The Key Points of Postoperative Monitoring and Nursing Care

A Series of Anesthesia-related Maternal Deaths in Michigan, 1985–2003

Anesthesiology ◽

10.1097/01.anes.0000267592.34626.6b ◽

2007 ◽

Vol 106 (6) ◽

pp. 1096-1104 ◽

Cited By ~ 118

Author(s):

Jill M. Mhyre ◽

Monica N. Riesner ◽

Linda S. Polley ◽

Norah N. Naughton

Keyword(s):

African American ◽

Maternal Mortality ◽

Airway Obstruction ◽

General Anesthesia ◽

Patient Death ◽

Postoperative Monitoring ◽

Maternal Deaths ◽

Key Points ◽

System Errors ◽

African American Race

Background Maternal Mortality Surveillance has been conducted by the State of Michigan since 1950, and anesthesia-related maternal deaths were most recently reviewed for the years 1972-1984. Methods Records for pregnancy-associated deaths between 1985 and 2003 were reviewed to identify 25 cases associated with a perioperative arrest or major anesthetic complication. Four obstetric anesthesiologists independently classified these cases, and disagreements were resolved by discussion. Precise definitions of anesthesia-related and anesthesia-contributing maternal death were constructed. Anesthesia-related deaths were reviewed to identify the chain of medical errors or care management problems that contributed to each patient death. Results Of 855 pregnancy-associated deaths, 8 were anesthesia-related and 7 were anesthesia-contributing. There were no deaths during induction of general anesthesia. Five resulted from hypoventilation or airway obstruction during emergence, extubation, or recovery. Lapses in either postoperative monitoring or anesthesiology supervision seemed to contribute to 5 of the 8 anesthesia-related deaths. Other characteristics common to these cases included obesity (n=6) and African-American race (n=6). Conclusions The 8 anesthesia-related and seven anesthesia-contributing maternal deaths in Michigan between 1985 and 2003 illustrate three key points. First, all anesthesia-related deaths from airway obstruction or hypoventilation took place during emergence and recovery, not during the induction of general anesthesia. Second, system errors played a role in the majority of cases. Of concern, lapses in postoperative monitoring and inadequate supervision by an anesthesiologist seemed to contribute to more than half of the deaths. Finally, this report confirms previous work that obesity and African-American race are important risk factors for anesthesia-related maternal mortality.

Download Full-text

Communication Interaction With Elderly Japanese in Nursing Care Settings

Perspectives on Gerontology ◽

10.1044/gero10.1.11 ◽

2005 ◽

Vol 10 (1) ◽

pp. 11-14

Author(s):

Joan C. Kosta

Keyword(s):

Nursing Care ◽

Communication Interaction ◽

Elderly Japanese

Download Full-text

Autism and Neurodiversity: Addressing Concerns and Offering Implications for the School-Based Speech-Language Pathologist

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00188 ◽

2020 ◽

pp. 1-7

Author(s):

Laura S. DeThorne ◽

Kelly Searsmith

Keyword(s):

Service Provision ◽

Individualized Education Program ◽

Institutional Constraints ◽

Individualized Education ◽

Existing Structures ◽

Eligibility Determination ◽

Speech Language Pathologist ◽

School Based ◽

Key Points ◽

C Center

Purpose The purpose of this article is to address some common concerns associated with the neurodiversity paradigm and to offer related implications for service provision to school-age autistic students. In particular, we highlight the need to (a) view first-person autistic perspectives as an integral component of evidence-based practice, (b) use the individualized education plan as a means to actively address environmental contributions to communicative competence, and (c) center intervention around respect for autistic sociality and self-expression. We support these points with cross-disciplinary scholarship and writings from autistic individuals. Conclusions We recognize that school-based speech-language pathologists are bound by institutional constraints, such as eligibility determination and Individualized Education Program processes that are not inherently consistent with the neurodiversity paradigm. Consequently, we offer examples for implementing the neurodiversity paradigm while working within these existing structures. In sum, this article addresses key points of tension related to the neurodiversity paradigm in a way that we hope will directly translate into improved service provision for autistic students. Supplemental Material https://doi.org/10.23641/asha.13345727

Download Full-text