Professional conflicts in anaesthesia in the United States.
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Anesthesiology↗
Biomedical subjects
S M Ouellette
Publications and source records attributed to S M Ouellette.
The National Commission on Nurse Anesthesia Education 10 years later--Part 2: Years following the commission (1994 to present).
In 1989, the National Commission on Nurse Anesthesia Education was implemented to reverse a severe shortage of CRNAs. The Commission, charged with scrutinizing all aspects of nurse anesthesia educational programs, developed 8 goals with corresponding strategies that were used by the Commission Implementation Task Force to actualize its charge. These goals and strategies contributed to an increase of annual graduates from nurse anesthesia programs and the development of 10 new programs. These activities were documented in Part 1 of this article, which appeared in the October 2001 AANA Journal. Following completion of the 3-year project, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) and the AANA Education Committee began carrying out the final recommendations made by the Commission. Part 2 addresses the accomplishments of the Education Committee and COA in implementing the recommendations of the Commission, discusses current status of educational programs and CRNA manpower, and identifies roles for both educators and practitioners in protecting the future of the profession.
Education, Nursing↗
TheNational Commission on Nurse Anesthesia Education 10 years later--Part 1: The commission years (1989-1994).
The significant decrease in the number of anesthesia providers during the late 1980s prompted American Association of Nurse Anesthetists (AANA) leaders to establish the National Commission on Nurse Anesthesia Education (NCNAE). The NCNAE was charged with scrutinizing all aspects of nurse anesthesia educational programs and developing strategies to reverse the critical shortage of nurse anesthetists. The tactics outlined by the commissioners were implemented, and they resulted in an increase of annual nurse anesthesia program graduates. Although there has been continued realization of NCNAE strategies, 10 years later the critical shortage of CRNAs has resurfaced. This 2-part article describes the commission years, the years that followed, and the current status of Certified Registered Nurse Anesthetist (CRNA) manpower.
Anesthesiology↗
The International Federation of Nurse Anesthetists: 10 years later.
In 1978, 2 European nurse anesthetists attended the Annual Meeting of the American Association of Nurse Anesthetists (AANA). Their interest in international cooperation among nurse anesthetists and AANA's agreement planted the seed for what would later become the International Federal of Nurse Anesthetists (IFNA). In this article we describe the history, philosophy, objectives, and functions of the IFNA. We also address the role of a nurse anesthetist worldwide, educational and research activities, and the importance of networking with other organizations. The article concludes with steps toward globalization of the profession and the future of the IFNA.
Europe↗
The International Federation of Nurse Anesthetists: its role in the globalization of nurse anesthesia education and practice.
Since its beginning in 1989, the International Federation of Nurse Anesthetists (IFNA) has had as its major goal in the advancement of educational standards and practices that support and enhance patient care and safety. This article highlights the development of the IFNA, its purpose, and its structure. Educational and practice standards are discussed and quality assurance in international education highlighted.
Educational Measurement↗
Nurse anesthesia education: a different challenge.
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Curriculum↗
The application process for nurse anesthesia programs: is there room for improvement?
In summary, we have observed that competition among programs for applicants has been strong in recent years. We believe the answers to preparation of adequate numbers of CRNAs in the future should be based upon cooperation and major recruitment activities within our geographical area. In addition, the results of this study will help us focus on strengths and areas needing improvement in our application process and programs. This is important to attract well-qualified students and maintain our reputation for excellence.
Choice Behavior↗
Newer trends in the prevention or treatment of postoperative nausea and vomiting.
Postoperative nausea and vomiting are common and distressing postsurgical complications. Prevention or early treatment of this complication should be a goal of all anesthesia providers. This article addresses the pathophysiology of nausea and vomiting and identifies patients at risk for this complication. Pharmacological actions and side effects of commonly used antiemetics are addressed. The new serotonin antagonists and combined antiemetic therapy are highlighted.
Antiemetics↗
Monitoring for intraoperative awareness.
Despite advances in anesthetic technique and technology, intraoperative awareness continues to occur with alarming regularity. The psychological effects on patients and the medicolegal consequences to providers have created the need for a reliable monitor of the hypnotic component of anesthesia. A new technology known as bispectral analysis (BIS) has the potential to put an end to the devastating occurrence of intraoperative awareness, as well as improve the overall effectiveness of anesthetic delivery and the surgical experience. Applicable to almost any situation requiring sedation or general anesthesia, BIS's reliability is a real-time measure of hypnosis levels.
Anesthesia↗
AANA Journal course: update for nurse anesthetists--diabetes mellitus: overview and current concepts in anesthetic management.
Diabetes mellitus is one of the more common endocrine disorders encountered in the anesthetic management of surgical and obstetrical patients. These patients often have complications associated with the disease process which may increase perioperative morbidity and mortality. Optimal management depends upon an understanding of the disease process as well as special considerations unique to the diabetic. This AANA Journal course reviews the pathophysiology of diabetes and common complications associated with the disease. Perioperative considerations include assessment and metabolic control during the time of surgical stress. In concludes with acute complications and their recognition and management.
Anesthesia↗
Financing nurse anesthesia education.
Health care spending in the United States outpaces all other nations or 14% of the gross domestic product. Although the escalating increases in health care costs which have characterized the industry over the past quarter century have begun to slow down, if changes in the current health care policy are not implemented, spending is expected to increase at a rate of 11.5% during each of the next 5 years. Health care spending will reach $1.1 trillion or 15% of the gross domestic product in the near future. Both hospitals and universities are facing mounting pressures to reduce their costs and improve their services. In this environment, it becomes increasingly important for directors of nurse anesthesia programs to financially justify their existence. This discussion begins with a brief overview of nurse anesthesia education in the United States. The value of and need for nurse anesthetists in the US health care system is addressed. Advantages and disadvantages of hospital versus university-based programs are highlighted and funding sources identified. Future needs and challenges in nurse anesthesia education conclude this discussion.
Cost-Benefit Analysis↗
Clinical aspects of CRNA practice. General anesthesia.
General anesthesia is a state of reversible, descending depression of the central nervous system that is induced by inhalational or intravenous drugs. Components of general anesthesia include hypnosis, analgesia, amnesia, and muscle relaxation. Recognized anesthesia providers include CRNAs and anesthesiologists. Improvements in pharmacologic agents, technology, and education of providers have sharply reduced morbidity and mortality associated with anesthesia.
Anesthesia, General↗
Regional anesthesia: is it safer?
This article provides an overview of the current status of general anesthesia and regional anesthesia techniques including complications occurring after using these techniques. The advantages, disadvantages, mortality, and morbidity are described for these two techniques.
Anesthesia, Conduction↗
Mechanisms and management of allergic reactions in the surgical patient.
The use of anesthetic agents, drugs and chemicals during anesthesia induces a certain number of anaphylactoic or anaphylactoid reactions. The incidence of anaphylaxis during general anesthesia, according to a recent study, is 1:4500. Despite appropriate treatment, mortality is about 6%. Different mechanisms are involved in mortality. Multiple risk factors have been identified in at-risk patients. With adequate understanding of the pathophysiological events that occur during anaphylaxis, anesthetists may avoid the occurrence of allergic reaction or be better prepared to manage these serious situations that may become fatal. This article covers different areas associated with anaphylactic and anaphylactoid reactions. Focus is placed on the different mechanisms of allergic reaction, and special attention is given to the clinical aspects of this complication. Treatment of these reactions as well as steps in prevention perioperatively are highlighted.
Anaphylaxis↗
Sucralfate administration via nasogastric tube.
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Aluminum↗
A pharmacokinetic evaluation of the effect of plasma exchange on tobramycin disposition.
The effect of plasma exchange on the disposition of tobramycin was studied in three procedures done on two patients. Serum tobramycin levels were obtained when the subjects were off plasma exchange to calculate individualized tobramycin pharmacokinetic parameters. The amount of drug removed was measured and serum levels were obtained during plasma exchange. The effect of the procedure was evaluated by calculating the percentage of total body stores removed and comparing drug elimination half-life data on and off plasma exchange. The procedures resulted in the removal of 6.1%, 5.9% and 4.3% of total body stores of tobramycin. Plasma exchange provides an additional route of elimination for tobramycin which should be considered when dosing the drug in patients undergoing this procedure.
Adult↗
Cost justifying a pharmacy residency program.
Cost justification of a pharmacy residency training program was prepared. The contributions of the pharmacy residents were tabulated and compared with the cost of the program to the hospital. Contributions were determined by identifying the activities performed by residents that could be quantified in financial terms. The residents' activities that benefited the hospital included administrative support, completion of special projects, scheduling staff assignments, and coordinating education programs. Costs were derived from salaries, fringe benefits, and training expense. An output value analysis was performed by comparing the contributions of the residents to the institution with the cost of the training program. The contributions of the residents exceeded the costs of the training program by a ratio of 1.3 to 1.
Budgets↗