AANA Anesthesia E-ssential
Anesthesia E-ssential

April 15, 2015


Vital Signs

On 92-8 Vote, U.S. Senate Passes AANA-Backed Bill Permanently Repealing Medicare SGR Cuts, Clearing It for President’s Signature into Law
The U.S. Senate Tuesday evening April 14 passed H.R. 2, the Medicare Access and CHIP Reauthorization Act repealing Medicare SGR cuts permanently and reforming Medicare payment. Having defeated six amendments and a budget point of order earlier in the evening, the Senate passed the bill on a bipartisan 92-8 vote. Because the House already approved H.R. 2 March 26 without any anti-CRNA provisions on a 392-37 bipartisan majority vote, the AANA-backed bill now goes to President Obama for his signature into law shortly, accomplishing a major policy objective for AANA and CRNAs and setting up future work associated with its implementation.
Enactment of legislation permanently ending the Medicare SGR cuts means that each year’s threatened 21 percent or greater Part B reductions, risking $15,000 in annual income to the average CRNA and driving an annual legislative exercise to reverse the cuts, are coming to an end. More information will be provided to AANA members about the bill and its implementation, particularly its transitions of Medicare payment from fee-for-service models to alternative models focused more on quality, patient outcomes and cost-efficient healthcare delivery.
In the meantime, AANA members participating in Mid-Year Assembly starting this coming weekend will have a first-hand opportunity to thank members of the House and Senate for passing this critical legislation that culminates nearly 20 years of work to overturn the harmful SGR cuts. The AANA expresses its sincere thanks to AANA members who have sent more than 9,000 CRNAdvocacy messages to U.S. Representatives and Senators this past month in support of H.R. 2 and in opposition to harmful anti-CRNA provisions.
To learn more about the contents of the bill in detail, see this. To see how your representative voted, see http://clerk.house.gov/evs/2015/roll144.xml. See how your Senator voted here.

CPC Pulse

Information in this section is provided to help CRNAs keep their finger on the pulse of what’s happening with the NBCRNA’s Continued Professional Certification (CPC) program, which will launch on Aug. 1, 2016
CPC Exam vs. NCE: Different Exams for Different Audiences
We know that the knowledge required of an experienced practitioner is different from the knowledge that is required of a new practitioner. The CPC Examination is not the NCE, or National Certification Examination. The CPC Examination will not be as encompassing as the NCE, rather focusing on core domains of nurse anesthesia practice, relevant to every CRNA. The NBCRNA began the process of planning the CPC Examination by conducting a professional practice analysis (PPA) in 2009. NBCRNA surveyed nurse anesthetists in practice and used those findings to establish the topic areas of the CPC Examination content outline and the core modules: airway management, equipment and technology, applied clinical pharmacology, and physiology and pathophysiology. The NBCRNA will follow up this 2009 PPA with a second PPA survey in May 2015, to validate and refine the content outline. This process will ensure that the focus of the CPC Examination is on the knowledge that all nurse anesthetists in practice should know, regardless of their practice focus. More information can be found on the AANA and the NBCRNA websites.
CPC Sound Bite: Do I Really Have to Take an Exam to be Recertified?
This is the third in a series of video messages on the Continued Professional Certification (CPC) Program, recorded by President Sharon Pearce, CRNA, MSN, and President-elect Juan Quintana, CRNA, DNP, MHS. In these brief videos, President Pearce and President-elect Quintana answer questions about the CPC program. Click here to view the video.


The Pulse

  • CMS Announces It Plans to Hold Physician and CRNA Medicare Claims until Further Congressional Action on SGR
  • April 18, 2015 – 8 a.m. EDT - AANA Board Meeting Open Session to be Live Audio Streamed!
  • National Institutes of Health Releases Draft National Pain Strategy; AANA Members Involved in Its Development
  • Online Forum for Candidates for the AANA Board of Directors
  • ANA Seeks Comments on Draft Position Statement
  • Need CE Credits?
  • Apply Now - May 1 Deadlines
  • Student Rep Position on AANA Foundation Board of Trustees Available for 2015-2017
  • Register Now for Business of Anesthesia Conference
  • Registration Now Open for Jack Neary Pain Management Workshop, Part 1
  • Update on the Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care
  • AANA Participates in Medicare’s Working Session on Healthcare Payment Learning and Action Network
  • AANA Provides Support for Additional Nurse Anesthesia Traineeship and Nurse Workforce Development Funding in FY 2016 Appropriations Testimony 
  • Last Chance to Register for the 2015 AANA Mid-Year Assembly, the CRNA-PAC Event, and the First-Ever Capitol Hill Rally
  • Amendments

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
CMS Announces It Plans to Hold Physician and CRNA Medicare Claims until Further Congressional Action on SGR
The Centers for Medicare & Medicaid Services (CMS) announced at the end of March that it would hold physician and CRNA Medicare Part B claims for a short period of time until further Senate action and presidential approval on legislation repealing the sustainable growth rate (SGR) cuts. For CRNAs, this means that Part B claims submitted for services April 1 and thereafter will be held by Medicare so the 21 percent SGR payment reduction is not assessed. Under current law, electronic claims are not paid sooner than 14 calendar days after the date submitted. The hold on claims is meant to “minimize claims reprocessing and disruption,” the agency said. See more information here.
April 18, 2015 – 8 a.m. EDT - AANA Board Meeting Open Session to be Live Audio Streamed!
The April 18, 2015, Open Session of the AANA Board Meeting will be audio streamed live at 8 a.m. EDT. AANA membership and pre-registration is required. More information is available at: http://www.aana.com/myaana/AANABusiness/governance/Pages/Open-Session-Board-Meeting-Agendas.aspx.

National Institutes of Health Releases Draft National Pain Strategy; AANA Members Involved in Its Development
The National Institutes of Health (NIH) released its draft National Pain Strategy on April 2, which the AANA is reviewing and circulating among AANA membership in advance of a late May deadline for public comments. Because CRNAs are always addressing patients’ challenges with pain, it is important for the profession to evaluate and respond to the draft plan which will shape future government funding, policy and healthcare industry direction in pain prevention, assessment and care delivery systems.
As authorized by the Affordable Care Act, the Assistant Secretary for Health and Human Services (HHS) asked the NIH Interagency Pain Research Coordinating Committee (IPRCC) to oversee the creation of the National Pain Strategy. Six expert working groups explored important areas of need identified in the recommendations in the Institute of Medicine’s 2011 report “Relieving Pain in America”—population research, prevention and care, disparities, service delivery and reimbursement, professional education and training, and public awareness and communication. Two AANA members, Margaret Faut-Callahan, CRNA, PhD, FNAP, FAAN, and Jackie Rowles, CRNA, MBA, ANP-BC, FAAPM, FAAN, a past president of the AANA, were nominated by the AANA and appointed to two of the expert working groups to the IPRCC.
NIH is seeking comments on the draft plan by May 20. AANA is reviewing the draft plan for comment. Read the draft National Pain Strategy, “Relieving Pain in America,” and the Federal Register solicitation.
Online Forum for Candidates for the AANA Board of Directors
Take advantage of this opportunity to become better acquainted with the candidates seeking election to the AANA Board of Directors. The Online Forum for Candidates for the AANA Board of Directors will be available to members for question submission on Monday, April 20, 2015. This un-moderated forum is located in the members-only section of the AANA website at: http://www.aana.com/electioncenter. The forum will be available for members to view until the voting cut-off date of June 2, 2015.
ANA Seeks Comments on Draft Position Statement
The American Nurses Association's (ANA’S) Workplace Violence and Incivility Professional Issues Panel is requesting public comment on its draft position statment. Comment period is open until 5 p.m. ET on April 30, 2015. Click here to access the public comments page.
Need CE Credits?
The recertification period is now open, and the July 31 deadline is coming up fast. AANALearn can help with a plethora of courses. AANA members save 30 percent every day. Find out more.

Apply Now – May 1 Deadlines
Applications for the following are due May 1, 2015, and are at www.aanafoundation.com.
“State of the Science” – General Poster Presentation
An opportunity for CRNAs and nurse anesthesia students to present their research findings and innovative educational approaches through a poster presentation at the AANA Annual Congress. Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics.
Research Grant Proposals
General research grants are awarded to AANA member CRNAs in good standing. Research funding priorities change annually. Please refer to the research priorities on the proposal application for more information.
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
Student Rep Position on AANA Foundation Board of Trustees Available for 2015-2017
Attention Students… The AANA Foundation would like to encourage energetic and highly motivated students to apply for the student representative position on the AANA Foundation Board of Trustees. The student representative serves a two-year term as a full board member with equal voting privileges and represents an integral role as the voice for students across the country. The student representative is a valued and essential board member for accomplishing the AANA Foundation’s mission. Click here for the Student Trustee Application. The deadline for the application has been extended to May 1, 2015. For additional information, please review the application requirements and/or email foundation@aana.com.

Register Now for Business of Anesthesia Conference
Join us in San Diego on June 26-27 for a two-day conference that will arm you with critical tools for navigating the business aspects of anesthesia practice. Get real-world advice from expert speakers with experience in building and maintaining a successful practice. Whether you are still in training or have owned your practice for years, you’ll benefit from best practices and strategies for success in an ever-changing healthcare climate. Register before May 26 and Save $50!
Register Now for the Nurse Anesthesia Annual Congress
August 29-Sept. 1
Salt Lake City
The Nurse Anesthesia Annual Congress is the world's largest educational, professional, and social event for Certified Registered Nurse Anesthetists. Choose from seven education tracks, including practical hands-on learning and networking, in addition to the largest exhibit of its kind. Register Now!

Fall Leadership Academy: Save the Date!
November 6-8, 2015
Westin O'Hare, Rosemont, Ill.
Watch the AANA website and future issues of the NewsBulletin and E-ssential for more information!

Update on the Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care
The AANA and its members continue to advocate for legislation and a Veterans Health Administration (VHA) proposal that would authorize all advanced practice registered nurses (APRNs), including CRNAs, to practice as full practice providers in the VHA and help improve veterans’ access to quality healthcare.
Clear understanding of the complex procedural aspects of this VHA issue is critical to knowing what to say to your lawmakers in support of veterans access to care delivered by CRNAs. In short:
  • The AANA is supporting new legislation in the House, H.R. 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill has nine cosponsors including Reps. Jared Polis (D-CO), James Langevin (D-RI), James McGovern (D-MA), Raul Grijalva (D-AZ), Elise Stefanik (R-NY), Collin Peterson (D-MN), Scott Rigell (R-VA), and Frank LoBiondo (R-NJ). AANA is requesting that AANA members contact their U.S. Representatives to cosponsor this bill. Please do so here.
  • The AANA has expressed strong concerns about legislation in the Senate, S. 297, the “Frontlines to Lifelines Act,” sponsored by Sen. Mark Kirk (R-IL). Unlike the House bill, H.R. 1247, S. 297 recognizes only three of the four APRN specialties for full practice authority in the VHA, omitting CRNAs. The AANA encourages CRNAs to contact their U.S. Senators with similar concerns about S. 297, and to request that the bill be amended to include CRNAs. Please do so here.
  • The AANA continues to strongly support the VHA’s efforts to update its Nursing Handbook to recognize CRNAs and other APRNs to their full practice authority, consistent with the recommendations of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. According to the VHA, the agency intends to publish regulatory rulemaking later this year recognizing CRNAs and other APRNs to their full practice authority in the VHA. Thousands of AANA members have already contacted the VHA in support of this work; AANA members are currently being requested to focus on contacting Congress.
Since mid-February, AANA members have sent over 12,000 messages to their federal legislators expressing support for H.R. 1247 and concern for S. 297 as written.
If you have not already done so, please contact your Representative and request that they cosponsor H.R. 1247: https://www.crna-pac.com/actionalerts.aspx. If you have not yet contacted your Senators, take action today and request that they refrain from cosponsoring or supporting S. 297 until it is amended to include CRNAs: https://www.crna-pac.com/actionalerts.aspx (requires AANA member login and password). 
AANA Participates in Medicare’s Working Session on Healthcare Payment Learning and Action Network
The administration inaugurated its new Healthcare Payment Learning and Action Network (HCPLAN) on March 25, and the AANA was present as a stakeholder. Hosted by the Centers for Medicare & Medicaid Services (CMS), the HCPLAN is intended to examine issues and challenges associated with the development and deployment of alternative payment models for Medicare. As previously reported, Medicare proposed on Jan. 26 to have 85 percent of its provider payments made in relation to healthcare quality or value outcomes by the end of 2016. The AANA has become a stakeholder in the HCPLAN and was invited to participate in the working session along with several health plans, health systems, trade associations, and professional associations. Individual CRNAs should consider working with their facilities to determine whether they should join the HCPLAN, or, if their facility has already joined, how they can play a role in this initiative. To learn more about the Health Care Payment Learning and Action Network, visit: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-03-25.html, and to register for the Health Care Payment Learning and Action Network, go to http://innovationgov.force.com/hcplan
AANA Provides Support for Additional Nurse Anesthesia Traineeship and Nurse Workforce Development Funding in FY 2016 Appropriations Testimony
In support of nurse anesthesia workforce development, the AANA on March 27 submitted testimony to the House and Senate Labor-HHS-Education Appropriations Subcommittees in support of Title 8 nurse workforce development funding and nurse anesthesia traineeships.
In requesting at least $4 million for nurse anesthesia traineeships, $66.76 million for Advanced Education Nursing, and $244 million for Title 8 nurse workforce development programs, AANA President Sharon P. Pearce, CRNA, MSN, stated, “This funding request is justified by the safety and value proposition of nurse anesthesia, and by anticipated growth in demand for CRNA services as baby boomers retire, become Medicare eligible, and require more healthcare services.” The AANA also joined the Nursing Community in support of its request for $244 million in Title 8 funding and $150 million in funding for the National Institute for Nursing Research.
Lawmakers in the House and Senate also circulated “Dear Colleague” letters to demonstrate support for Title 8 nurse workforce development programs important to CRNA education. The House letter was circulated by Reps. Richard Hanna (R-NY) and Lois Capps (D-CA) and the Senate letter was being circulated by Sen. Jeff Merkley (D-OR).
Last Chance to Register for the 2015 AANA Mid-Year Assembly, the CRNA-PAC Event, and the First-Ever Capitol Hill Rally
To make your voice and the voices of CRNAs strong in Washington, only a couple of days remain to join your colleagues for the AANA Mid-Year Assembly, April 18-22, 2015, in Arlington, Va. For the first time ever, our Capitol Hill advocacy days, starting Tuesday, April 21, will kick off with a CRNA rally with members of Congress at the base of Capitol Hill. Kick start Congressional visits with a bang! This energetic event will take place with the U.S. Capitol as our backdrop and is within a five-minute walk to your House and Senate appointments. http://www.aana.com/meetings/aanaassemblies/Pages/Mid-Year-Assembly-Registration.aspx
The following is an FEC required legal notification 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 its 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. Each contributor must be a US Citizen.  


Pregnant Women Pass on Opioid Addiction to Infants
A large retrospective study confirms that expecting mothers are routinely given opioid pain relievers (OPRs) during pregnancy, which subsequently increases the risk of addiction and withdrawal in their babies. Researchers in Tennessee analyzed 112,029 women statewide, finding that 28 percent were prescribed at least one OPR while they were pregnant to treat conditions such as anxiety, depression, and migraine headache. Neonatal abstinence syndrome (NAS) was documented in 1,086 infants, the majority of which—65 percent—were delivered to women with at least one OPR prescription. A closer look revealed that NAS was more likely to develop in cases where the mother used OPRs, smoked cigarettes every day, or used selective serotonin reuptake inhibitor (SSRI) in the 30 days before delivery. "These associations provide compelling evidence that OPRs and other concurrent antenatal exposures have a measurable deleterious impact on infants who are more likely than others to be born with NAS and related complications" such as low birth weight, seizures, and feeding difficulties, the researchers wrote online in Pediatrics.
From "Pregnant Women Pass on Opioid Addiction to Infants"
Medscape (04/13/15) Davenport, Liam
Effective Pain Interventions for Veterans
A regimen incorporating analgesics, self-management strategies, and cognitive behavioral therapy promises to provide relief from chronic pain in veterans of recent deployments. The ESCAPE (Evaluation of Stepped Care for Chronic Pain) study enrolled 241 military members who returned from Iraq or Afghanistan with musculoskeletal back, neck, knee, or shoulder pain. Research participants were randomly assigned to receive the stepped-care treatment or the standard approach, which entailed educational literature and directives to discuss pain with a doctor. Veterans who completed the 12-week stepped-care intervention experienced a minimum nine-month reduction in pain-related disability and pain severity; the treatment protocol also curtailed the extent to which pain influenced patients' mood, work, physical and social activity, sleep, personal relationships, and enjoyment of life.
From "Effective Pain Interventions for Veterans"
HCPLive (04/02/15)
FDA Issues Final Guidance on the Evaluation and Labeling of Abuse-Deterrent Opioids
The Food and Drug Administration (FDA) issued on April 1 final guidance to help the industry develop opioids with abuse-deterrent properties. The agency is encouraging drug makers to develop opioids that work correctly when taken as directed; however, they may be formulated in a way that deters misuse, such as making it hard to snort or inject the drug. FDA's Guidance for Industry: Abuse-Deterrent Opioids – Evaluation and Labeling details the agency's views on the studies that should be conducted to demonstrate that a certain formulation has abuse-deterrent properties, and it makes recommendations about how the studies should be performed and evaluated. In addition, the agency discusses what labeling claims may be approved based on the studies. "The science of abuse-deterrent medication is rapidly evolving, and the FDA is eager to engage with manufacturers to help make these medications available to patients who need them," said FDA Commissioner Margaret A. Hamburg, MD. "We feel this is a key part of combating opioid abuse. We have to work hard with industry to support the development of new formulations that are difficult to abuse but are effective and available when needed."
From "FDA Issues Final Guidance on the Evaluation and Labeling of Abuse-Deterrent Opioids"
FDA News Release (04/01/15)
Rates of Opioid Misuse, Abuse, and Addiction in Chronic Pain
Opioid use in chronic pain treatment is complex because it while it serves to benefit, it can also cause harm. Increases in opioid prescription rates have made it very important to identify as many patients who are incorrectly using the drugs as possible. Researchers from the University of New Mexico conducted a review of 38 studies to determine the rates of problematic use by stratifying the data into three strictly defined categories: misuse (incorrect use regardless of effects), abuse (intentional misuse for nonmedical purposes), and addiction (pattern of compulsive, harmful use). The study found that rates of misuse ranged between 21 percent and 29 percent, while abuse was only reported in one study. Rates of problematic use ranged from less than 1 percent to 81 percent in the studies. Addiction rates were between 8 percent and 12 percent among the studies. Two major implications of the study are that misuse and addiction indicate problematic opioid use, and that misuse appears to be more common than addiction. In conclusion, the authors write that they "are not certain whether the benefits derived from opioids, which are rather unclear ... compensate for this additional burden to patients and health care systems."
From "Rates of Opioid Misuse, Abuse, and Addiction in Chronic Pain"
Pain (04/01/15) Vol. 156, No. 4, P. 569-576 Vowles, Kevin E.; McEntee, Mindy L.; Julnes, Peter Siyahhan; et al.
Efficacy and Safety of Paracetamol for Spinal Pain and Osteoarthritis
An Australian study has found that paracetamol (acetaminophen) is ineffective for the treatment of low back pain. The meta-analysis looked at randomized controlled trials comparing the efficacy and safety of paracetamol with placebo for spinal pain and osteoarthritis (OA) of the hip or knee. Data from the 12 reports studied show that there was high-quality evidence that paracetamol was ineffective for reducing pain intensity and disability or improving quality of life in the short term for patients with low back pain. Meanwhile, for hip or knee OA, there was high-quality evidence that the drug had a significant, though not clinically important, effect on pain and disability in the short term. Patient adherence to treatment and use of rescue medication was similar between the treatment and placebo groups. In addition, the groups had similar numbers of patients reporting any adverse event, any serious adverse events, or withdrawing from the study due to adverse events. The authors note that while the evidence indicated that patients taking paracetamol were more likely to have abnormal results on liver function tests, the clinical importance of that effect is not clear. The findings, they write, "support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines."
From "Efficacy and Safety of Paracetamol for Spinal Pain and Osteoarthritis"
BMJ (03/31/15) Machado, Gustavo C.; Maher, Chris G.; Ferreira, Paulo H.; et al.
Complexities of Opioid-Induced Hyperalgesia Poorly Understood
Opioid-induced hyperalgesia is a focal point in the national discussion of opioid addiction, and a Food and Drug Administration call for clinical trials to better understand the phenomenon highlights a problem that is more complex than many realize, according to an expert. Speaking at the American Academy of Pain Medicine 31st Annual Meeting, Norman Harden, MD, of the Rehabilitation Institute of Chicago at Northwestern University said there is an abundance of information about increased opioid use and hyperalgesia symptoms in rats, but there is limited information about the effects on humans. The main confusion stems from the hypersensitivity to pain that can occur in patients who use high-dose opioids for a long time. It is not yet understood whether this pain is caused by the opioids themselves or whether it is a natural tolerance that has developed. The symptoms may also represent allodynia and hyperalgesia. A pain test response comparison yielded no significant differences between patients, though a pinprick wind-up test revealed greater sensitivity in the patients not taking opioids. This supports the idea that hyperalgesia in many cases may be part of the natural progression of chronic pain. Researchers agree that a lot of work still needs to be done to fully understand the phenomenon.
From "Complexities of Opioid-Induced Hyperalgesia Poorly Understood"
Medscape (03/31/15) Melville, Nancy A.
Improving the Safety of Epidural Steroid Injections
A multidisciplinary working group recently discussed possible adverse effects of epidural steroid injections and recommended safety improvements. The Food and Drug Administration's Safe Use Initiative coordinated the group's deliberations; however, it had no role in the final recommendations. The panel recommended that all cervical and lumbar interlaminar epidural steroid injections be performed with image guidance, with appropriate views and a test dose of contrast medium. With cervical and lumbar transforaminal epidural steroid injections, contrast medium should be injected under real-time fluoroscopy or digital subtraction imaging before any substance that may be hazardous to the patient is injected. Cervical interlaminar epidural steroid injections are recommended at C7-T1, but preferably not higher than C6-7 level. Particulate steroids should be avoided for therapeutic cervical transforaminal injections. Further research should compare nonparticulate steroids with particulate steroid formulations.
From "Improving the Safety of Epidural Steroid Injections"
Journal of the American Medical Association (03/30/15) Benzon, Honorio T.; Huntoon, Marc A.; Rathmell, James P.
Health Providers' Stand Could Invite Other Execution Methods
Following the American Pharmacist Association's adoption of a resolution against participation in lethal injections, the medical community is united in its opposition to playing any role in executions. Corrections departments may find it increasingly hard to obtain the already scarce chemicals for lethal injections and prompt states with the death penalty to return to previously rejected methods, according to people on both sides of the issue. APhA's resolution—which said that participation in executions goes against its members' core values as health care providers—echoes ethics codes adopted by associations for doctors, nurses, and anesthesia providers on the issue. While not legally binding, the policies likely will decrease the number of businesses willing to sell such lethal injection drugs to prison departments.
From "Health Providers' Stand Could Invite Other Execution Methods"
Associated Press (03/31/15)
National Action Plan for Combating Antibiotic-Resistant Bacteria
The White House has released its National Action Plan for Combating Antibiotic-resistant Bacteria, a detailed plan to address the issue of antibiotic resistance. The 63-page plan outlines steps for adopting the National Strategy for Combating Antibiotic-Resistant Bacteria and implementing the policy recommendations of the President's Council of Advisors on Science and Technology. The plan lists five goals: slow the emergency of resistant bacteria and prevent the spread of resistant infections; strengthen national one-health surveillance efforts to combat resistance; advance development and use of rapid and innovative diagnostic tests for the identification and characterization of resistant bacteria; accelerate basic and applied research and development for new antibiotics, therapeutics, and vaccines; and improve international collaboration and capacities for antibiotic resistance prevention, surveillance, control, and antibiotic research and development. In addition, the plan sets 2020 targets for significant reductions in the incidence of urgent and serious pathogens, including carbapenem-resistant Enterobacteriaceae, methicillin-resistant Staphylococcus aureus, and Clostridium difficile.
From "National Action Plan for Combating Antibiotic-Resistant Bacteria"
White House (03/27/15)
Stellate Ganglion Block May Promote Placebo Effect in PTSD
Despite promising results from earlier research, a new investigation into stellate ganglion block failed to demonstrate the same kind of potential as a treatment for post-traumatic stress disorder (PTSD). The procedure entails injecting local anesthetic into a cluster of nerves at the back of the neck in order to block their function, which is believed to control fight-or-flight response and mediate pain signals. In uncontrolled trials and case studies, the technique quickly and dramatically alleviated depression, anxiety, flashbacks, and other PTSD symptoms. However, a controlled intervention involving 42 military subjects observed no statistically significant difference between soldiers who received stellate ganglion block and service members who were given a pseudo injection. PTSD symptoms did improve markedly in both groups following treatment, though. "The most obvious explanation would be that the previously reported benefits for PTSD were attributable to placebo effect," speculates study author Robert McLay, MD, PhD. "Alternatively, it is possible that only particular people with PTSD respond well to the SGB treatment, or that small variations in how the technique is performed result in different outcomes for PTSD."
From "Stellate Ganglion Block May Promote Placebo Effect in PTSD"
Neurology Advisor (03/26/15) Ciccone, Alicia
Amid Crisis, States Expand Access to Opioid Rescue Drug
Thirty states and the District of Columbia have enacted laws or developed pilot programs to widen access to naloxone, according to the National Conference of State Legislatures. Ohio began with a year-long pilot program in a single county that allowed trained emergency responders to use naloxone, then last year passed a statewide law allowing medical professionals to distribute it and family and friends of addicts to use it on overdose victims without fear of prosecution. Kentucky lawmakers are now considering whether to allow doctors to prescribe not only to addicts, as under current law, but to family, friends, police, and firefighters as well. "This is a strategy that's sweeping the nation," says Van Ingram, executive director of the Kentucky Office of Drug Control Policy. "It's a proven way to save lives." Fatal drug overdoses have risen more than six-fold in the past three decades, according to the Network for Public Health Law; government figures show they now claim the lives of about 120 people each day in the United States. Opioids kill by depressing respiration until breathing stops. Naloxone reverses this. While naloxone is generally considered safe, some in the drug-treatment world worry that addicts will take more opioids to counteract the withdrawal they experience after being injected, leading to a second overdose.
From "Amid Crisis, States Expand Access to Opioid Rescue Drug"
USA Today (03/24/15) Unger, Laura
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