Excerpt: Gavronsky, Koeniger-Donohue, Steller, and Hawkins (2012) concluded that, 48 hours after major pelvic surgeries for cancer, the women in their study experienced equivalent pain relief from either manual acupuncture or percutaneous electrical nerve stimulation. This statement was not supported by the study data because of the lack of blinding and insufficient controls. Despite the numerous strengths of the study, due to weaknesses in the study design with regard to blinding and control groups, the addition of acupuncture to percutaneous electrical nerve stimulation should not yet be ruled out as a method of obtaining enhanced pain relief.

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Abstract  Background: The operating team consists of various professions that possess unique skills and knowledge that are needed for patient-safe care. The anesthesia nurse and anesthesiologist have an important role in the team, they need to work together and use their knowledge and skills to maintain patient safety. Work environment, sense of community, effective communication and hierarchical structures were considered to be the factors that had the greatest impact on this international collaboration. Aim: The purpose of the study is to investigate the anesthesia nurse's experience of collaboration with anesthesiologist in the intraoperative stage. Methods: The study was conducted as a qualitative interview study with semi-structured questions. The data collection took place in two operating departments in Stockholm, where 10 anesthesia nurses were interviewed. The analysis was carried out according to Lindgren et al. (2020) description for qualitative content analysis. Results: Four categories were identified. The categories were: Sense of security in the professional role facilitates with subcategories the importance of professional experience and feeling trust in collaboration. When cooperation fails with subcategories of not being listened to and lack of trust. The effect of interpersonal relationships with subcategories personal chemistry in collaboration and handling conflicts. The impact of clarity on the working process with subcategories clear dialogue facilitates and having a clear division of labor. Conclusions: The cooperation in the team is important as the intraoperative environment is complicated. The results shows that good communication, planning, trust and respect for each other’s professional competencies promotes teamwork and thereby increases patient safety.

The development of anesthesia has greatly contributed to the safety of surgeries, reduced the level of invasiveness of many procedures, and provided increased comfort for patients. The delivery of anesthetics has been primarily provided by one of two unique health care providers: a trained physician who has specialized in anesthesia, or an advanced practice nurse—the certified registered nurse anesthetist (CRNA). Both providers have a similar scope of practice, are nationally certified, and often work side-by-side. However, in recent years there has been some controversy between the two providers regarding autonomy, safety, and quality of services. The purpose of this study was to utilize current research comparing the two professions to determine if there is a difference in the quality of care and cost effectiveness between these two providers. This research was focused on studies performed in the United States after 1985. Results indicated no significant differences in quality of care between providers; however, a cost difference does exist. CRNA's provide a high quality of care equivalent to their physician counterparts, but at a reduced price. They additionally offer access to care in rural areas that lack anesthesiologists. Limitations include an inability to assess the impact of doctoral level programs for nurse anesthetists (required for entry into practice beginning in 2025) and how this may affect the main components of patient care assessed in this study (quality of care and cost). Future studies should look at ways to improve the relationship between the two providers and to remove barriers to nurse anesthetists’ scope of practice in order to increase overall access to care.

<p>Introduction: Globally, more than 200 million patients undergo major non-cardiac surgery each year and more than 10 million patients will be exposed to postoperative myocardial ischemia, a condition strongly associated with 30-day mortality. The majority of these events go undetected without postoperative Troponin screening. Methods: We conducted a model-based cost-consequence analysis comparing a postoperative Troponin T screening vs. standard care in patients undergoing noncardiac surgery. In a first model, we evaluated the incremental number of detected perioperative myocardial infarctions and the incremental costs. A second model assessed the effect of the screening and consequent treatment on 1-year survival and the related cost. Model inputs based on the Vascular events In Non-cardiac Surgery patIents cOhort evaluatioN (VISION) Study, a large international cohort. We run probability sensitivity analyses with 5,000 iterations. We conducted extensive sensitivity analyses.</p> <p>Results: The cost to avoid missing an event amounted to CAD$ 5,184 for PMI and CAD$ 2,983 for isolated Troponin T. The cost-effectiveness of the postoperative Troponin screening was higher in patients’ subgroups at higher risk for PMI, e.g. patients undergoing urgent surgery. The incremental costs at 1 year of a postoperative PMI screening by 4 Troponin T measurements were CAD$ 169.20 per screened patient. The cost to prevent a death at 1 year amounted to CAD$ 96,314; however, there was relevant model uncertainty associated with the efficacy of the treatment in the 1-year model.</p> <p>Conclusion: Based on the estimated incremental cost per health gain, the implementation of a postoperative Troponin T screening after noncardiac surgery seems appealing, in particular in patients at high risk for perioperative myocardial infarction. However, decision-makers will have to consider it in terms of opportunity costs, i.e. in relation to the cost-effectiveness of other potential programs within the broader health care context.</p> / Master of Science (MSc)

BACKGROUND: Randomized controlled trials show acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness and received governmental support (NIH, PPACA, WHO, U.S. Military), but have not yet diffused into mainstream anesthesia practice. This study examined US anesthesia providers' perceptions of acupuncture and acupressure. METHODS: Ninety-six anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children’s hospitals, and VA hospitals) were selected for participation in an anonymous, online survey. The target sample was 1,728 providers of which N = 292 (54% anesthesiologists, 44% CRNAs, 2% AAs) responded yielding an overall 17% response rate. RESULTS: Spearman’s correlation coefficient revealed a statistically significant correlation between acupuncture and geographic region, with the West having the highest predisposition toward acupuncture use (rs = 0.159, p = 0.007). Females are more likely to use acupuncture than men (rs = -.188, p = 0.002). Age yielded a moderate effect size with providers between the ages of 31-50 years old experiencing the best outcomes administering acupuncture (rs = 0.65, 95% CI = 2.79, 3.06). A strong effect size exists between acupuncture and country of pre-anesthesia training (rs = 1.00, 95% CI = 1.08, 1.16). Some providers have used acupuncture (27%) and acupressure (18%) with positive outcomes, however the majority of providers have not used these modalities, but would consider using them (54%, SD = 1.44 acupuncture; 60%, SD = 1.32 acupressure). Seventy-six percent of respondents would like acupuncture education and 74% would like acupressure education (SD = 0.43, SD = 0.44, respectively). Lack of scientific evidence (79%, SD = 0.73) and unavailability of credentialed providers (71%, SD = 0.92) were the primary barriers. CONCLUSIONS: While most U.S. anesthesia providers have not used these modalities, they still report a favorable perception of acupuncture/acupressure’s role as part of an anesthetic and the majority of providers express an interest in receiving education. This study adds to the body of acupuncture and acupressure research by providing insight into anesthesia providers’ perceptions of these alternative medicine modalities.

The purpose of this study was to determine the effects of needle play in reducing pre-school children's anxiety concerning injections. The Pre-school Observational Scale of Anxiety was used to measure the degree of anxiety experienced by the children. The hypothesis stated that there would be a significant decrease in anxiety of pre-school children who participated in needle play as compared with the anxiety scores of pre-school children who did not participate in needle play.The sample consisted of 20 pre-school children who were receiving routine health care and injections for immunizations or PPDs (purified protein derivative) at a county health department in the southeast. After obtaining informed consent, children were randomly assigned to either a control group (n = 10) or experimental group (n = 10). The control group was involved in putting together a puzzle with the investigator prior to their injection. The experimental group participated in needle play with the investigator prior to their injection. The Pre-school Observational Scale of Anxiety (POSA) which specifies behavioral indicators of anxiety in children was used on all subjects immediately prior to the actual needle penetration and a score was given to each subject.The scores on the Pre-school Observational Scale of Anxiety showed no statistically significant difference between the control group and the experimental group when analyzed using the Mann-Whitney U Test. On the basis of these findings, the hypothesis that pre-school children who participate in needle play immediately prior to receiving an injection would show a significant decrease in anxiety when compared to pre-school children who did not-participate in needle play prior to an injection was not accepted.

There are no reliable tools that evaluate pain in adult critical care patients who cannot communicate as a result of sedation or illness. This was an observational study in which postoperative cardiothoracic intensive care patients were assessed for pain using both the newly devised Corbett Pain Scale (CPS) and the Numerical Pain Scale (NPS). The CPS was evaluated for content validity, criterion validity, construct validity, test re-test reliability and internal consistency. Thirteen male and seven female patients (n=20) were enrolled and underwent a maximum of five pain assessments each. The mean total scores of the CPS (.740, SD+1.03) and the NRS (.000, SD+1.00) were compared using a paired t-test. No significant differences were found. There was poor internal consistency (-.1225) and there was insignificant correlation between the scales. Pain measurement of sedated, non-communicative patients continues to be problematic.

This thesis deals with the development of education in anesthesiology and intensive care in the Czech Republic. The operational objective of the historical-theoretical thesis is to explore specialized education in the field of intensive care from its roots to the present. At the beginning of the thesis describes the development of the field of Anesthesiology and Intensive Care, also are given information about the work of nurses, including their competencies in this field before the official introduction of specialized study. The following chapters are devoted specialized education from 1971 to 2013. Each of these chapters ends with a list of competencies of nurses, which are then compared. The thesis is the comparison of specialized study from 1971 to 2013. The thesis also deals with the development of the field paramedic and informs about current possibilities of specialization in intensive care and specialization at universities with their comparison.

The topic of this thesis is "Evaluation of patient satisfaction with perioperative anaesthesia care." The work is divided into theoretical and practical parts. The theoretical section describes the definition of satisfaction from multiple points of view and analyses factors affected satisfaction of patients and psychosocial needs that have a significant impact on the experience of the hospital care. The practical part deals with the questionnaire survey. The questionnaire is focused on the evaluation of patient satisfaction with perioperative anaesthesia care. Questionnaire results are statistically analysed. The aim of this work is to determine the level of satisfaction of patients in the preoperative and postoperative period.