketorolac may carry significant analgesic benefits for patients," said Stanford School of Medicine associate anesthesia professor Brendan Carvalho, who led the study. "Continuous administration of small doses of analgesics within a surgical wound may be preferable to the higher systemic doses routinely used in post-cesarean delivery." If future studies support the findings, Carvalho speculated there could be fewer side effects and reduced transference of medications from mother to child.
From "Peripheral NSAIDs Reduce Pain, Inflammation After Cesarean Delivery"
Anesthesiology News (09/01/12) Crowe, Amanda
Study: Nitrous Oxide Has a More Rapid Onset With Direct Measure of Brain Activity
In the September issue of Anesthesia & Analgesia,
researchers describe their tests of a more direct measure of anesthetic activity to improve accuracy of the model brain uptake. Previous modeling of the uptake and elimination of anesthesia drugs used the electroencephalogram, but this technique lags brain activity because of the time needed to acquire a signal. The investigators studied 20 subjects at 30 percent nitrous oxide and monitored the digit symbol substitution test. Results showed that, in subanesthetic concentrations, nitrous oxide has rapid onset and offset. With a half-time of two minutes, it outperformed the values expected during anesthesia with processed electroencephalogram.
From "Study: Nitrous Oxide Has a More Rapid Onset With Direct Measure of Brain Activity"
Becker's ASC Review (09/12) Linder, Heather
Alzheimer's Pathology Might Be Increased in Patients After Surgery and Anesthesia
The term "post-operative cognitive decline" refers to the loss of cognitive abilities, typically observed in older adults, within days or weeks of surgery. Some patients even experience the onset of Alzheimer's disease (AD) symptoms after a surgical procedure; but researchers have yet to determine how anesthesia, surgery, and dementia interact. Researchers at the Perelman School of Medicine at the University of Pennsylvania reported last year that AD pathology, indicated by cerebral spinal fluid biomarkers, may increase in patients after surgery and anesthesia—although they were not able determine whether the anesthetics or the surgery itself was the cause. Further research by this same team, published online this month in the Annals of Surgery, suggests that the surgery itself—not the anesthesia—has a greater impact on a brain that is vulnerable to dementia. Researchers exposed mice with human AD genes to either anesthesia alone or anesthesia and an abdominal surgery similar to a human appendectomy or colectomy. A significant cognitive impairment persisted for at least 14 weeks after surgery compared to controls receiving anesthesia alone. At the time of surgery, the AD mice showed no outward symptoms of AD. The connection between surgery and its cognitive effects may be inflammation. However, researchers do not yet know how an inflammatory process, common after surgery, takes effect in the brain. Research so far suggests that in a vulnerable brain, cognitive deficits that develop after surgery might be irreversible.
From "Alzheimer's Pathology Might Be Increased in Patients After Surgery and Anesthesia"
Hot Enough for You? Patient-Controlled Warming for TKA
While patient-controlled IV analgesia is common and considered effective for lowering the risk of perioperative hypothermia, Canadian researchers set out to determine if temperature-controlled gowns could make patients even more comfortable. University of Manitoba anesthesia professor Bill Ong, MD, led a randomized study of patients undergoing total knee arthroplasty—a procedure that often triggers perioperative hypothermia. All 30 subjects received bupivacaine spinal anesthesia and intrathecal morphine; but half of them were covered with standard warm blankets, while the other half wore gowns with portable warming units that blow heated air. Handheld remotes allowed patients to control their gown's temperature. The research found that not only were the single-use gowns effective in mitigating hypothermia risk, patients using them needed fewer postoperative opioids and reported greater satisfaction with thermal comfort than did those with standard blankets. Ong and his team attributed those results to the superior temperature control of the gowns—which may have improved the overall perioperative experience for those patients, including by reducing their stress. "Active patient-controlled warming should be assessed further," he stated. "Measures to provide better patient comfort and feelings of control may be another useful adjunct for pain relief."
From "Hot Enough for You? Patient-Controlled Warming for TKA" Anesthesiology News
(09/01/12) Vlessides, Michael
Study: Anesthesia Drug's Amnesia Does Not Block Emotional Arousal
Although dexmedetomidine impairs long-term picture memory, the anesthesia drug does not hinder memory for emotional arousal, as past research has suggested. In the new study, researchers used neuroimaging to highlight alterations in the brain activity of 48 volunteers who viewed and rated 80 emotionally arousing and non-arousing pictures. Dexmedetomidine was found to impair overall picture memory but not to differentially modulate memory as a function of emotional arousal. Both test groups demonstrated better memory for arousing pictures, the researchers wrote in the September issue of Anesthesiology.
From "Study: Anesthesia Drug's Amnesia Does Not Block Emotional Arousal" Becker's ASC Review
(09/12) Linder, Heather
Light Controls Modified Anesthetic
Researchers at Ludwig Maximilian University in Munich, Germany, have discovered that light can be used to control the narcotic impact of propofol. The drug, like other anesthetics, works by manipulating inhibitory neurotransmitters that restrict neuron activity. Propofol, specifically, accomplishes this through interaction with receptors on neural cell membranes that normally bind the inhibitory neurotransmitter gamma-amino butyric acid (GABA). By blocking the binding process, which opens up protein channels that let negatively charge chloride ions enter the cell, the anesthetic prevents pain. Chemical biology and genetics professor Dirk Trauner added a light-sensitive molecule to propofol that regulates the GABA receptor using light, using a tadpole study to demonstrate the effect. Exposed to a low dose of his propofol derivative, the tadpoles were anesthesized; and the derivative was more potent in the dark than propofol alone. Illuminated with violet light, however, the tadpoles revived at once and remained active only as long as they were in the light. The effect of the light-sensitive trigger was completely reversible, with the tadpoles recovering fully after being returned to their regular habitat. Trauner believes his propofol derivative could be used to treat certain forms of blindness and eye disease.
From "Light Controls Modified Anesthetic"
Laboratory Equipment (09/12)
Preparation Process Eases MRI for Children With Sickle Cell
SPreparation and support procedures (PSP) can help children with sickle-cell disease (SCD) reduce their need for sedation during magnetic resonance imaging (MRI) scans, researchers report in a study published online June 19 in Pediatric Radiology. Researchers at St. Jude Children's Research Hospital in Memphis studied 71 children, ages five to 12 years, who had SCD. The scientists evaluated the impact of PSP in reducing the children's need for sedation during MRI examinations of the brain or liver. Ninety-one percent of children who received PSP completed an interpretable MRI exam, compared with 71 percent of children who did not receive PSP. "The use of PSP was of significant benefit to children as young as 5 years of age in completing an interpretable MRI exam of the liver or the brain without sedation/anesthesia," the authors wrote. "The PSP program helped improve coping with MRI diagnostic procedures within the hospital environment while minimizing the risks from sedation known to be associated with children with SCD."
From "Preparation Process Eases MRI for Children With Sickle Cell"
Doctors Lounge (09/13/2012)
Inhaled Analgesia Appears to Be Effective in Reducing Pain Intensity in First Stage of Labour
Researchers report that inhaled pain relief can effectively lessen pain intensity in the first stage of labor for expecting mothers, many of whom would prefer a less-invasive option than epidural anesthesia. An inhaled mixture of oxygen and either a flurane derivative or nitrous oxide can quickly curb pain while allowing the patient to remain awake and swallow normally, according to a systematic review of data culled from more than two dozen studies involving a total of 2,959 women. Women who used nitrous oxide experienced more pain relief compared to women who received no analgesic at all; however, the gas can cause side effects such as nausea, vomiting, dizziness, and drowsiness. In cases were fluranes were available, their use provided a more powerful effect than nitrous oxide, with fewer side effects. Fluranes can only be given to women under supervision of an educated analgesia provider, but nitrous oxide can be administered by midwives. The researchers, whose results were published in The Cochrane Library, recommended additional research involving larger numbers of women—with particular examination of which forms of anesthetic give a woman a greater sense of control and satisfaction in labor.
From "Inhaled Analgesia Appears to Be Effective in Reducing Pain Intensity in First Stage of Labour"
Federal Grants Bolster Nursing Faculty, Diversity
Nursing workforce development will be supported by $30.2 million in grants announced by the U.S. Department of Health and Human Services, with $23.3 million allocated to 112 nursing schools to boost the population of qualified U.S. nursing faculty. The program enables nursing schools to offer eligible students partial loan forgiveness when they graduate in exchange for working as full-time nursing faculty for a prescribed period. Fourteen nursing schools received $4.6 million to broaden nursing education opportunities for disadvantaged individuals, including racial and ethnic minorities that are underrepresented among registered nurses (RNs). Academic support, financial assistance, and student mentoring will be among the activities supported by the grants. Finally, 81 nurse anesthetist education programs will get $2.3 million to supply traineeships to licensed RNs enrolled as full-time students in a master's or doctoral nurse anesthesia program. Traineeships will cover all or part of the costs of tuition, books, fees, and reasonable living expenses of the individual during the period of the traineeship.
From "Federal Grants Bolster Nursing Faculty, Diversity" Nurse.com
Real-Time Prescription Data May Cut Opioid Abuse
A new study published in the CMAJ, the journal of the Canadian Medical Association, found that real-time prescription data appears to have helped Canadian pharmacists stop "doctor shoppers" from getting excessive amounts of opioid painkillers and tranquilizers. Researchers found that after a province-wide prescription database was introduced in British Columbia in 1995, the number of inappropriate prescriptions for these drugs experienced a sudden drop. The findings were published less than a week after New York Gov. Andrew Cuomo signed a law requiring the state to create a real-time prescription drug database called I-STOP. Under the British Colombian system PharmaNet, inappropriate opioid prescriptions dropped from 3.2 percent to 2.1 percent, while suspect prescriptions of benzodiazepines slumped from 1.2 percent to 0.71 percent.
From "Real-Time Prescription Data May Cut Opioid Abuse"
Reuters (09/05/12) Joelving, Frederik
CUSP Reduces SSIs
A study published in the August issue of the Journal of the American College of Surgeons by researchers at the Johns Hopkins University School of Medicine found that a comprehensive unit-based safety program (CUSP) successfully reduced post-operative surgical site infection (SSI) rates among colorectal surgery patients by a significant margin. The research involved gathering administrators, surgeons, nurses, techs and anesthesia professionals together in small groups to discuss clinical practices, dissect inconsistencies and brainstorm solutions for handling this high-infection-risk patient population. The goal was to create a culture of patient safety in which front line staff could speak openly when they observed potential hazards, using standardized prep procedures, active patient warming and safety checklists. In the year before implementing the CUSP, the mean SSI rate among colorectal surgery patients was 27.3 percent, and one year after the program's introduction the rate was 18.2 percent.
From "Speak Up to Reduce SSIs"
Outpatient Surgery (09/04/12) Bernard, David