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CRNA : the clinical forum for nurse anesthetists最新文献

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Human immunodeficiency virus/acquired immune deficiency syndrome-related drug therapy: anesthetic implications. 人类免疫缺陷病毒/获得性免疫缺陷综合征相关药物治疗:麻醉意义。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-08-01
C A Griffis
{"title":"Human immunodeficiency virus/acquired immune deficiency syndrome-related drug therapy: anesthetic implications.","authors":"C A Griffis","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article reviews advances in the diagnosis and treatment of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Newer drugs used to treat HIV/AIDS, such as protease inhibitors and non-nucleoside reverse transcriptase inhibitors, are described, including their potential interactions with anesthetic drugs. Common areas of concern for CRNAs related to these drugs are reviewed, such as end-organ toxicity, liver and kidney effects, and bone marrow suppression.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 3","pages":"107-16"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21576172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surgery, pain, and immune function. 手术，疼痛和免疫功能。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-08-01
M J Kremer
{"title":"Surgery, pain, and immune function.","authors":"M J Kremer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Research findings have demonstrated that surgery negatively affects immune function. Pain also has deleterious effects on immune function. Most research in this area has been conducted on animals. Psychoneuroimmunology provides the framework for this article. Psychoneurological phenomena, such as stress, depression, and pain, can influence immune system functioning through neuroendocrine pathways. Biological and behavioral processes appear to be closely related and need to be jointly considered when planning and providing anesthesia care. The anesthesia planning process increasingly involves aggressive assessment and treatment of postoperative pain, which may benefit immune function.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 3","pages":"94-100"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21576170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Alterations in immune response associated with anxiety in surgical patients. 手术患者免疫反应改变与焦虑相关
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-08-01
W P Fehder
{"title":"Alterations in immune response associated with anxiety in surgical patients.","authors":"W P Fehder","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Anesthesia practitioners have begun to focus on the immune function of their patients as more research is done on the interface between anesthesia, surgery, and immune alterations. The anxiety associated with anesthesia and surgery produces alterations in immune function through several mechanisms which affect recovery from surgery and wound healing. Immune status may be assessed by traditional measures such as complete blood count and differential as well as using newer technologies such as flow cytometry, lymphocyte proliferation assays and natural killer cell cytotoxicity. Anxiety produces immune changes through sympathetic adrenal medullary and hypothalamic pituitary adrenal cortical mechanisms, as well as through the neurotransmitter substance P. Anxiety also produces changes in immune function through alteration in health behaviors such as increased smoking, increased alcohol consumption, drug use, and changes in diet and sleep. Recommendations for psychological and pharmacological measures that are effective in reducing stress-induced immunosuppression among this group of patients are provided. The future use of substance P antagonists, which are currently under investigation, as well as cytokine manipulation, hold promise for further measures to reduce immune alterations associated with anxiety.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 3","pages":"124-9"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21576176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anesthetic drug interactions. Quarterly update. 麻醉药物的相互作用。每季度更新。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-08-01
M S McAuliffe, E A Hartshorn
{"title":"Anesthetic drug interactions. Quarterly update.","authors":"M S McAuliffe,&nbsp;E A Hartshorn","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 3","pages":"130-4"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21576177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Current perspectives on the perioperative management of the latex-allergic patient. 乳胶过敏患者围手术期处理的现状。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-08-01
J Smit, M Faut-Callahan
{"title":"Current perspectives on the perioperative management of the latex-allergic patient.","authors":"J Smit,&nbsp;M Faut-Callahan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The increasing incidence of latex allergy necessitates thorough preanesthetic screening for risk factors, which will be delineated in this article, that are associated with latex allergy. The pathophysiology, epidemiology, and testing procedures for latex allergy will be reviewed. This case report will illustrate the management of a patient who was found to be latex-sensitive during surgery and the management of intraoperative anaphylaxis is provided. Safe perioperative care can be provided for latex-sensitive patients if latex avoidance techniques are used consistently.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 3","pages":"117-23"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21576175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pain in human immunodeficiency virus/acquired immune deficiency syndrome patients: a review for nurse anesthetists. 人类免疫缺陷病毒/获得性免疫缺陷综合征患者的疼痛:麻醉护士综述。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-08-01
S J Yermal
{"title":"Pain in human immunodeficiency virus/acquired immune deficiency syndrome patients: a review for nurse anesthetists.","authors":"S J Yermal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pain is the most common reason for the hospitalization of people with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The epidemiology of this disease and limitations of available therapies suggest that HIV/AIDS pain will be a treatment challenge within and beyond the perioperative realm for some time to come. This paper examines HIV/AIDS pain by major body systems. Suggestions are provided for pain assessment in HIV/AIDS patients. Both pharmacological and nonpharmacological treatment of pain in this complex population are described.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 3","pages":"101-6"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21576171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Regulation of health care professionals, Part 2: Validation of continued competence. 医疗保健专业人员的管理，第2部分:持续能力的验证。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-08-01
I P Gunn
{"title":"Regulation of health care professionals, Part 2: Validation of continued competence.","authors":"I P Gunn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Today's demand for professional accountability regarding patient outcomes of care stems from two principle concerns: (1) the risks associated with health care services and their delivery, and (2) health care cost-containment and wanting to get the best care with the best patient outcomes at the best cost. Whereas patient outcomes are a function of multiple factors, health care professionals and their practice are considered key to those outcomes. Today's society and particularly the payers for health care services, have grown skeptical of professions and their willingness to do a good job of self-policing their own members, incompetent performers. In the 1970s, this early skepticism and the concurrent malpractice crisis led professionals and state regulators over time to move beyond the one-time testing for a lifelong credential so long as you didn't get into major problems, to considering alternatives for assuring continued competency in practice. The first efforts focused on voluntary or mandatory requirements for continuing education as a basis of attesting to continuing or recredentialing (licensure or certification). Unfortunately, this continuing education process has never been validated, demonstrating its efficacy in assuring continued professional competence and currency of knowledge as it plays out in practice and patient outcomes. Reasonable assumptions are no longer publicly acceptable; evidence is being demanded. Also, a problem that has plagued private credentialers has been the legal concept of a license or certification as a lifelong property right based on the such conditions when it was awarded. Credentialing bodies have been at legal risk in removing a license or certification for failure to comply with new criteria, particularly if the criteria has not been validated as making a difference. Rather than looking solely at currency of knowledge and competence in its utilization (including the associated technology), it is now being recommended that a multifaceted methodology be used in assessing those professional attributes deemed essential for achieving quality patient outcomes.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 3","pages":"135-41"},"PeriodicalIF":0.0,"publicationDate":"1999-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21575478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anesthetic drug interactions. Quarterly update. 麻醉药物的相互作用。每季度更新。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-05-01
M S McAuliffe, E A Hartshorn
{"title":"Anesthetic drug interactions. Quarterly update.","authors":"M S McAuliffe,&nbsp;E A Hartshorn","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 2","pages":"80-5"},"PeriodicalIF":0.0,"publicationDate":"1999-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21366977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The expert witness: defending the profession or prosecuting your peers. 专家证人:捍卫职业或起诉你的同行。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-05-01
R E Haas, M J Bradshaw
{"title":"The expert witness: defending the profession or prosecuting your peers.","authors":"R E Haas,&nbsp;M J Bradshaw","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The use of CRNAs as expert witnesses in court cases is well-established. The CRNA who acts as a legal consultant or an expert witness is not retained merely to pontificate in the courtroom based on their considerable experience and expertise. The CRNA will undertake many roles in the process of assisting the attorney including those of (1) record reviewer and data analyst, (2) researcher and retriever, (3) synthesizer, and (4) teacher. Beyond these roles is the philosophical premise that the person best suited to evaluate the competence of a nurse anesthetist is another nurse anesthetist. Poor practitioners who are a danger to the public ought to be held accountable for their failings, whereas excellent practitioners who are mistakenly accused of negligence ought to be defended. Although challenging and time consuming, the role of the legal consultant and expert witness is rewarding in both financial and personal satisfaction terms. The role and functions of the CRNA who takes on the challenges of appearing as an expert witness or legal consultant is explored. The fine points of medical malpractice is not discussed, except as a cursory overview. The goal is to provide the practicing CRNA with the basic tools needed for these roles.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 2","pages":"71-9"},"PeriodicalIF":0.0,"publicationDate":"1999-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21366976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Setting up an office anesthesia practice. 设立办公室麻醉诊所。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1999-05-01
M J Mannino
{"title":"Setting up an office anesthesia practice.","authors":"M J Mannino","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The number of office surgery suites have drastically increased over the past several years. As a result, the quantity of anesthesia practice opportunities has also increased. It is the purpose of this report to assist the nurse anesthetist in the process of finding, developing, and maintaining an office anesthesia practice.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 2","pages":"54-8"},"PeriodicalIF":0.0,"publicationDate":"1999-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21367801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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