Prediction of internal electric current distribution from surface application in atrophied muscle tissue.

The use of surface electrical stimulation therapy for clinical rehabilitation has created the need for an improved modeling method to predict internal current density. A method was developed to model quantitatively the current density delivered to an atrophied muscle. Some stimulation protocols do not produce measurable physiological effects, such as muscle contraction. Therefore, traditional response-based current density modeling cannot be used. Additionally, lumped circuit models do not provide the resolution needed to optimize electrode size, shape, and placement. The quantitative approach developed here can be used to optimize electrical stimulation protocols in abnormal muscle tissue. In this study, the finite element method (FEM) is used to model the low intensity electric current stimulation resulting from surface application. FEM provides the ability to model complex tissue properties found in living tissue. A leg of lamb was modeled because its size and level of tissue complexity is similar to that of a human child's thigh. Voltage gradient measurements were made upon a sacrificed leg of lamb during the application of bipolar stimulation. These measurements were made at numerous points in the stimulated leg of lamb and allowed the mapping of the current density. The leg of lamb was then sliced and photographed to be able to create the finite element model. The empirical data compared favorably to the results of the FEM model, thus verifying the method. This FEM model was then modified to study the effects of muscle atrophy on electric current densities. This modeling method will ultimately lead to improved stimulation protocols and better clinical treatment.

Analysis of noteworthy indicators on the anesthesia record: a prospective, multiregional study.

A national sample of anesthesia records were studied prospectively for the presence or absence of predetermined, noteworthy record indicators judged important in documenting a basic core of information describing the monitoring and care provided in a generic clinical setting. Only records involving the administration of a volatile anesthetic for the purpose of achieving general anesthesia, prepared by providers with at least 6 months of experience in anesthesia care were examined. No identifying patient, provider, or institutional data were recorded. Indicators were scored in a "present/absent" format. All data were pooled; the goal was to describe the overall phenomena in terms of frequency of compliance. A total of 4,989 anesthesia records were evaluated in terms of 13 record indicators. Those missed ranged from 0.0% (patient identification) to 28.6% (notation regarding emergence). Ten were omitted on less than 6% of the records: 3 (surgery and/or anesthesia start time, notation regarding emergence, surgical positioning noted) were omitted on more han 13.0% of the records. Given he observed inconsistencies, perhaps the anesthesia record needs redesign or the rationale behind documentation requires increased emphasis in educational and equally assurance programs.

From nurse to nurse anesthetist: the influence of age and gender on professional socialization and career commitment of advanced practice nurses.

The purpose of this study was to identify the influence of age and gender on professional socialization and career commitment of student registered nurse anesthetists. A 78-item, self-administered questionnaire was mailed to the United States population of student nurse anesthetists (n = 2,008). Responses were received from 1,106 (55 per cent response rate). Forty per cent of the respondents were male, and 60 per cent were female. Thirty-nine per cent of respondents were age 20 to 30 years; 48 per cent were 31 to 40 years old; and 13 per cent were older than 40 years. Demographic data and scales identifying the three dimensions of socialization were analyzed with Chi square and GSK analysis of variance to measure responses and differences to all Guttman-scaled items. Age and gender both correlated significantly (P < .05) with the socioeconomic rewards of the profession. Increasing age was negatively correlated with professional socioeconomic rewards and attraction and the dimension of relatedness to the professional role. Male gender was positively correlated with a bureaucratic orientation and administrative/supervisory roles, and female gender was positively correlated with holistic patient care. Men achieved socialization more readily in the dimension of occupational orientation. Nurses, particularly advanced practice nurses, are socialized into a hierarchy that has implicit values and roles. The influence of age and gender must be considered in the professional socialization process.

Verification of the finite element method to model subthreshold electrical current density in saline.

Therapeutic electrical stimulation (TES) is a rehabilitative stimulation therapy for individuals with neuromuscular disorders. TES uses subthreshold transcutaneous electrical stimulation to cause muscle growth and neuron sprouting through increased blood flow. To optimize TES therapy, a new method was required to determine the electrical current density in the target muscle. This is because TES's subthreshold stimulation intensity does not produce any measurable physiological effect. The finite element method (FEM) was the numerical modeling method chosen. FEM provides the ability to the model complex properties found in living beings, such as different tissue types and anisotropic tissue properties. TES uses a 35 Hz biphasic waveform. At this low frequency, the quasi-static approximation was used. This allows the heat transfer model solution to be used to find the steady state electric field solution. The goal of this paper is to show that the heat transfer results are the same as the electric field measurements made in a biological phantom. Laboratory measurements were made in a one liter cylinder of normal saline using bipolar stimulation. Electric field measurements were made using silver chloride electrodes at various points in the stimulated solution. This allowed the mapping of the electric potentials. The empirical data compared favorably to the results of the FEM thus validating in the method and assumptions. Finite element modeling provides an accurate method to visualize the electrical current densities resulting from bipolar stimulation. The FEM can now be used to determine the optimal electrode configuration for TES and other electrical stimulation protocols. This computer modeling method will ultimately lead improved patient results.

From nurse to nurse anesthetist: the relationship of culture, race, and ethnicity to professional socialization and career commitment of advanced practice nurses.

The purpose of this study was to identify the relationship of culture, race, and ethnicity on professional socialization and career commitment of student registered nurse anesthetists. A 78-item, self-administered questionnaire was mailed to the United States population of student nurse anesthetists (N = 2,008) yielding a 56% response. Demographic data and the dimensions of socialization were analyzed with chi-square and weighted least-squares linear analysis of variance. Four scales assessed the relationship of age, gender, culture/race/ethnicity, and views of culturally congruent care on the socialization process. In all dimensions of socialization, culture and race/ethnicity both correlated significantly (p < .05) for all nondominant groups compared to the dominant European American White group. Responses from Asian-Pacific Islanders were most positively correlated to all dimensions of socialization. Hispanics responded least positively to a life-time commitment to the career in nurse anesthesia by culture (p = .003) and ethnicity (p = .009).

Electrical current density model from surface electrodes.

The goal of this research is to determine the optimum electrical current for subthreshold electrical stimulation. The first step is to collect atrophied muscle impedance data from children with neuromuscular disorders using Bioelectric Impedance Analysis (BIA). Then to incorporate this impedance data into a model using the 3-D Finite Element Method (FEM). This will allow the evaluation of electric current densities in the target muscle resulting from Therapeutic Electrical Stimulation (TES). Using the FEM, optimum electrical stimulation parameters, levels, and electrode placement can be determined. The FEM will provide the first means to determine the quantity of electric current flowing through the target muscle from surface electrode stimulation. TES is adding new life to electrical stimulation therapy. TES is low intensity (subthreshold), long duration transcutaneous stimulation using surface electrodes. TES effects muscle growth and peripheral nerve sprouting leading to increased functional control and sensation. The initial parameters used in TES have been proven clinically to be effective for use in rehabilitation therapy for people with neuromuscular disorders. This research is the first step towards optimization of the TES protocol. Ultimately, the results will lead to improved quality of life for children with neuromuscular disorders.

Perioperative nursing in Israel.

Perioperative nursing in Israel's Hadassah Medical Organization hospitals-Ein Kerem and Mt Scopus-reflects quality patient care practices paralleling those in US hospitals. Although these two hospitals, both located in Jerusalem, represent only 5% of the hospital beds in Israel, they receive more than 60% of referrals made to all Israel hospitals. Throughout Israel's tumultuous history, the Hadassah Medical Organization has served the country during both war and peace. In 1991, Mt Scopus was designated as the hospital on duty in case of a chemical attack during the Gulf War. The authors provide an overview of perioperative nursing at the Eln Kerem and Mt Scopus Medical Centers of the Hadassah Medical Organization and describe one American nurse's experience as a volunteer in the Mt Scopus Medical Center OR during the Gulf War.

Nurse anesthesia and multiculturalism.

Program directors from 90 accredited nurse anesthesia programs in the United States and Puerto Rico were surveyed concerning multicultural issues. This article summarizes the identified needs of clients and student nurse anesthetists from culturally diverse backgrounds. Noteworthy findings include the perception that clients were more disadvantaged than students because of differences in socioeconomic status; the fact that about half of the programs provided students with instruction on cultural differences; and the observation that specific units of instruction within courses were the most frequent way of giving instruction in this subject area.

CRNAs: an enviable legacy of patient service.

The profession of nurse anesthesia and the role of the certified registered nurse anesthetist (CRNA) is chronicled to acquaint the general nursing population and those within advanced practice specialties of nursing to the discipline of anesthesiology. Historical highlights, professional definitions, scope of practice, insights into the educational preparation of CRNAs, employment settings, and marketplace opportunities are described. Professional challenges and opportunities facing CRNAs have come from both within and outside the nursing community. By facing these challenges CRNAs have demonstrated their tenacity in professional commitment to the delivery of quality patient care for more than 100 years.

Ketorolac and propofol administration for prevention of nausea and vomiting in patients undergoing minor gynecologic surgery.

This clinical review explores the efficacy of the nonsteroidal antiinflammatory agent, ketorolac tromethamine, added to an anesthetic regimen utilizing intravenous propofol. Both agents have been shown to reduce the incidence of nausea and vomiting postoperatively when administered to patients undergoing minor gynecologic surgery. Because the incidence of nausea and vomiting is significantly reduced when ketorolac is used in place of opioids to attenuate postoperative pain, it would appear to be an appropriate choice of agent to use following propofol anesthesia. The use of this combination of drugs may not only reduce the incidence of postoperative nausea and vomiting in patients undergoing minor gynecologic surgery, but could reduce the duration of hospitalization and enhance recovery from anesthesia.