The effectiveness of a blended POCUS curriculum on achieving basic focused bedside transthoracic echocardiography (TTE) proficiency. A formalized pilot study.

OBJECTIVE: The study objective is to evaluate the effeteness of an existing educational platform blending didactic presentation and hands-on simulation for university doctoral SRNAs in the area of basic, 4 view identification and performance of transthoracic echocardiography (TTE). METHODS: Following IRB approval, SRNAs were exposed to a pre test to evaluate existing skills, then they were exposed to a graphic rich, live presentation of basic 4 view TTE. The presentation was then followed by hands on simulation and performance of the 4 basic TTE views on live models. RESULTS: Pretest scores averaged 58% and post tests scores rose to 95%. See Table 1. CONCLUSION: Our results support the concept that the existing blended platform is effective to train university SRNAs in basic 4 view, bedside transthoracic echocardiography.

It's Never Just a Block: An Analysis of Regional Anesthesia Closed Claims.

Anesthesia care increasingly includes use of regional anesthesia techniques, either as a primary anesthetic or to reduce the patient's postoperative pain. Both neuraxial anesthesia and peripheral nerve blockade have several noteworthy functions. These functions include diminishing sensory sensation to pain and potentially producing a motor blockade, both of which may facilitate the surgical procedure. The desire to reduce reliance on opioid medications, protocols to enhance and accelerate patient recovery from surgery, and patient expectations all contribute to the likelihood that use of regional anesthesia will continue to gain popularity. As such, it is essential to understand whether an association exists between regional anesthesia and adverse outcomes of care. The American Association of Nurse Anesthetists Foundation Closed Claim Research Team searched the most current database of closed claims that involved adverse outcomes when either a peripheral nerve block or a neuraxial block was a component of care in the claims. Although there were only 32 claims in the dataset, a thematic analysis resulted in the identification of 3 themes: errors in cognitive decision making, ineffective communication patterns, and production pressure.

Adverse Events During Cosmetic Surgery: A Thematic Analysis of Closed Claims.

According to the American Society of Plastic Surgeons, there were approximately 1.8 million cosmetic and reconstructive surgeries performed in the United States in 2012. Very few anesthesia-related mortality statistics and detailed descriptions of adverse events during cosmetic/plastic surgery are found in existing literature. This article describes the use of thematic analysis, and subsequent findings, of a cosmetic closed-claim database generated by the American Association of Nurse Anesthetists (AANA) Foundation Closed Claim Research Team. From the most current dataset of 245 claim files provided by the insurance company (CNA), we isolated 25 claims regarding patients undergoing cosmetic and/or related plastic surgery procedures performed from 2003 to 2012. Three major themes emerged from the claims data: (1) normalization of deviance, (2) ineffective communication patterns, and (3) nonadherence to the AANA Standards for Nurse Anesthesia Practice. Detailed descriptions of the adverse events as they relate to the major themes are provided, and suggestions are offered for actions that may mitigate future adverse events in this subset of the population.

Identifying Patterns and Meanings Across the AANA Foundation Closed Claim Dataset Using Thematic Analysis Methods.

The American Association of Nurse Anesthetists (AANA) Foundation Closed Claim Research Project was initiated in 1995 and remains active to date. The charge accepted by the Closed Claim Research Team is to conduct comprehensive analyses of adverse anesthesia outcomes from medical malpractice claims, identify causes of anesthesia patient injury and negative patient outcome trends, provide data that can be used to facilitate nurse anesthesia educational curricula, and facilitate recommendations for AANA practice standards. The overall goal of closed-claim research is to improve patient safety.

Mechanical strain to maxillary incisors during direct laryngoscopy.

BACKGROUND: While most Direct laryngoscopy leads to dental injury in 25-39% of cases. Dental injury occurs when the forces and impacts applied to the teeth exceed the ability of the structures to dissipate energy and stress. The purpose of this study was to measure strain, (which is the change produced in the length of the tooth by a force applied to the tooth) strain rate, and strain-time integral to the maxillary incisors and determine if they varied by experience, type of blade, or use of an alcohol protective pad (APP). METHODS: A mannequin head designed to teach and test intubation was instrumented with eight single axis strain gauges placed on the four maxillary incisors: four on the facial or front surface of the incisors and four on the lingual or back, near the insertion of the incisor in the gums to measure bending strain as well as compression. Anesthesiology faculty, residents, and certified registered nurse anesthetists intubated with Macintosh and Miller blades with and without APP. Using strain-time curves, the maximum strain, strain rate, and strain time integral were calculated. RESULTS: Across the 92 subjects, strain varied 8-12 fold between the 25th and 75th percentiles for all four techniques, but little by experience, while strain rate and strain integral varied 6-13 fold and 15-26 fold, respectively, for the same percentiles. Intubators who had high strain values with one blade tended to have high strains with the other blade with and without the APP (all pairwise correlation rho = 0.42-0.63). CONCLUSIONS: Strain varies widely by intubator and that the use of the APP reduces strain rate which may decrease the risk of or the severity of dental injury.