AANA Anesthesia E-ssential

Anesthesia E-ssential February 27, 2015

AANA Anestehsia E-ssential
Anesthesia E-ssential

February 27, 2015


Board Update

Help Secure Full Practice Authority for VHA CRNAs and APRNs
Over the past two years, AANA has been working to advance the Veterans Health Administration (VHA) recognition of full practice authority for CRNAs and other APRNs. Your AANA leadership has met with VHA officials on numerous occasions, collaborated with 53 APRN and nursing organizations, secured support for full practice authority recognition from more than 30 members of Congress, launched a member advocacy effort, and met with many organizations and representatives serving our veterans to educate them about the value and role of CRNA services in the VHA.
A recently filed Senate bill, S. 297, undermines these efforts! Introduced by Sen. Mark Kirk (R-IL), this bill permits APRNs in the VA system to function without physician supervision but carves out CRNAs. The repercussions of this legislation go well beyond the VHA and could filter down to all states. Used by the American Society of Anesthesiologists and state societies to bolster their argument for restrictions to practice, the possibility exists of CRNAs not being included in independent practice language being adopted by states as part of the APRN Consensus Model.
The AANA has responded strongly to this development, but more remains to be done to educate Congress and to support the VHA in its work. Help us secure full practice authority for VHA CRNAs and APRNs and stop attacks on the accessible, safe, and cost-effective care that we provide as CRNAs. Take action NOW by contacting your legislators today through our CRNAdvocacy system. Time to put politics aside and put our nation's veterans first.


The Pulse

  • USA Today Special Section on Patient Safety Features CRNAs
  • Focus on Class B Requirements
  • CPC Sound Bite: Why Change the Recertification Process for CRNAs?
  • Supreme Court Rules in Favor of FTC in NC Board of Dental Examiners Case
  • AANA Journal Seeks Cover Images
  • Spring Fellowship Applications Now Available
    Deadline Date – April 1, 2015
  • “State of the Science” Oral and General Poster Presentation
    Applications Now Available
  • AmazonSmile Supports the AANA Foundation
  • Attention Students…
    AANA Foundation Student Opportunities
  • Nurse Anesthesia Annual Congress Registration Opens Soon!
  • Advocate for Your Profession and Earn CE Credits at the Mid-Year Assembly
  • The AANA Essentials of Obstetric Analgesia/Anesthesia Workshop
  • Registration Now Open for Spinal-Epidural Workshop
  • Business of Anesthesia Conference Registration Now Open
  • AANA Objects to Omission of CRNAs from Senate Bill Recognizing VHA APRNs; CRNAs and SRNAs Requested to Continue Taking Action Now
  • House Committee Examines VA Budget Request; GAO Releases Report on VHA Healthcare Costs
  • AANA Member Jan Setnor, CRNA, Speaks at Nursing Community Briefing February 24
  • To Protect and Advance CRNA Practice, the CRNA-PAC 2015 Development Campaign is Under Way
  • Alternative Payment Models Should Help Decrease Healthcare Costs and Improve Quality of Care, AANA Tells Federal Trade Commission
  • AANA and APRN Organizations Comment on the House Energy and Commerce Committee’s “21st Century Cures Act of 2015” Discussion Draft
  • AANA Participates in AcademyHealth National Policy Conference
  • 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
USA Today Special Section on Patient Safety Features CRNAs
CRNAs and the AANA have a big presence in a special section dedicated to Patient Safety appearing in the print version of the Feb. 27, 2015, weekend edition of USA Today, as well as online at Mediaplanet’s www.futureofhealthcarenews.com. The special section is being distributed in print to select markets across the United States, including Chicago, Los Angeles, Minneapolis, New York, Seattle, Washington, D.C., and Baltimore, and will reach more than 1.3 million USA Today readers. CRNAs are featured in a full page of editorial content titled “While You Were Sleeping,” as well as a full page ad with the headline “Anesthesia Care for the Ages.” CRNAs are also featured in various digital ads on the Mediaplanet website, delivering the AANA’s message that CRNAs are the “future of anesthesia care today.” Read the special section at www.futureofhealthcarenews.com. AANA has participated in two other special sections previously, one honoring our military veterans and the other on pain management. Both can be viewed at www.aana.com.

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
Focus on Class B Requirements
Class B requirements are professional development or non-assessed learning activities that enhance the nurse anesthetist’s foundational knowledge of nurse anesthesia practice, support patient safety, or foster the nurse anesthetist’s understanding of the broader healthcare environment. If an activity addresses at least one of these three concepts, it would qualify for the Class B requirement. Class B does not have to be assessed for prior approval. Professional requirements, education and teaching, presentations, research, professional service, or administrative functions, such as clinical coordinator or chief nurse anesthetist duties, would qualify as Class B. Some clinical or employer requirements, such as morbidity and mortality conferences or infection prevention training, also would qualify. Additional qualifying activities are available on the NBCRNA’s CPC page. If you take more Class A credits than the 60 required for any 4-year CPC cycle, you may apply those excess credits to Class B requirements. CRNAs can earn up to 40 Class B credits. More information about Class A and Class B requirements can be found in the CPC Report on the AANA and the NBCRNA websites. 
CPC Sound Bite: Why Change the Recertification Process for CRNAs?
This is the first 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. (AANA member login and password required.)

Supreme Court Rules in Favor of FTC in NC Board of Dental Examiners Case
On Wednesday, Feb. 25, the U.S. Supreme Court issued a decision in favor of the Federal Trade Commission in the North Carolina Board of Dental Examiners v. FTC case, essentially affirming the arguments that AANA raised in its Amicus Brief filed in August 2014, supporting the FTC position. AANA is very pleased to hear that the U.S. Supreme Court upheld the decision of the lower court ruling that the North Carolina Board of Dental Examiners illegally thwarted competition by engaging in anticompetitive conduct to prevent non-dentists, including those offering lower prices, from providing teeth whitening services. The AANA and its co-Amici had a strong interest in this case because unnecessary restrictions on the practice of any qualified healthcare provider limit patient access to quality care, may increase cost, and can compromise the quality of healthcare delivery.
The Supreme Court Decision is consistent with the arguments made by the AANA and its co-Amici who urged the Supreme Court to affirm the appellate court’s decision for a number reasons, including concerns that unsupervised state regulatory boards comprised mostly of practicing professionals have the potential of acting in their own economic self-interest by protecting their competitive position in ways not intended or authorized by the state, thus warranting oversight.
The AANA and its co-amici believe that requiring active supervision by an independent state agency will provide the necessary assurances that such boards will act in the public’s interest, as opposed to their own private economic interests.
For further information, read the AANA Press Release, the Supreme Court's 6-3 full opinion, the amicus brief, and the AANA Statement.
AANA Journal Seeks Cover Images
AANA members are encouraged to submit original photographs for possible publication on the cover of AANA Journal. Photos should depict CRNAs performing their job function. Email photos to Larry Sawyer at lsawyer@aana.com. Include a detailed description of the activity in each picture, including identification of all individuals by name, title, and credentials. CRNAs depicted in the OR should be shown following all practice guidelines including wearing gloves, cap, goggles, and mask. Be sure to obtain/submit a signed release form from all those pictured. Image size/resolution must be at least 2513 pixels X 2456 pixels at a minimum of 300 dpi.


Spring Fellowship Applications Now Available
Deadline Date – April 1, 2015
Attention Researchers… Post-Doctoral and Doctoral Fellowship applications are currently available on the AANA Foundation website at www.aanafoundation.com. Click here to access the application.
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
“State of the Science” Oral and General Poster Presentation
Applications Now Available

“State of the Science” offers an opportunity for CRNAs and SRNAs to present their research findings and innovative educational approaches at the AANA Nurse Anesthesia Annual Congress. Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics. Click here to access the applications, which are currently available on the AANA Foundation website at www.aanafoundation.com.
  • Oral Poster Presentation – April 1 Deadline – An award of up to $1,000 accompanies oral presentation.
  • General Poster Presentation – May 1 Deadline.

If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.

AmazonSmile Supports the AANA Foundation
When you shop at AmazonSmile, Amazon donates 0.5 percent of the purchase price to the AANA Foundation. Please bookmark the link http://smile.amazon.com/ch/36-3145692 and support the Foundation every time you shop
Attention Students…
AANA Foundation Student Opportunities
Click here to visit the AANA Foundation Student webpage for exciting opportunities for nurse anesthesia students. Applications are now available for the following:
  • Student Scholarship – Due March 1, 2015
  • AANA Foundation Board of Trustees Student Representative – Due April 1, 2015
  • “State of the Science” Oral Poster Presentation – Due April 1, 2015
  • “State of the Science” General Poster Presentation – Due May 1, 2015
  • If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.

Nurse Anesthesia Annual Congress Registration Opens Soon!
Save the date for the 2015 Nurse Anesthesia Annual Congress, Aug. 29-Sept. 1, 2015, in Salt Lake City, Utah. Watch your mailbox for the Preliminary Program: Registration opens in mid-March!
Advocate for Your Profession and Earn CE Credits at the Mid-Year Assembly
This year's AANA Mid-Year Assembly, April 18-22, in Arlington, Va., is an excellent opportunity for you to participate in the national policymaking impacting our profession, and with 10 educational sessions to choose from, you can earn CEs while you're there. Register today: Early Bird pricing ends March 27.
The AANA Essentials of Obstetric Analgesia/Anesthesia Workshop
Building and maintaining knowledge of the parturient is critical to the success of CRNAs who work, or who are preparing to begin working, in the labor and delivery suite. AANA’s Essentials of Obstetric Analgesia/Anesthesia Workshop will be held on May 13, 2015, at the AANA’s offices in Park Ridge, Ill. Register here.
Registration Now Open for Spinal-Epidural Workshop
The Spinal-Epidural Workshop, to be held May 14-16, 2015, in Park Ridge, Ill., provides a thorough overview using lecture and guided hands-on experiences of epidural and spinal anesthesia procedures. Register now—space is limited and this popular workshop fills up fast! 

Business of Anesthesia Conference Registration Now Open
The AANA Business of Anesthesia Workshop addresses critical business issues facing CRNAs and will be held June 26-27, 2015, in San Diego, Calif. Whether you are employed or have your own business, this workshop has the necessary information to help you navigate the changing business environment in healthcare.

AANA Objects to Omission of CRNAs from Senate Bill Recognizing VHA APRNs; CRNAs and SRNAs Requested to Continue Taking Action Now
The AANA asked and CRNAs have delivered: Following a CRNAdvocacy Alert, AANA members sent more than 7,000 messages to their U.S. Senators, expressing concern that a new bill (S 297, Kirk, R-IL) fails to recognize CRNAs among the APRN specialties it authorizes for full practice authority in the Veterans Health Administration (VHA). 
But many more members must speak in order for this critical message to be heard: CRNAs and all APRNs provide excellent care to Veterans every day, and would be able to help reduce Veterans’ wait times for care if they all could provide care to their full practice authority.
AANA urges its members to contact their U.S. Senators and request that S 297, which has been referred to the Senate Veterans Affairs Committee, be amended to recognize VHA CRNAs to their full practice authority.  In a letter to the Chair and Ranking Member of the Senate Veterans Affairs Committee, AANA President Sharon Pearce, CRNA, MSN, stated, “Ensuring that CRNAs may practice within the VHA to their full practice authority is a common-sense part of the solution to the well-documented problem of Veterans being denied or delayed access to care…Should the Committee move S 297, we request that you include CRNAs…”.
Take action today and request your U.S. Senators to refrain from cosponsoring or supporting this legislation until it is amended to include CRNAs: https://www.crna-pac.com/composeletters.aspx?AlertID=177  (requires AANA member login and password). See the AANA’s letter here. Text for S 297 is available here.
House Committee Examines VA Budget Request; GAO Releases Report on VHA Healthcare Costs
To help protect and advance CRNA practice, the AANA attended several House Veterans’ Affairs Committee hearings in February to monitor the progress of the Veterans Health Administration (VHA) Nursing Handbook revisions process. Testifying before the panel Feb. 11 was Veterans Affairs Secretary Robert McDonald, who focused on the Administration’s 2016 budget request.
The Veterans Administration is requesting $168 billion in fiscal year 2015, an increase of 7.8% from fiscal year 2015. The request comes at the same time as the Government Accountability Office (GAO) released a report on Feb. 11 stating that VHA healthcare costs had tripled since 2002 to more than $59 billion a year. According to the GAO, most of the increase comes from providing care to Iraq and Afghanistan Veterans, and to providing care to aging Vietnam Veterans. The GAO reports that the costs will likely continue as the VA mends a broken system of long delays to care.
The AANA continues to advocate on behalf of the high quality care CRNAs provide as a commonsense part of the solution to expanding access to critical services to Veterans. To read reviews of the GAO Report, see: http://kaiserhealthnews.org/morning-breakout/report-va-system-at-high-risk-for-fraud-mismanagement/. To read the full report, see: http://www.gao.gov/assets/670/668415.pdf
AANA Member Jan Setnor, CRNA, Speaks at Nursing Community Briefing February 24
The AANA participated in the Nursing Community Congressional Briefing titled, “Solving Today’s Pressing Healthcare Issues: Nursing’s Impact,” on Feb. 24. Col. Janet Setnor, CRNA, MSN, USAFR, NC, President-Elect of the Virginia Association of Nurse Anesthetists, spoke in support of the Veterans Health Administration’s proposal to allow CRNAs to practice to their full practice authority. During her presentation, Col. Setnor stated, “Congress should support efforts which seek to improve patient access to high quality, cost-effective care by supporting the full practice authority for APRNs, including CRNAs.”
Col. Setnor was joined by Maryann Alexander, PhD, RN Chief Officer, Nursing Regulation, National Council of State Boards of Nursing, Julie Sochalski, PhD, RN, FAAN, Associate Professor of Nursing, University of Pennsylvania School of Nursing, and Maureen Swick, PhD, MSN, RN, NEA-BC, Senior VP and Chief Nurse Executive, Inova Health System. The purpose of the briefing was to discuss how the Institute of Medicine’s “Future of Nursing: Leading Change, Advancing Health,” recommendations have been implemented into practice. In her remarks, Dr. Sochalski also provided support for Title VIII funding, touting the return on investment in the form of additional workforce and healthcare innovation. The Nursing Community is requesting funding levels of $244 million for FY 2016 for Title VIII programs, which includes the Advanced Education Nursing program in which CRNA programs participate.
To learn more about the Nursing Community, see: http://www.thenursingcommunity.org/. To take action in support of the VHA’s proposal, see: https://www.crna-pac.com/composeletters.aspx?AlertID=177 (AANA member login required).
Col. Janet Setnor, CRNA, MSN, USAFR, NC, second to right, appeared at a Capitol Hill forum sponsored by The Nursing Community to discuss the role and value of APRNs and CRNAs in healthcare delivery, including the Veterans Health Administration. She is pictured here with, left to right: Julie Sochalski, PhD, RN, FAAN; Maryann Alexander, PhD, RN; and  Maureen Swick, PhD, MSN, RN, NEA-BC
To Protect and Advance CRNA Practice, the CRNA-PAC 2015 Development Campaign is Under Way
Led by CRNA-PAC Chair Rick Jueneman, CRNA, the CRNA-PAC’s 2015 development campaign is under way! Focused on building member engagement to protect and advance CRNA practice through federal advocacy, the CRNA-PAC is undertaking its 2015 campaign in four major phases. With the theme of “#MyCRNACause,” the first phase involves educating AANA members about the role and benefits of the CRNA-PAC to the nurse anesthesia profession and to CRNAs, particularly in a time of major health policy and industry change. The second phase will reach out to members via email, mail and telephone to ask for their support. In the third phase, the CRNA-PAC will undertake a new peer-to-peer Ambassador Program initiative to raise funds for both the CRNA-PAC and state PACs in 10 selected states. The campaign will conclude with “Great Moments in Time,” the CRNA-PAC gala event being held Sunday, April 19, in Washington, DC, at the Newseum.
Learn more about the CRNA-PAC or make a contribution at www.crna-pac.org (requires AANA member login and password).  For more information please contact AANA Associate Director Political Affairs Kate Fry at kfry@aanadc.com
Alternative Payment Models Should Help Decrease Healthcare Costs and Improve Quality of Care, AANA Tells Federal Trade Commission
In a letter sent to the Federal Trade Commission (FTC) on Feb. 16, the AANA states that alternative payment systems should recognize and reward all qualified healthcare providers, such as CRNAs, for ensuring patient access to safe, cost-effective healthcare services. The AANA sent the comment letter in advance of the FTC and the Department of Justice Antitrust Division’s workshop on competition in the healthcare marketplace Feb. 24-25, where healthcare reimbursement issues of interest to CRNAs were addressed and the AANA was present.
AANA President Sharon Pearce, CRNA, MSN, expressed support for the FTC’s efforts to explore the potential cost-saving benefits of alternative payment models and whether they can assist in improving care quality. “As the FTC examines the merits of alternative payment systems, we recommend ensuring that these alternatives are in the best interests of the patients receiving care, that they encourage improvements in patient care quality and efficiency, and that the alternative payment systems have been developed and deployed in a manner that healthcare professionals deem as valid.”
For further information, view the AANA’s comments on the FTC’s 2015 workshop (member ID and password required); the Federal Register Notice of the announcement of the workshop and questions for comment; and the webcast on the FTC’s Examining Health Care Competition Workshop webpage.
AANA and APRN Organizations Comment on the House Energy and Commerce Committee’s “21st Century Cures Act of 2015” Discussion Draft
Organized by the AANA, a workgroup of APRN organizations requested the House Energy and Commerce Committee include provider-neutral language throughout the legislative discussion document titled, “21st Century Cures Act.”
In a comment submitted on Feb. 13, the workgroup also praised the committee’s dedication to improving patient access to healthcare services through telecommunications technology, yet provided caution for the potential for physician tele-supervision of APRNs services. Updates to the Medicare Administrator Contractor Local Coverage Determinations (LCDs) process were supported by the group, as they provided additional stipulations for a public comment period. The AANA also requested APRNs, including CRNAs, sit on the Carrier Advisory Committees that review LCDs that limit coverage to an item or service. The House Energy and Commerce Committee is expected to develop and move legislation on this topic early this year, while the Senate’s parallel proposal may move later in 2015.
To see the APRN workgroup’s comments, click here (AANA login required). Review a section by section summary of the initiative here.
AANA Participates in AcademyHealth National Policy Conference
The AANA Federal Government Affairs team attended the National Health Policy Conference Feb. 9-10 in Washington to monitor developments in payment reform critical to CRNAs. Sponsored by AcademyHealth, the conference covered topics including: updates on ACA implementation, challenges and innovations in payment reform, quality measurement, and delivery system transformation.
Several executives and members of prominent health care news organizations such as UnitedHealth Group and Kaiser Health News expressed the need for all healthcare providers to practice at the top of their license, including APRNs and CRNAs. Richard Migliori MD from UnitedHealth Group stated that practice models are most efficient when all types of providers are included. An executive with Primary Care Progress also stated more states should allow APRNs, including CRNAs, to work at the top of their skill sets – especially as states spend more on healthcare and governors become increasingly invested in cost saving measures. The remarks helped underscore how important localized reimbursement advocacy work is for AANA members, state associations and state reimbursement specialists.
CRNAs should also continue to be aware of payment changes at the local level, as the AANA learned that new potential bundled payment arrangements could include some same day ambulatory procedures and episodic specialty services. Representatives from America’s Health Insurance Plans (AHIP) said that the private sector is continuing to change healthcare payment systems so that they promote better healthcare outcomes, improved health and lower costs. 
For more information on the conference, see: http://www.academyhealth.org/Events/content.cfm?ItemNumber=1551.
  • The House and Senate are in session the week of Monday, Mar. 2. If you see your legislators or their staff at home, let us know how your visits went by logging your visit on the CRNA-PAC website at: https://www.crna-pac.com/legisreport.aspx (AANA login required) and sending us pictures at info@aanadc.com. To see when Congress is in Washington or at home, go to House schedule, Senate schedule.
  • While the Drug Enforcement Administration last year upscheduled drugs containing hydrocodone, the action is now having impacts on Veterans access to care, according to a Feb. 18 article in the Washington Post. Because the upscheduling requires certain patients to visit their healthcare professionals more frequently, when those patients are Veterans and their care is provided by the Veterans Health Administration there are issues with waiting and access to care.  To read more, click here.
  • Register today for the AANA Mid-Year Assembly. 
  • See the Medicare 2015 anesthesia conversion factor list by locality (requires AANA member login and password).  The new rates took effect for services on Jan. 1, 2015.
  • Stay up to date on CRNA reimbursement issues by obtaining Version 2.1 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members (requires AANA member login and password).
  • Engage with your profession’s social media feed on Facebook at https://www.facebook.com/AmericanAssociationofNurseAnesthetists and Twitter at https://twitter.com/aanawebupdates
  • Keep up with the AANA’s new efforts for educating hospital administrators, healthcare policymakers and other health industry leaders about the role and value of CRNA care at http://www.future-of-anesthesia-care-today.com.
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.

The percentage of people taking prescription narcotics stronger than morphine rose from 17 percent in 1999 to 37 percent in 2012, according to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics. The federal study found that the use of opioid painkillers like OxyContin are on the rise, with sales quadrupling between 1999 and 2010. As the use of these drugs increases, painkiller-related deaths also have risen. About 16,007 people died from pain pill overdoses in 2012, three times the number who died in 1999. However, the study found that the number who died in 2012 from those overdoses represents a 5 percent decline from 2011 when 16,917 people died, the CDC reported last year.
From "CDC: Deaths Soared as Narcotic Painkillers Grew Popular" 
USA Today (02/25/15) Leger, Donna Leinwand

Association of NSAID Use With Risk of Bleeding and Cardiovascular Events in Patients Receiving Antithrombotic Therapy After Myocardial Infarction
Use of nonsteroidal anti-inflammatory drugs (NSAIDs) is linked to a higher risk of bleeding and excess thrombotic events in patients receiving antithrombotic therapy after myocardial infarction (MI), according to new research. The observational study, which used nationwide administrative registries in Denmark from 2002 to 2011, included nearly 62,000 patients 30 years and older who were admitted with first-time MI and were alive 30 days after discharge. Approximately one-third of the patients filled at least one NSAID prescription. The researchers report there were 18,105 deaths in a median follow-up period of 3.5 years. Overall, there were more than 5,200 bleeding events, including 799 fatal bleeds, and 18,500 cardiovascular events. Using multivariate-adjusted Cox regression analysis, the researchers noted a greater risk of bleeding with NSAIDs compared with no NSAID treatment. The cardiovascular risk was higher as well. Furthermore, the researchers report, the "increased risk of bleeding and cardiovascular events was evident with concomitant use of NSAIDs, regardless of antithrombotic treatment, types of NSAIDs, or duration of use." While further studies are needed, the authors recommend that physicians use caution when prescribing NSAIDs for individuals who recently had an MI.
From "Association of NSAID Use With Risk of Bleeding and Cardiovascular Events in Patients Receiving Antithrombotic Therapy After Myocardial Infarction" 
Journal of the American Medical Association (02/24/15) Vol. 313, No. 8, P. 805 Olsen, Anne-Marie Schjerning; Gislason, Gunnar H.; McGettigan, Patricia; et al.

International Study Shows Potential New Therapy to Treat Patients With Neuropathic Pain
An international team of researchers believes the key to treating neuropathic pain may lie in drugs that selectively target the melatonin MT2 receptor in the brain, which regulates sleep among other functions. They have shown that the drug UCM924—already known to alleviate insomnia when administered in high doses—also influences the part of the brain that controls pain, turning off neurons that trigger it and turning on those that block it. In new animal studies, meanwhile, UCM924 has been show to alleviate chronic pain. Led by investigators at McGill University in Canada, team members suspect the drug could provide dual benefits to sufferers of chronic pain—who also often complain of significant sleep disturbance. The findings have been published in the journal Pain, and the researchers are now seeking partners interested in clinical development and commercialization of this new class of analgesic drugs.
From "International Study Shows Potential New Therapy to Treat Patients With Neuropathic Pain" 
News-Medical (02/19/15)

Adverse Event Reporting Is Better With Anonymity
Accurate reporting of adverse events is a critical step in the campaign to improve the quality of anesthesia care. However, researchers say a number of factors—including fear of professional or legal backlash—often deter providers from candid participation in such registries. Adopting adverse event (AE) reporting systems that shield the identity of users improves the accuracy of the data collected, according to a team led by Lindsay Lopata, MD, of Long Island Jewish Medical Center and North American Partners in Anesthesia (NAPA). To test that theory, they looked at anonymous reports submitted by nine "experienced" anesthesia providers on intraoperative and postanesthesia care unit complications for every case at a single 184-bed NAPA hospital. Compared to a similar period of time a year earlier, during which identities were cloaked, AEs were higher during the anonymous period in 11 categories and significantly higher in six. Overall, AEs increased 2.5 times during the anonymous time frame compared to the open time frame. "More confidentiality with the submitted data may alleviate some of these concerns yet still allow providers to identify patterns in their own practice compared to benchmarks to improve quality of care," Lopata remarked.
From "Adverse Event Reporting Is Better With Anonymity" 
General Surgery News (02/01/15) Vol. 42, No. 2 Dunleavy, Brian

Study Proposes New Therapy to Suppress Opioid Tolerance

In what is billed as the first human study on opioid tolerance, a condition that demands an increasing amount of narcotic to achieve the same level of effect, researchers believe they may have identified the root of the problem. It seems chronic administration of opioids in rodents as well as in people—cancer patients taking pain medications, specifically—produces higher concentrations of the protein CXCL1. When the rats' CXCL1 levels were artificially inflated even higher through spinal injections, the rate of onset and severity of opioid tolerance accelerated. A CXCL1 neutralizing or blocking agent administered to the rats, however, at least partly maintained opioid efficacy. "By suppressing opioid tolerance, we can help patients achieve prolonged pain relief without the side effects of increased opioid dosages," said researcher Chih-Peng Lin, MD, from the anesthesiology department at National Taiwan University College of Medicine. Experts reacted to the research, published in Anesthesiology, with interest but agreed that more study is needed to demonstrate the clinical implications of treating opioid-addicted patients by blocking CXCL1 proteins.
From "Study Proposes New Therapy to Suppress Opioid Tolerance"
Forbes (02/19/15) Arlotta, CJ
Preoperative IV Ibuprofen Improves Recovery After Lap Chole
Based on the premise that nonsteroidal anti-inflammatory drugs (NSAIDs) may curb the stress response to surgery—and, thus improve overall recovery from it—researchers tested the theory on a group of laparascopic cholecystectomy patients. Of 55 study participants, each was randomized to receive either a single IV dose of 800 mg of ibuprofen or placebo saline before their procedure. According to the team from Rutgers New Jersey Medical School, recovery scores were better for the ibuprofen group than for the controls on the first postoperative day. Moreover, the NSAID patients were less fatigued than the placebo patients in the postanesthesia care unit and on the first and third days following surgery. Patients who received the NSAID also outperformed controls in terms of comfort, emotion, and pain.
From "Preoperative IV Ibuprofen Improves Recovery After Lap Chole" 
Gastroenterology & Endoscopy News (02/15) Vol. 66, No. 2 Vlessides, Michael

New Narcotic Opioid Analgesic Rules Cause Grief for Veterans and VA
New Drug Enforcement Administration rules that make it harder to get narcotic opioid analgesics are taking an unexpected toll on thousands of veterans who depend on these prescription drugs to treat a wide variety of ailments. The restrictions are for the first time, in effect, forcing veterans to return to the doctor every month to renew their medication, although many were already struggling to get appointments at overburdened health facilities at the Department of Veterans Affairs (VA). The new rules pose an additional hardship for many who live a good distance from the health centers. Many veterans are being treated for injuries sustained during the long wars in Iraq and Afghanistan and have become dependent on the Department of Veterans Affairs' beleaguered health-care system for medical care. More than half a million veterans are now on prescription opioids, according to the VA. Pain experts at the VA say that in hindsight they have been overmedicating veterans, and doctors at the Pentagon and VA now say that the use of the opioid analgesics contributes to family strife, homelessness, and even suicide among veterans.
From "New Narcotic Opioid Analgesic Rules Cause Grief for Veterans and VA"
Washington Post (02/19/15) Wax-Thibodeaux, Emily

Data Show NSAIDs Prescribed Over Analgesics for New Musculoskeletal Pain
Story teOf 3,236 new cases of reported musculoskeletal pain in 2006, most patients—58 percent—did not receive analgesic medication to treat the condition. For the 42 percent who did receive pain prescriptions, researchers say clinicians showed a clear preference for NSAIDs. An analysis of prescriptions filled within two weeks of the first consult indicated that, of the 42 percent, NSAIDs were dispensed to 47 percent of patients, basic analgesics were prescribed to 24 percent, moderate-strength analgesics were given to 18 percent, and strong analgesics went to just 11 percent. Further examination indicated that patients in less-deprived communities were not as likely to be prescribed analgesics. Although aging patients were more likely to receive pain medications, they were typically basic or moderate-strength options. Patients without comorbidity were more likely to be put on an NSAID regimen, whereas patients with a history of analgesic medication usually were prescribed stronger analgesics.xt
From "Data Show NSAIDs Prescribed Over Analgesics for New Musculoskeletal Pain" 
Healio (02/18/2015) Tingle, Casey
Researchers Examine Hand Hygiene During Anethesia in the OR
Researchers collected observational data at a single surgical department in an effort to gauge the extent to which hand hygiene protocols were followed during routine anesthetic care in the operating room. The team documented 2,393 opportunities for hand hygiene during the study, which tracked activity during 94 procedures. Compliance was best, at 15.9 percent, during full-length surgeries following exposure of bodily fluid and worst, at 2.2 percent, during the anesthesia induction phase prior to an aseptic task. Hand hygiene adherence overall was just over 8 percent, suggesting to the investigators an urgent need to improve practices. Reported in Antimicrobial Resistance and Infection Control, the study concluded that enhancement strategies should entail education plus practical instruction on how to execute hygiene and aseptic techniques and proper use of gloves.
From "Researchers Examine Hand Hygiene During Anethesia in the OR"
Infection Control Today (02/17/15)

How to Make Surgery Safer
A 2014 analysis in Patient Safety in Surgery estimated that 46 percent to 65 percent of adverse events at hospitals occur during operations, largely due to human error. Given these numbers, the effort to reduce risk is becoming ever important. One approach finds hospitals increasingly monitoring their own performance. About 600 sites are using the National Surgical Quality Improvement Project to report complications, with the goal of closing safety gaps and developing best practices. In anesthesiology, meanwhile, a new voluntary registry lets providers enter the details of adverse events and compare their data against their peers' data. Other strategies involve hospitals using big data to screen patients for individual risk and better prepare them for the operating room, such as with preoperative antiseptic baths. For those most at risk for complications from surgery or anesthesia, that might mean postponing elective procedures until the patient boosts nutritional intake or stops smoking, for example. Postoperatively, hospitals are getting patients up and moving sooner. The medical community also is using data analysis and adopting technology, such as surgical sponges with radio-frequency identification tags, to avoid leaving objects in patients; and they are doing more to educate personnel about the use—and potential dangers—of energy devices in the OR as well. Additionally, more attention is being paid to infection prevention guidelines, greater teamwork between surgeons and others working in the OR, and the use of surgical checklists.

From "How to Make Surgery Safer"
Wall Street Journal (02/16/15) Landro, Laura

Sucrose Plus Radiant Warmth Relieves Newborns' Pain
A study of 29 infants led by Larry Gray, MD, of the University of Chicago's Department of Pediatrics found a 50 percent reduction in the time newborns spent crying and grimacing after vaccination when given a few drops of 24 percent sucrose solution and briefly exposed to radiant warmth prior to vaccination. Research has shown that the taste of sucrose, sucking on a pacifier, and breast-feeding have pain-alleviating effects on infants; and this study of full-term newborns aimed to determine the calming effect of adding radiant warmth—which mimics the warmth transmitted to babies by breast-feeding mothers—to sucrose administration. Published in Pediatrics, the study determined that the 14 infants who received sucrose plus additional radiant warmth of 0.5 degrees Celsius for two minutes prior to hepatitis B vaccination cried and grimaced for 50 percent less time afterwards than the 15 infants who received only sucrose. "Encouraging breastfeeding in the newborn nursery and keeping the mother and healthy infant together is an increasingly important priority for the health care provider," write the study authors. "When breastfeeding is not possible, however, this study adds another natural nonpharmacologic analgesic technique for health care providers to protect the newborn from the pain of a routine immunization needle stick."
From "Sucrose Plus Radiant Warmth Relieves Newborns' Pain"
Medscape (02/16/15) Henderson, Diedtra
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