Anesthesia E-ssential

October 15, 2012 

Vital Signs

Celebrate National Nurse Anesthetists Week

Promotional Items Available in November

CRNAs all across the country are gearing up for the 14th annual National Nurse Anesthetists Week, to be celebrated January 20-26. The theme for 2013 is "Patient Care Extraordinaire."
Promotional Items Available Soon
Promotional items, including posters, buttons, ink pens, table tents, and more are now available. This year, for the first time, AANA will be using QR codes on select items to encourage patients, healthcare colleagues, and others to visit the refreshed patients’ area of the AANA website. In addition, the ever-popular Nurse Anesthetists Week logo merchandise, including T-shirts and mugs, will be available for purchase.
New in 2013: Online Ordering
The AANA has switched to an easy and convenient all-online ordering system for this year’s promotional items. Visit the website at beginning in November. The AANA website will feature downloadable items such as sample press releases and ideas for promoting National Nurse Anesthetists Week. Please note: Ordering is now online-only. Phone, fax, or mail orders will not be accepted.
Don’t Wait to Order
Don’t wait to order; these popular promotional items go fast.


The Pulse

  • Calling All CRNAs and Student Registered Nurse Anesthetists!
  • High Performance Leadership: The Topic of Fall Assembly Leadership Academy Keynote Address
  • AANA Seeks Chief Operating Officer
  • Volunteer Opportunity
  • AANALearn® - New Pharmacology Course Offered
  • AANA Delegation Brings CRNA Voices to White House Forum on Health Reform
  • Physician Representatives Urge Medicare to Oppose CRNA Pain Care
  • Protect My Pain Care: Tell Your Reps Not to Sign Broun Anti-CRNA “Dear Colleague” Letter
  • Have You Contacted Congress Again about CRNA Pain Care?
  • HHS Inspector General Looking at Anesthesia, Says 2013 Work Plan
  • CRNAs: Check Your Medicare Revalidation So You Can Continue Being Reimbursed
  • Medicare Payment Advisory Commission Focuses on Geographic Payment Adjustments
  • Stay Tuned for the State Reimbursement Director (SRD) Program Rollout
  • Where Are the Presidential Candidates on the Major Health Issues? 
  • Wall Street Journal Response

Healthcare Headlines

Healthcare 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
Calling All CRNAs and Student Registered Nurse Anesthetists!
Have you ever been to the Broadmoor Hotel nestled at the base of the Rocky Mountains in Colorado Springs, Colo.? Ever attended the AANA's Fall Assembly Leadership Academy, designed to captivate, invigorate, motivate, and educate past, present, and future leaders of the nurse anesthesia profession? If not, check out this video promo by clicking here to see why you don't want to miss your opportunity to enjoy both experiences at one time! The 2012 Fall Assembly Leadership Academy will take place at the breathtaking Broadmoor November 16-18. Register before October 26 and take advantage of a special $50 discount on your registration fee. Connect, learn and lead at this year's Fall Assembly Leadership Academy! Register now here.
High Performance Leadership: The Topic of Fall Assembly Leadership Academy Keynote Address
Don’t miss this exciting opportunity to hear Franchee Harmon speak at the Fall Assembly Leadership Academy at the Broadmoor Hotel in Colorado Springs, Colo., on Friday, Nov. 16, 2012. Harmon partners with top-tier executive teams on issues related to business strategy and organizational leadership. She has spoken at conferences worldwide and will be speaking at the Fall Assembly Leadership Academy about “High Performance Leadership.”
Harmon will identify the differentiating characteristics of high-performance workgroups and the barriers that hinder performance.  She has authored several articles for publication in business journals, contributed to The Real Cost of Capital (FT Prentice Hall, 2004), and wrote Making Purpose Work: The Challenge of Growing Ourselves and Our Companies (HPH Publishing, 2005). She serves on the Board of Directors of Blue Northern Energy, LLC. Previously, she served as VP of Personal and Professional Development on the Board of the University of Chicago Women’s Business Group.  Register online today!

AANA Seeks Chief Operating Officer
The AANA is conducting a search for a chief operating officer (COO). The COO will provide overall strategic direction and guidance to all administrative and programmatic functions at the American Association of Nurse Anesthetists. This newly-created position will report directly to the AANA’s executive director, allowing her to concentrate on strategic activities vital to the organization’s growth as a preeminent healthcare association. 
The Chief Operating Officer, a seasoned, mission-focused operations strategist, will lead a 12-member senior management team.The Chief Operating Officer will serve as an integral part of the AANA senior management team by translating the Executive Director’s vision and strategy into a clear operational plan with prioritized goals and objectives.  The Chief Operating Officer will focus on developing and strengthening core operational and program relationships, enhancing organizational processes and infrastructure, and growing revenues to support the activities of the AANA.
The ideal candidate for this position will provide the following qualifications: five to eight years of senior leadership experience in business, programs and administration with success overseeing diverse functional areas; prior experience in a professional nonprofit association is highly preferred, particularly in financial, operational, programmatic and resource management; a team-focused leader with a track record of hiring, managing, motivating, retaining and developing diverse high-performing teams; an MBA and/or CAE are strongly preferred while a bachelor’s degree with equivalent work experience is required.
To be considered for this opportunity, please send resume to:
Dan Nevez
Consultant, Executive Search
(P) (312) 896-8901
One East Wacker Drive, Suite 3350
Chicago, IL 60601
Volunteer Opportunity
Kenya Relief is a non-profit organization, started by Steve James, CRNA, which offers numerous medical and non-medical volunteer opportunities to Kenya. To learn more about upcoming volunteer opportunities or other ways you can help, visit

AANALearn® - New Pharmacology Course Offered
Were you unable to attend the AANA Annual Meeting? Several pharmacology lectures from the Annual Meeting were videotaped and are being developed into individual courses for online continuing education credit. The first course, available this month, is “Anticoagulation – Past, Present, and Future” presented by Mark Gabot, CRNA, MS. As a special benefit to AANA members, this will be offered at a half price SALE for a limited time only. Members always receive a discounted enrollment fee for courses in AANALearn® and easy access is provided with the AANA member login. Visit – it’s never too early to consider your recertification needs for continuing education.


AANA Delegation Brings CRNA Voices to White House Forum on Health Reform
At a White House conference on Improving Clinician Understanding and Engagement Around the Affordable Care Act Sept. 28 in Washington, D.C., AANA President Janice Izlar, CRNA, DNAP, and President-elect Dennis Bless, CRNA, MS, discussed the value and importance of CRNAs with health leaders and policymakers at the highest levels of the government and across the private sector.
Top administration officials outlined for about 100 conference participants the practical effects of health reform implementation, and Izlar and Bless learned that advising state-based exchanges about the advantages of CRNA care depends on building relationships with the exchanges and with health plans in each state – a recommendation consistent with AANA’s guidance for state nurse anesthetist association leaders.
See pictures from the conference here, and information released Sept. 28 about the Affordable Care Act for healthcare professionals here.
Physician Representatives Urge Medicare to Oppose CRNA Pain Care
Thirteen members of the House Republican Doctors Caucus have sent Medicare a letter dated Sept 24 opposing Medicare approving resumption of direct reimbursement of CRNA pain care services.  The GOP physicians’ letter reflects existing American Society of Anesthesiologists (ASA) talking points and was reportedly backed by Rep. Andy Harris, MD (R-MD-1), the sole anesthesiologist in Congress, who was said to have argued strenuously and loudly against CRNA pain care in a GOP Doctors Caucus meeting last week.  
In addition to Harris, the letter was also signed by representatives Phil Gingrey, MD (R-GA-11); Dan Benishek, MD (R-MI-1); Charles Boustany, MD (R-LA-7); Paul Broun, MD (R-GA-10); Larry Bucshon, MD (R-LA-7); Bill Cassidy, MD (R-LA-6); Scott Desjarlais, MD (R-TN-4); John Fleming, MD (R-LA-4); Paul Gosar, DDS (R-AZ-1); Joe Heck, DO (R-NV-3); Tom Price,MD (R-GA-6); and Phil Roe, MD (R-TN-1).
Repeating the opposition lodged by the ASA, the letter adds one more criticism – a claim that “none of the stakeholders were involved in framing the regulation.”  The letter goes on to claim interventional pain management is solely the “discipline of medicine” and repeats negative claims about CRNA training and practice that are addressed in the AANA’s comments to the agency Sept. 4.  It also notes that non-fellowship trained “physicians treating chronic pain receive additional training, mentoring and education outside of a formal fellowship.”
For further information, see the House GOP Doctors Caucus Lettera list of the Doctors Caucus membership (several did not sign the letter), the AANA's comment to CMS about pain care, and a Lewin Group study on the costs of alternatives to CRNA pain care.
Protect My Pain Care: Tell Your Reps Not to Sign Broun Anti-CRNA “Dear Colleague” Letter
Rep. Paul Broun, MD (R-GA-10), is circulating a “Dear Colleague” letter among U.S. Representatives inviting them to sign a letter to the Medicare agency in opposition to what he calls “new and expansive national payment policy” authorizing reimbursement of CRNA pain care services.  AANA members are being asked to contact their U.S. Representatives and say, “Do NOT sign onto Congressman Broun’s (pronounced “brown”) “Dear Colleague” letter regarding pain management.   The primary reasons to oppose signing that letter are that (a) the Institute of Medicine says 100 million Americans suffer from chronic intractable pain without sufficient providers to deliver pain care, (b) CRNAs have been providing chronic pain management services for many years, (c) Medicare has reimbursed CRNA chronic pain management for many years, and (d) the letter misrepresents CRNA education and practice, and misrepresents the fact that CRNA practice is governed by states not Medicare, and if its policy is followed it would impair patient access to needed care. At press time, Broun said he is circulating this letter for signatures until Oct. 10, a deadline he may extend.  Broun was not among the House GOP physicians who signed a similar letter to the Medicare agency late September. 
Have You Contacted 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.  There’s no time to waste! Get up to speed on this issue and contact your U.S. Representatives and Senators. Act now!
  • Write your U.S. Representatives and Senators.  AANA members are provided online tools via to write Congress once again about protecting CRNA chronic pain management services.  AANA members and allies are being 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.  AANA members will also be asked to follow up a couple of weeks thereafter.
  • Know that the American Society of Anesthesiologists is running its own grassroots campaign, having its members call U.S. Representatives and Senators against Medicare patient access to CRNA pain care. The ASA in fact has its annual meeting in Washington Oct. 13-17, 2012. ASA members will work to be heard in Washington – will you?
  • In the meantime, the Medicare agency is 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 invaluable.
  • With Congress headed for a post-election “lame duck” session, the AANA and its allies must educate lawmakers as a protection against potentially harmful anti-CRNA “poison pill” language being included behind closed doors in end-of-year budget bills. Time that CRNAs spend 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 with contacting Capitol Hill on CRNA pain care at, and viewing the ASA's most recent campaign information
HHS Inspector General Looking at Anesthesia, Says 2013 Work Plan
The U.S. Department of Health and Human Services Office of the Inspector General (HHS OIG) has identified an aspect of Medicare anesthesia payment among the topics the agency intends to newly investigate as part of its 2013 work plan, released the Oct. 2.  Specifically, the HHS OIG workplan contains a section titled “Anesthesia Services—Payments for Personally Performed Services (New).” The AANA and its expert members involved in anesthesia reimbursement are evaluating this HHS OIG work plan notification, and will continue to monitor this effort and update AANA members as appropriate.
According to the workplan section titled “Anesthesia Services—Payments for Personally Performed Services (New),” “We will review Medicare Part B claims for personally performed anesthesia services to determine whether they were supported in accordance with Medicare requirements. We will also determine whether Medicare payments for anesthesiologist services reported on a claim with the “AA” service code modifier met Medicare requirements.
Physicians report the appropriate anesthesia modifier to denote whether the service was personally performed or medically directed. (CMS’s Medicare Claims Processing Manual, Pub. No. 100-04, ch.12, § 50) The service code “AA” modifier is used for anesthesia services personally performed by an anesthesiologist, and the “QK” modifier is used for medical direction of two, three, or four concurrent anesthesia procedures by an anesthesiologist. The QK modifier limits payment at 50 percent of the Medicare-allowed amount for personally performed services claimed with the AA modifier. Payments to any service provider are precluded unless the provider has furnished the information necessary to determine the amounts due.”

For more information, read CRNA reimbursement issue essentials (requires AANA member login and password).  The Medicare Part B anesthesia payment rules are found in Sec. 50 and 140 of the Medicare Claims Processing Manual Chapter 12.
CRNAs: Check Your Medicare Revalidation So You Can Continue Being Reimbursed
The Medicare agency hosted a national provider call Oct. 10 on Medicare revalidation, with crucial information for AANA members: Without a valid Medicare identification, you cannot bill or have someone else bill for services you provide Medicare patients. The AANA first reported back in November 2011 that over a period of several months each Medicare Administrative Contractor (MAC) is sending all healthcare providers, including CRNAs, a letter directing all providers to revalidate their Medicare identification within 60 days of the letter’s date.  If a CRNA gets such a letter, he or she should follow the letter’s instructions immediately, and provide it to his or her employer or billing agent as appropriate. CRNAs should also be aware that Medicare claims can be denied if a referring/ordering provider, such as a surgeon, has incomplete or missing enrollment information with Medicare.  CRNAs may want to work with their employer or billing agent to ensure that ordering and referring providers have completed their Medicare revalidations as well.
For further information on Medicare Revalidation see the AANA Hotline for the Week of Nov. 14, 2011,  (requires AANA member login and password) and the Medicare Revalidation Lists.
Medicare Payment Advisory Commission Focuses on Geographic Payment Adjustments
The Medicare Payment Advisory Commission (MedPAC) meeting Oct. 4, which was attended by AANA representatives, focused on geographic adjustment of payment for health professionals and on Medicare payment differences across settings for ambulatory care services.  The AANA is monitoring the Commission’s work for any influences it may have on payment for CRNA services.
Medicare Part B payment for CRNA and physician services varies by locality around the country, with those areas Medicare sees as higher cost being reimbursed at higher rates than lower cost areas are reimbursed.  Under the Middle Class Tax Relief and Job Creation Act of 2012, MedPAC is required to consider whether certain payments under the physician fee schedule should be adjusted geographically. Under this mandate, the commission is to assess whether any adjustment is appropriate to distinguish the difference in work effort by geographic area and, if so, what the level of the adjustment should be and where it should be applied.  The commission is assigned to develop a final recommendation before the year end and will publish its recommendation in its June report.
The MedPAC is also examining differences in payments for services provided in hospital outpatient departments versus those provided in office-based settings, as payments tend to be higher in the hospital outpatient department.  The commission had recommended in its March report to equalize payments for evaluation and management services.  The commission staff identified 25 additional services that could potentially be equalized, highlighting four diagnostic services such as bone density testing and the procedure for laser eye surgery, but did not share with the public the entire list of services that were up for consideration. The AANA will continue to monitor this effort.
For further information on this meeting, click here. The Institute of Medicine examined this issue in July 2012, recommending among other things that “In order to promote access to appropriate and efficient primary care services, the Medicare program should support policies that would allow all qualified practitioners to practice to the full extent of their educational preparation.”
Stay Tuned for the State Reimbursement Director (SRD) Program Rollout
In September, the AANA Board of Directors approved the development of a State Reimbursement Director (SRD) Program, with the goal of representation from all 50 state associations of nurse anesthetists for effective reimbursement advocacy in each state.  With the AANA’s Federal Political Director (FPD) Program as a template, the SRD will be the point person for reimbursement knowledge and advocacy in each individual state. The SRD Program is currently being developed with the goal of having a full complement of SRDs aboard by early 2013.  Stay tuned for additional information regarding the role and responsibilities of the SRD, as well as educational materials and other resource information that will be available to assist states in implementing this program.
We look forward to receiving the name and contact information for an SRD from every state nurse anesthetist association.  If you have someone in mind as your state’s SRD for the AANA Fiscal 2013 year, please send the pertinent information to with the subject line “State Reimbursement Director.”  You may also ask any questions about the program through the same email address and we will get back to you quickly.
We look forward to hearing from you.  Please watch for more information about the SRD program in the coming months.
For more information, read CRNA reimbursement essentials and our initial CRNA reimbursement advocacy plans for each state distributed earlier in 2012. Both of the preceding links require AANA member login and password).
Where Are the Presidential Candidates on the Major Health Issues?
Kaiser Health News has published a helpful summary of President Obama's Healthcare Agenda and Gov. Romney's Healthcare Agenda.
Wall Street Journal Response
The AANA posted a response to the Oct. 3 Wall Street Journal about the Medicare CRNA pain management reimbursement issue at
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 US Citizen.


CDC Leads Fight Against Meningitis Outbreak
Scientists at the Centers for Disease Control and Prevention (CDC) have determined that two fungi rather than one are linked to a multi-state outbreak of lethal meningitis from contaminated steroids. As a result, the CDC must reevaluate treatment protocols and advise physicians on using a wider range of drugs to relieve chronic pain. There were 137 cases of fungal meningitis and 12 deaths in 10 states as of October 10. Epidemiologists have found that the patients most vulnerable to the infection are the elderly. The CDC also learned that some people may have received the contaminated steroid shots in their joints rather than spines, which could potentially cause a painful swelling of the joints called septic arthritis. Health officials say the outbreak stemmed from steroids used in pain injections formulated by a company in Massachusetts. The steroids were delivered to 75 clinics across 23 states, and up to 13,000 people may have received injections of the substance between May and September, according to health officials. People who have been injected with the steroids need to watch out for such symptoms as fever, stiff neck, slurred speech, and swelling at the site of the injection, officials say.
From "CDC Leads Fight Against Meningitis Outbreak"
Atlanta Journal-Constitution (10/11/12) Schneider, Craig

Medicare Shift Fails to Cut Hospital Infections
A widely publicized Medicare policy intended to curb hospital-acquired infections by reducing payments linked to treating them has been found to be ineffective, according to a new study in the New England Journal of Medicine. The study examined the impact of the 2008 payment change on bloodstream and urinary-tract infections related to catheters, finding "no evidence" that the shift had any measurable effect on the infections. Using data from 398 hospitals from 2006 to 2011, researchers compared the infection rates before the policy started in October 2008 to the period after it was implemented. They also reviewed ventilator-associated pneumonia rates, which was not targeted by the payment change. The researchers found that there were "no significant changes" in the rates of any of the three conditions following the shift. Grace Lee, the study's lead author, said the findings may indicate that the financial consequences of the policy were limited, or that hospitals were already seeing results from their earlier efforts to curb the infections. Starting in 2015, however, Medicare will impose payment penalties on hospitals that have the highest rates of certain hospital-acquired health conditions. The Centers for Medicare and Medicaid Services noted its efforts to reduce hospital-acquired infections and cited other efforts, such as a program funded by the Agency for Healthcare Research and Quality that was linked to a 40 percent decrease in the rate of the catheter-linked bloodstream infections in hospital intensive-care units.
From "Medicare Shift Fails to Cut Hospital Infections"
Wall Street Journal (10/11/12) P. A8 Mathews, Anna Wilde

Sucrose for Procedural Pain Management in Infants
The use of oral sucrose has been extensively studied as a pain intervention in newborns. Of more than 150 published studies, 100 cite sucrose as a calming and analgesia treatment in care for infants. Sucrose, glucose, or other sweet solutions were found to generally reduce pain responses during routine painful procedures in diverse populations of infants up to 12 months of age. The use of sucrose has been widely recommended for newborn and young infants, yet these recommendations have not been translated into consistent use in clinical practice. One reason may be related to knowledge and research gaps in the analgesic effects of sucrose. For instance, the mechanism of sweet-taste-induced analgesia is not precisely understood, which impacts the use of research evidence in practice.
From "Sucrose for Procedural Pain Management in Infants"
Pediatrics (10/12) Harrison, Denise; Beggs, Simon; Stevens, Bonnie

Anesthesia Depth Not Linked to Post-Op Outcomes
A study by researchers at the Cleveland Clinic found that reducing anesthesia does not curb the incidence of postoperative morbidity and short-term mortality in patients undergoing noncardiac surgery. Basem Abdelmalak and colleagues compared more than one dozen serious outcomes—such as myocardial infarction, stroke, sepsis, and 30-day mortality—in 194 patients given light anesthesia and 187 given deeper anesthesia. Anesthetic depth was analyzed using bispectral index monitoring (BIS). The researchers also compared plasma concentrations of the inflammatory marker high-sensitivity C-reactive protein (hsCRP). They found no major differences in the incidence of morbidity and mortality between the two groups. In addition, they found no correlation between median BIS values, time spent under anesthesia with a BIS value less than 45, and morbidity/mortality. Concentrations of hsCRP were comparable in both groups, they said. Daniel Sessler, a co-investigator of the study, noted that although the mean BIS difference in the deep and light anesthesia groups was just 8, patients randomized to deep anesthesia spent four times longer with a BIS value less than 45. "Despite this substantial difference, our primary outcome—a composite of serious complications—did not differ between the groups," he said.
From "Anesthesia Depth Not Linked to Post-Op Outcomes"
Anesthesiology News (10/09/12) Wild, David
Study Evaluates Frequency of Pediatric Pain Assessments
Pain-intensity scores among hospitalized infants vary widely, and many children experience moderate to severe pain during hospital stays, according to a study investigating the nature and frequency of pain assessments in children. Researchers at Toronto's Hospital for Sick Children evaluated the medical charts of 3,840 children. The average per-child number of documented pain assessments was 3.3, but 60 percent of the children were assessed with non-validated pain measures. While two-thirds of the children studied had a pain assessment performed within a 24-hour period, an improvement over previous reports, pain assessments were variable and inconsistent and often did not meet national accreditation guidelines. The researchers noted that pain-assessment scores should be part of clinical decision-making and pain relief should become a priority in a healthcare organization. In another study, researchers at Children's Hospital in Boston examined the fear-avoidance model in 350 children with chronic pain. The results showed that the fear-avoidance model can help understand and predict functional disabilities in young patients, but it provided less guidance for understanding depressive symptoms associated with pain. Shorter duration of pain was associated with higher pain ratings among younger children, though not in adolescents. These findings indicate that fear of pain may play a stronger role in adolescents than younger children, so a focus on anxiety-related pain responses in adolescents may lead to more favorable outcomes. These studies are published in the Journal of Pain.
From "Study Evaluates Frequency of Pediatric Pain Assessments"
Newswise (10/03/12)
High Concentrations of Inhaled Oxygen During and After Cancer Surgery May Increase Risk of Death
A recent study out of Copenhagen University Hospital found that cancer patients who received 80 percent oxygen during and after cancer surgery saw their mortality rates increase by 45 percent in the one-to-three year period after the surgery. High inhaled oxygen concentrations can have harmful effects on the lungs in some cases, and the researchers, led by Dr. Christian Meyhoff, said such high concentrations could increase the risk of cancer recurrence. This study acts as a follow-up to previous research that looked at if higher concentrations of inhaled oxygen during and after major surgery led to greater infection rates after those surgeries were complete. That research found that patients who were administered 30 percent oxygen during and after surgery had a lesser mortality rate than those who were administered 80 percent oxygen. Researchers from the current study stress that their results are preliminary and they did not have enough data to make a mortality rate comparison to cancer surgery patients administered lesser concentrations of oxygen. However, they additionally stressed that 80 percent oxygen concentrations have no well-documented benefits over lesser concentrations and so should not be used unless absolutely needed to maintain proper saturation. This study is published in the journal Anesthesia & Analgesia.
From "High Concentrations of Inhaled Oxygen During and After Cancer Surgery May Increase Risk of Death" (09/26/2012)

Influenza Vaccination Coverage Among Health-Care Personnel—2011-12 Influenza Season, United States
An Internet panel survey of 2,348 health-care personnel (HCP) in April by the Centers for Disease Control and Prevention found that 66.9 percent received the flu vaccine for the 2011-2012 season. The vaccination rate was 85.6 percent for physicians, 77.9 percent for nurses, and 62.8 percent for other HCP. The report also shows that 76.9 percent of HCP in hospitals, 67.7 percent in physician offices, and 52.4 percent in long-term care facilities had been immunized. The vaccination rate was 95.2 percent for those whose hospitals required immunization, compared to 68.2 percent of those whose hospitals do not have such requirements. Physicians who worked in hospitals had the highest vaccination rate of 86.7 percent, while HCP working in long-term care facilities had the lowest, at 50.2 percent. Vaccination rates were highest among HCP age 60 and under (75.7 percent), HCP whose worksites offered vaccination at no cost on multiple days (78.4 percent), and HCP whose employers promoted vaccination (75.8 percent). Of the 33.1 percent of HCP who were not vaccinated, 28.1 percent believed they did not need to be immunized, 26.4 percent expressed concerns about effectiveness, and 25.1 percent were worried about side effects.
From "Influenza Vaccination Coverage Among Health-Care Personnel—2011-12 Influenza Season, United States"
Morbidity and Mortality Weekly Report (09/28/12) Vol. 61, No. 38, P. 753

Another Manufacturer Blocks Drug for Execution Use
A German drug company is the latest in a string of manufacturers to ban the use of their product for lethal injections in the United States. Fresenius Kabi USA, one of two domestic suppliers of propofol and the only one currently distributing the anesthetic in the states, says prisoner executions are "inconsistent" with its corporate mission. The decision represents yet another roadblock for American correctional departments, whose primary method for carrying out death sentences has been challenged after more than 30 years. Of the 33 states that allow capital punishment, most had long used sodium thiopental as part of a three-drug cocktail; but that option disappeared when the European supplier ceased to sell it for executions. As that anesthetic was depleted, most states simply substituted with pentobarbital—supplies of which subsequently have tightened after its maker refused to continue making it available for lethal injections. Now, authorities in Missouri and other states that have implemented a single-drug method using propofol are in a similar quandary. "States have chosen a medical model. And in general, the medical profession is not involved in things other than life-preserving acts," notes Death Penalty Information Center executive director Richard Dieter. "It's going to be an ongoing problem. States might have to keep changing [drug protocols], or come up with a whole new execution method."
From "Another Manufacturer Blocks Drug for Execution Use"
Medicalxpress (09/27/2012) Zagier, Alan Scher
Anesthetics and Proteins: Understanding the Interactions
Spanish scientists have used a combination of mass-resolved electronic spectroscopy and ab initio quantum chemistry calculations to model the interactions between anesthetics and proteins in finer detail than ever before. While it has been known for many years that anesthetic effects are produced through interactions between anesthetics and proteins, the Spanish team's new models show these non-covalent interactions on a sub-molecular level, allowing for a deeper understanding of the mechanisms at work. Such details were previously unknown due to the very low energy of such interactions, which made them difficult to observe. The research is ongoing and aims to perfect the method, but the results of the scientists' observations of the protein interactions of propofol were recently published in ChemPhysChem. Among the many possible applications of this research is the manufacture of more selectively targeted anesthetics that would cut down on the incidence of undesirable secondary effects on patients.
From "Anesthetics and Proteins: Understanding the Interactions" (09/24/2012)

Treating Pain More Quickly for Children With Sickle Cell Disease at Boston Medical Center
Healthcare providers at the Boston Medical Center (BMC) have been able to halve the time needed to deliver pain medications to sickle-cell patients in the pediatric emergency department (ED). Individuals with sickle-cell disease often go to the ED for pain triggered by simple problems such as cold or dehydration. In such a crisis, blood cells become sickle-shaped and get caught in blood vessels, causing pain, organ dysfunction, or even stroke. Treatment includes anti-inflammatory and pain medications, but patients often experience long waits before treatment, contributing to more frequent hospitalizations. The BMC partnered with the National Initiative for Children's Healthcare Quality's Working to Improve Sickle Cell Healthcare initiative. This national project, which aims to improve screening and treatment of sickle-cell disease, is funded through the Health Resources and Services Administration. The initiative is helping 15 U.S. healthcare teams improve care for sickle-cell patients, using techniques to improve ED wait times, coordination of care among professionals, transition of care from pediatrics to adulthood, and screening patients who may be carrying sickle-cell trait. BMC regularly recorded a 50-60 minute wait until sickle-cell patients received their first pain treatment, but after taking quality improvement steps and standardizing the process, the average wait in the pediatric ED for these patients to receive pain medication is now 20-25 minutes. Improved techniques included replacing intravenous treatment with intranasal fentanyl and developing a pain delivery calculator to determine pain doses.
From "Treating Pain More Quickly for Children With Sickle Cell Disease at Boston Medical Center"
National Initiative for Children's Healthcare Quality (09/05/2012) Grifantini, Kristina

Regional Anesthesia Improves Outcome After Distal Radius Fracture Fixation Over General Anesthesia
In this study, researchers compared the efficacy of anesthetic type on clinical outcomes following surgery for distal radius fractures. A total of 187 patients with a distal radius fracture were identified within a registry of 600 patients. Patients with operative distal radius fractures had undergone open reduction and internal fixation with a volarly applied plate and screws under regional or general anesthesia. After a minimum of one-year follow-up, there were no differences between the groups with regard to patient demographics or fracture types treated. At both three and six months post-surgery, pain had decreased among patients who received a regional block. Blocks were performed using the infraclavicular nerve block technique, which is a regional anesthetic technique for procedures performed distal to the midshaft of the humerus. Wrist and finger range of motion for patients who received regional versus general anesthesia was enhanced at all follow-up points. In addition, patients who had received regional anesthesia had higher functional scores as measured by the Disabilities of the Arm, Shoulder & Hand at three and six months. The researchers suggest that patients who are candidates should be offered regional anesthesia when undergoing repair of a displaced distal radius fracture.
From "Regional Anesthesia Improves Outcome After Distal Radius Fracture Fixation Over General Anesthesia"
Journal of Orthopaedic Trauma (09/12) Vol. 26, No. 9, P. 545 Egol, Kenneth A.; Soojian, Michael G.; Walsh, Michael; et al.
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