High-fidelity simulation for continuing education in nurse anesthesia.

Simulation represents a true paradigm shift in teaching and learning that has revolutionized healthcare education. However, few continuing education opportunities for anesthesia providers exist using simulation of any type. This article explores the usefulness of high-fidelity simulation (HFS) as a valuable tool for continuing education and reports the results of a needs assessment conducted among 22 practicing nurse anesthetists. The questions related to their exposure to HFS and asked them to rank their experience with 11 anesthesia events. Next, respondents were asked to rank a similar list of anesthesia events that would be useful for continuing education using simulation. Of participants, 71% ranked advanced cardiac life support scenarios, anesthesia machine mishaps, and malignant hyperthermia as highly effective choices for using HFS. Eighty-one percent of participants identified that they envision simulation as a valuable tool to assess competency, but respondents had mixed written responses when asked if simulation should be used for recertification. This needs assessment represents a beginning, grassroots attempt to establish nurse anesthetists' perceptions related to using HFS as a tool for continuing education.

Recipe for success: stories of evidence-based practice implementation.

Through a collaborative partnership with administrators at a university, nurse leaders at a local hospital worked to create a culture in which nurses could provide evidence-based practice (EBP). The Best Practice Series was started, and two participants' experiences of implementing EBP in their units are described with encouraging results.

Longitudinal quality of life in liver transplant recipients.

More than 75,000 deceased donor liver transplants have been performed in the United States since 1984, thus giving many people another chance at life. Liver transplantation is often scrutinized because of its high cost and limited resources (i.e., organs). Measuring recipient's quality of life posttransplant is one outcome to determine whether liver transplantation is making a difference. Limited information is available from a longitudinal perspective that studies the same recipient over time. The purpose of this study was to describe liver transplant recipients' quality of life pretransplant and 1 and 2 years posttransplant. Patients completed the Quality of Life form at initial evaluation for liver transplant at 1 and 2 years posttransplant. Data from 139 recipients were extracted from a database maintained by a large transplant center in the southwest United States. Repeated-measures analysis of variance showed a statistically significant difference in quality of life at 1 and 2 years posttransplant as compared with quality-of-life scores pretransplant. The major finding was a statistically significant difference in quality of life between men and women, with men reporting higher overall quality-of-life scores. Liver transplantation does make a difference in improving quality of life. Further investigation is suggested to explore the difference of quality of life between genders.

New drug, fospropofol disodium: a propofol prodrug.

The use of propofol presents chemical and clinical concerns, including pain on injection, allergy risks, possible bacteria growth, and hyperlipidemia. These concerns have encouraged the search for alternative propofol formulations. Elimination of the soybean oil and lecithin carrier agents is difficult because the highly lipophilic diisopropyl phenol molecule does not dissolve in water. Propofol in aqueous solution would be a preferable alternative to lipid-based emulsions. One formulation of propofol is fospropofol disodium (Lusedra, Eisai Corporation of North America, Woodcliff Lake, New Jersey), previously known as Aquavan (MGI Pharma, Bloomington, Minnesota). Fospropofol is an aqueous solution of a propofol prodrug intended for injection. The discovery and development of this drug may address the concerns with the current propofol emulsion formulations while offering altered pharmacokinetics and pharmacodynamics for sedation. The structure, pharmacokinetics, pharmacodynamics, clinical studies, clinical applications, and implications are discussed.

Safety and effectiveness of large-volume enema solutions.

The effectiveness and side effects of three types of enema solutions were compared in healthy subjects. Using a repeated-measures, double-blind design, the three different enemas (soapsuds, tap water, and polyethylene glycol-electrolyte solution) were given at 1-week intervals to 24 healthy volunteers. Soapsuds and tap water enemas produced significantly greater returns than polyethylene glycol electrolyte solution (PEG-ES) and were also more uncomfortable. Rectal biopsies showed surface epithelium loss after soapsuds and tap water but not after PEG-ES enemas. Before recommending changes in nursing practice, further research is needed to determine the mechanism for the surface epithelium damage and to determine if this damage produces a stronger defecation stimulus and discomfort.