scholarly journals Common Clinical Dilemma Leading to American Society of Anaesthesiologists Physical Status Class Assignment Variation and the Impact of 2019 Amendment

2021 ◽  
Vol 49 (2) ◽  
pp. 186-189
Author(s):  
Habib Md Reazaul Karim ◽  
Keyword(s):  
Physical Status ◽  
American Society ◽  
Clinical Dilemma ◽  
The Impact ◽  
Class Assignment

scholarly journals Implicit Memory and Anesthesia: A Systematic Review and Meta-Analysis

Life ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 850
Author(s):  
Federico Linassi ◽  
David Peter Obert ◽  
Eleonora Maran ◽  
Paola Tellaroli ◽  
Matthias Kreuzer ◽  
...  
Keyword(s):  
Systematic Review ◽  
General Anesthesia ◽  
Implicit Memory ◽  
Deep Sedation ◽  
Meta Analysis ◽  
Memory Formation ◽  
Auditory Task ◽  
Physical Status ◽  
American Society ◽  
The Impact

General anesthesia should induce unconsciousness and provide amnesia. Amnesia refers to the absence of explicit and implicit memories. Unlike explicit memory, implicit memory is not consciously recalled, and it can affect behavior/performance at a later time. The impact of general anesthesia in preventing implicit memory formation is not well-established. We performed a systematic review with meta-analysis of studies reporting implicit memory occurrence in adult patients after deep sedation (Observer’s Assessment of Alertness/Sedation of 0–1 with spontaneous breathing) or general anesthesia. We also evaluated the impact of different anesthetic/analgesic regimens and the time point of auditory task delivery on implicit memory formation. The meta-analysis included the estimation of odds ratios (ORs) and 95% confidence intervals (CIs). We included a total of 61 studies with 3906 patients and 119 different cohorts. For 43 cohorts (36.1%), implicit memory events were reported. The American Society of Anesthesiologists (ASA) physical status III–IV was associated with a higher likelihood of implicit memory formation (OR:3.48; 95%CI:1.18–10.25, p < 0.05) than ASA physical status I–II. Further, there was a lower likelihood of implicit memory formation for deep sedation cases, compared to general anesthesia (OR:0.10; 95%CI:0.01–0.76, p < 0.05) and for patients receiving premedication with benzodiazepines compared to not premedicated patients before general anesthesia (OR:0.35; 95%CI:0.13–0.93, p = 0.05).

scholarly journals Management of a parenteral opioid shortage using ASHP guidelines

2021 ◽  
Vol 78 (5) ◽  
pp. 426-435
Author(s):  
Peter Vo ◽  
Daniel A Sylvia ◽  
Loay Milibari ◽  
John Ryan Stackhouse ◽  
Paul Szumita ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Drug Product ◽  
Health Record ◽  
Large Hospital ◽  
Hospital Administrators ◽  
Utilization Data ◽  
Electronic Health ◽  
Opioid Medications ◽  
American Society ◽  
The Impact

Abstract Purpose Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described. Summary In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions. Conclusion A multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.

The Impact of the Privacy Rule on Cancer Research: Variations in Attitudes and Application of Regulatory Standards

2009 ◽  
Vol 27 (24) ◽  
pp. 4014-4020 ◽  
Author(s):  
Elizabeth Goss ◽  
Michael P. Link ◽  
Suanna S. Bruinooge ◽  
Theodore S. Lawrence ◽  
Joel E. Tepper ◽  
...  
Keyword(s):  
Cancer Research ◽  
Future Research ◽  
Research Committee ◽  
Data Repositories ◽  
Privacy Rule ◽  
Regulatory Standards ◽  
American Society ◽  
Definition Of ◽  
High Level ◽  
The Impact

Purpose The American Society of Clinical Oncology (ASCO) Cancer Research Committee designed a qualitative research project to assess the attitudes of cancer researchers and compliance officials regarding compliance with the US Privacy Rule and to identify potential strategies for eliminating perceived or real barriers to achieving compliance. Methods A team of three interviewers asked 27 individuals (13 investigators and 14 compliance officials) from 13 institutions to describe the anticipated approach of their institutions to Privacy Rule compliance in three hypothetical research studies. Results The interviews revealed that although researchers and compliance officials share the view that patients' cancer diagnoses should enjoy a high level of privacy protection, there are significant tensions between the two groups related to the proper standards for compliance necessary to protect patients. The disagreements are seen most clearly with regard to the appropriate definition of a “future research use” of protected health information in biospecimen and data repositories and the standards for a waiver of authorization for disclosure and use of such data. Conclusion ASCO believes that disagreements related to compliance and the resulting delays in certain projects and abandonment of others might be eased by additional institutional training programs and consultation on Privacy Rule issues during study design. ASCO also proposes the development of best practices documents to guide 1) creation of data repositories, 2) disclosure and use of data from such repositories, and 3) the design of survivorship and genetics studies.

From Multi-Industry Planning to Keynesian Planning: Gardiner Means, the American Keynesians, and National Economic Planning at the National Resources Committee

1990 ◽  
Vol 2 (2) ◽  
pp. 186-212 ◽  
Author(s):  
Frederic S. Lee
Keyword(s):  
World War I ◽  
Economic Planning ◽  
World War ◽  
National Planning ◽  
National Economic ◽  
Basic Characteristics ◽  
American Society ◽  
Industry Planning ◽  
The Impact ◽  
American Economy

In recent years we have witnessed a revival of interest in the National Resources Committee (NRC) and its work on national planning. The research shows that the roots of national planning at the NRC are found in the Progressive Era, when individuals sought, through city, regional, and economic planning, to bring order to American society, in the government's management of the economy during World War I, and in Hoover's attempt at macromanagement of the economy. The research also shows that national economic planning, as distinct from other forms of planning, was an important component of the committee's work. In regard to this, researchers have acknowledged that Gardiner Means, as director of the Industrial Section of the Industrial Committee and author of The Structure of the American Economy, Part I: Basic Characteristics, was an important and outspoken advocate of economic planning within the NRC, but they have been less clear as to his specific contributions to economic planning. Moreover, the researchers have not extensively investigated the NRC position toward national economic planning, the economic models from which national economic plans would be developed, and the impact of the Keynesian revolution on the NRC approach to national economic planning. These omissions are not surprising inasmuch as neither Warken's (1979) nor Clawson's (1981) general coverage of the NRC provided much more than a brief and superficial description of the Industrial Section and a listing of its most important publications. Kalish (1963), on the other hand, discussed Means and the Industrial Section in more depth but in such a disjointed manner that it is impossible to grasp the movement toward economic planning that took place in the NRC and the important role Means played in the process. Finally, neither Chapman's (1981 and 1983) nor Jeffries's (1987) discussions of the impact of the Keynesian revolution on the activities of the NRC dealt specifically with its impact on Means's work on economic planning.

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