{"title":"Commentary: issues and perspectives affecting CRNA practice. Regulation of health professionals, Part 1: Telepractice.","authors":"I P Gunn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although the requirement to protect the public welfare and safety is a right guaranteed to the states by the US Constitution's 10th amendment, which grants states the \"police powers\" of government, it is not an absolute power. The Commerce clause of the Constitution limits the power of states in creating barriers to intrastate commerce. Changes in the health care delivery system of the US, such as the use of corporate models such as managed care entities and health maintenance organizations, as well as health insurers' development of utilization reviews before approval of reimbursable procedures in individual cases, has prompted concerns with regard to the care of patients occurring outside the state in which the patient resides, by health care professionals not licensed in that state. Many states have considered such decision making an \"unauthorized practice of medicine, or other practice\" creating the necessity for some providers to obtain an many as 20 licenses to cover their practice. The practice of telemedicine (or telenursing or telehealth) falls into this quagmire, and thus efforts are ongoing to try to find ways to permit such practices while maintaining quality control, with or without additional state licenses.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 2","pages":"86-92"},"PeriodicalIF":0.0,"publicationDate":"1999-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21366978","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}
{"title":"Starting your own anesthesia business.","authors":"L A DeLuca","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The business side of anesthesia is uncharted territory for most CRNAs. This article takes the personal experience of the author and translates it into a practical guide for nurse anesthetists looking to start their own businesses. The basic fundamentals referred to in this article provide the groundwork for moving toward self-employment.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 2","pages":"50-3"},"PeriodicalIF":0.0,"publicationDate":"1999-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21367800","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}
T E Sprague, K R Wren, R S Corpe, T E Philpot, S A Chaney, H L Bentz, L C Bandy
{"title":"Critical pathways: a means of managing the operating room.","authors":"T E Sprague, K R Wren, R S Corpe, T E Philpot, S A Chaney, H L Bentz, L C Bandy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Critical pathways help institutions in efficient and appropriate resource use to increase the quality of health care and minimize health care costs. However, many opportunities for pathway development and implementation are unexplored. This article delineates the development process for critical pathways and discusses the outcomes realized from use of the total joint pathway at the Medical College of Georgia, Augusta, GA.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 2","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"1999-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21366975","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}
{"title":"Employee and independent contractor relationships.","authors":"K R Wren, T L Wren, E J Monti, S J Turco","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Most practitioners find themselves at a disadvantage in dealing with business issues and relationships. As health care continues to change, knowledge of contracts and business relationships will help CRNA practitioners navigate new as well as traditional practice settings. This article discusses the advantages and disadvantages of two business relationships: employee and independent contractor.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 2","pages":"59-64"},"PeriodicalIF":0.0,"publicationDate":"1999-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21367802","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}
{"title":"Controversial issues in outpatient anesthesia: adult and pediatric.","authors":"R G Ouellette","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The 21st century will bring a new era of cost containment to the arena of ambulatory surgery force practitioners of anesthesia to reevaluate practice patterns. Along with the current increased interest in cost containment and optimal use of limited resources, growing concerns about patient outcome result in controversial issues in adult and pediatric outpatient anesthesia that must be addressed in the areas of preoperative evaluation, patient preparation and selection, laboratory screening, and practical discharge criteria. The future challenge for all practitioners is to provide high-quality anesthesia care at a reduced cost.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 1","pages":"2-5"},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21367794","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}
{"title":"Anesthetic considerations in hepatic porphyrias.","authors":"G H Hunter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Porphyrias are inherited defects of heme synthesis with manifestations that can mimic surgical diseases; they can be provoked by administration of certain drugs. Manifestations such as abdominal pain, vomiting, tachycardia, hypertension, neuropathy, fever, confusion, and seizures have been described. Management of patients with porphyria is designed to avoid triggering drugs, such as barbiturates, and perhaps, benzodiazepines and ketamines. Nontriggering drugs should be used in the management of patients with porphyria. Because starvation can induce an attack, glucose infusions are important in the prevention and treatment of porphyria.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 1","pages":"6-14"},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21367795","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}
{"title":"Newer trends in the prevention or treatment of postoperative nausea and vomiting.","authors":"S M Ouellette","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Postoperative nausea and vomiting are common and distressing postsurgical complications. Prevention or early treatment of this complication should be a goal of all anesthesia providers. This article addresses the pathophysiology of nausea and vomiting and identifies patients at risk for this complication. Pharmacological actions and side effects of commonly used antiemetics are addressed. The new serotonin antagonists and combined antiemetic therapy are highlighted.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 1","pages":"24-33"},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21367797","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}
{"title":"Issues and perspectives affecting CRNA practice. Professional identity and historical roots.","authors":"I P Gunn","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 1","pages":"41-7"},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21367799","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}
{"title":"Illicit drugs and anesthesia.","authors":"B Hyatt, K P Bensky","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Substance abuse is the nation's number one health problem. With illicit drug use so prevalent, the anesthesia care team undoubtedly sees more people under the influence of illicit drugs. Cocaine, heroin, and marijuana are the drugs that are commonly used. Cocaine acts as an intense stimulant, heroin has profound sedative effects, and marijuana may cause various respiratory problems. Many times when drug users present for anesthesia, they will not admit to using illicit drugs, leaving the anesthetist to treat complications intraoperatively. This article discusses the history, street practices, pharmacodynamics, and anesthetic management of people using cocaine, heroin, and marijuana. This knowledge of how to treat patients abusing drugs will undoubtedly improve anesthetic outcomes. There are many illicit drugs used by people that anesthetists do not see frequently in the care of their patients, but the anesthetist should be aware of the common street drugs in use.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 1","pages":"15-23"},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21367796","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}
{"title":"Anesthetic drug interactions. Quarterly update.","authors":"M S McAuliffe, E A Hartshorn","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"10 1","pages":"34-40"},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21367798","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}