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Kick off to
Autumn!!!
Fun Facts:
The most played song on American radio during the twentieth
century was You've Lost That Loving Feeling which was
written by Barry Mann, Phil Spector, and Cynthia Weil.
"Weird" Al Yankovic received a Bachelor's degree in
Architecture in 1981. He also served as valedictorian of his
high school at age 16.
The oldest business in the United States of America is the
cymbal company Zildjian which was founded in Constantinople
in 1623.
There are approximately ten million bricks in the Empire
State Building.
The lightning that we see actually goes from the ground to
the sky in what is known as the "return stroke" at 1/3 the
speed of light. We can't see the initial "stepped leader"
that passes from the sky to the ground.
From space, the brightest man-made place is Las Vegas,
Nevada.
More Fun Facts:
Janis Joplin's will called for a party for 200 people at her
favorite pub in San Alselmo, California at a cost of
$2,500.00.
Contrary to common belief, elephants are not afraid of mice.
Go to any zoo and chances are that the mice are living in
the same quarters as the elephants. The mice eat the grain
and nest in the hay that is so common to elephant habitats.
Actress Cheryl Ladd started her career as the singing voice
of the character Melody on the 1970's cartoon Josie and the
Pussycats.
The most common invention of the 19th century was the
washing machine. Between 1804 and 1873, at least 1676
patents were issued by the United States Patent Office for
various forms of this device.
Save yourself
time by keeping us updated with your credentials. Fax any
updated information to 248.646.0361 as soon as you receive
it or visit
www.nationalanesthesia.com
and create your online profile today! This will help in
keeping you credentialed in your current assignment or
preparing for a new one.
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A message from the President
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How can it already
be the end of September? Once again the long
days of summer have passed too quickly and
here in Michigan the warmth is fading! We
are already gearing up for the next quarter.
The leaves are changing colors, the sweaters
are going on, the furnaces are getting fired
up and the sounds of autumn are in the air!
Outside, I hear the sounds of cheering
football fans and the gaggles of geese
migrating south; inside our offices, I can
hear the National Anesthesia team on the
phones making plans to cover holiday
vacations and getting providers set up for
jobs in the new year! Now is the time to
schedule and also the time to talk with us
about 2010. Let us help you start your new
year off with a solid staff and strong
department.
In this issue of National News you can read
the article "A.M. Colonoscopies More
Effective" and find out if this is really
true. Just last week, Christi Brewer and
Randi Carter attended the MANA fall meeting
in Grand Rapids. You can read more in the
article "2009 MANA Fall Meeting" and learn
who won another fun gift from National
Anesthesia. To wrap this month's newsletter
up you will read part three of our
three-part series from "The Changing Face of
Surgery." You will read about how cataract
surgery and outpatient surgery may change in
the future. In addition to these topics they
also discuss going paperless and if it will
or could really happen.
We have many
great job opportunities at National
Anesthesia. Right now we have 2 positions in
south central Virginia for CRNAs who are
looking for independent practice and want to
settle down in a peaceful, rural community
hospital. We also have a great permanent job
with a growing anesthesia group in southern
MI if you're an MD with cardiac experience.
These are just a few of the many positions
we have available. Connect with us today at
1-800-642-1999 and let us know where you are
looking for a position. You can also visit
our website at
www.nationalanesthesia.com
to register online!
Stephen Read, President
National Anesthesia Services, Inc.
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Quote of the month
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To laugh often and
much, to win the respect of intelligent
people and the affection of children, to
earn the appreciation of honest critics and
endure the betrayal of false friends, to
appreciate beauty, to find the best in
others, to leave the world a bit better,
whether by a healthy child, a garden patch,
to know even one life has breathed easier
because you have lived. This is to have
succeeded!
----- Ralph Waldo Emerson |
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A.M. Colonoscopies More Effective
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Physicians detect
more adenomatous polyps during colonoscopies
performed in the morning, before fatigue
sets in during afternoon cases, according to
a study appearing in the American Journal of
Gastroenterology.
Madhusudhan R. Sanaka, MD, led a team of
investigators at the Cleveland Clinic in a
review of 3,619 colonoscopies, 1,871 of
which were performed after 12 noon. The
researchers report a physician adenoma
detection rate of 25.3% during afternoon
cases, compared to 29.3% in cases performed
in the morning.
In addition, they note a trend toward
declining detection rates for each
subsequent hour of the day, with the highest
rates occurring during cases beginning at 7
a.m. (34.2%) and the lowest rates recorded
during cases performed at 4 p.m. (22.4%).
Out of 34 endoscopists who performed
colonoscopies in the morning and afternoon,
25 demonstrated higher adenoma detection
rates during morning procedures.
Endoscopists might be less attentive or less
vigilant and might not spend as much time
during the withdrawal phase of colonoscopy
during afternoon procedures, say the
researchers. They conclude that performing
colonoscopies in the morning compared with
the afternoon appears to be an independent
predictor for increased adenoma detection,
even after excluding incomplete procedures
and procedures with inadequate bowel
preparations.
---Daniel Cook
www.outpatientsurgery.net
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2009 MANA Fall Meeting
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Account managers
Christi Brewer and Randi Carter attended the
annual MANA fall conference Sept. 25- 26.
The meeting was held at the Amway Grand
Hotel in Grand Rapids this year. Michigan
has so many great places to visit and this
venue was no exception, with the Art
Festival in town the city was buzzing with
activity. As always, we really enjoyed
seeing everyone at the conference, it was a
great opportunity to catch up and also meet
some new CRNAs and SRNAs. Thank you to
everyone who stopped by our booth and
congratulations to Jackie Evans, CRNA who
was the winner of our karaoke machine
giveaway!
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The Changing Face of Surgery Part 3
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How might cataract surgery change in
2020? Lasers may soon be used in
cataract procedures. "Within 5 years, I
foresee using femtosecond lasers in the OR
or pre-op area to perform some of the
surgical steps prior to incising the eye,"
says David Chang, MD, an ophthalmic surgeon
and researcher in Los Altos, Calif. The
laser would be used to create the phaco
incision, to correct astigmatism with
corneal relaxing incisions, to perform the
capsulorhexis and to pre-chop the nucleus
into multiple fragments for aspiration.
Patients might not be going home with
eyedrops, says Dr. Chang. "We would inject a
tiny sphere of medication that would last
for a week and replace the need to use any
other post-op eyedrop medications. There
would be no medication instructions or
questions to answer."
Eye surgeons may be using light-adjustable
IOLs to fine-tune the refractive result.
"Two weeks following surgery, the patient
would return and have any residual
refractive error corrected - like having
LASIK, but performed on the IOL itself. We
would even add multifocality if the patient
wanted," says Dr. Chang.
What might ORs look like in 2020? One of the
biggest changes in the OR will be fewer
cables, says Dr. Schwaitzberg. Signals will
be sent from imaging devices to monitors
wirelessly. As batteries become more
efficient and have greater capacity, more
devices will become battery-powered, which
will eliminate even more cords. Wireless
technologies will also help improve safety,
as radiofrequency identification systems for
sponges and instruments become more common
in surgical suites, says Dr. Schwaitzberg.
Will we really be paperless by 2020?
In 2020 the federal government's goal of a
universal application of electronic health
records may have become a reality, to some
degree. Thanks in part to federal incentive
funding, healthcare facilities will have
installed EHR systems. Whether all these
systems will be able to speak to each other
and send health records back and forth is a
big question mark.
Ms. Van Milligan doesn't see the medical
record flowing seamlessly from 1 provider to
next, especially when the providers belong
to different health systems. "It will move
within the system," she says. However,
sending an EHR outside a health system
network or regional network will remain a
challenge because of lack of
standardization.
One thing future-watchers do agree on is
that as EHRs become more common, so will
data collection for pay-for-performance
analysis. EHRs will make it easier to gather
information that documents that clinical
processes were done correctly because the
information will go directly into the
electronic record. Mandatory reporting and
cross-comparisons will be part of everyday
life, says Dr. Morris.
Although information capture will be much
easier, it will still be more work for
providers, especially nurses who will have
to wade through the systems. The graphical
interfaces may become more user- friendly,
but each EHR will have more pages, or
screens, of data and check-boxes for nurses
and physicians to click through, says Ms.
Van Milligan.
In spite of the extra work, data collection
will change the way your facility operates.
As more data on outcomes, medical errors,
patient satisfaction and adherence to safety
and quality guidelines becomes available,
facilities will constantly be fine-tuning
their operating procedures in order to
improve their scores and, in return, their
reimbursement from Medicare and insurers.
Currently CMS penalizes hospitals that do
not report quality data. But there's no
level of quality that providers need to meet
in order to receive the full market basket
update each year. "It's essentially 'pay-
for-reporting,'" says Ms. Lowe.
However, under a demonstration run by
Medicare for inpatient hospitals, providers
who meet certain criteria based on how they
follow protocols and standards of care for
procedures such as hip and knee replacements
and coronary artery bypass grafts receive
bonus payments from Medicare. Providers that
do not meet target scores sacrifice payments
if they continue to participate in the
voluntary program, says Ms. Lowe.
In the future, facilities with good quality
scores will use their ratings as a marketing
tool. Some already are. "Hospitals are using
it now to empower themselves," says Dr.
Morris.
How else might the face of outpatient
surgery change by 2020?
For one thing, more and more surgery will be
done on an outpatient basis. Today, more
than 77.5% of all surgeries are outpatient
procedures and 41% of all outpatient cases
are done in ambulatory surgery centers,
according to Outpatient Surgery Magazine
estimates based on state data. Fueled by
continuing advances in less invasive surgery
and safer anesthesia, both of those numbers
should continue to rise.
"Ten years ago, laparoscopic cholecystectomy
was only inpatient and now it's a common
outpatient procedure," says Ms. Deno.
For another, surgery will continue to
migrate from hospitals to ambulatory
surgical centers. Medicare spending on ASC
services grew annually by an average rate of
9.7% between 2000 and 2007, according to a
study by KNG Health Consulting. About 70% of
the growth in Medicare services provided by
ASCs was attributable to procedures -
particularly ophthalmology and
gastrointestinal - moving from the hospital
setting to ASCs, says the report.
For example, the ASC market share of GI
services grew from 17.3% to 36.6% between
2000 and 2007, while the HOPD market share
of those procedures fell from 75% to less
than 60%. The market share for physicians'
offices remained around 5%.
What the study did not find was any merit to
the charge lodged by ASCs' critics that
physician- ownership of surgery centers
leads to overutilization of services. "We
find little evidence that induced demand is
a driver of ASC service volume," the authors
write. "Most of the growth in Medicare
services since 2000 resulted from a movement
of services from the HOPD to the ASC."
---Kent
Steinriede
www.outpatientsurgery.net
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General Disclaimer:
The materials have been compiled by National
Anesthesia Services. Inc. from internal and
external sources. However, while we have
attempted to provide accurate information in
this publication, no representation is made
or warranty given as to the completeness or
accuracy of the Materials. In particular,
you should be aware that the Materials may
be incomplete, may contain errors, or may
have become out of date. You should
therefore verify information obtained from
this publication before you take any action
upon it.
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