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More research is needed concerning the management of COVID-19-infected patients, and CRNAs must become familiar with their ICU units' individual ventilator machine, but this brief review provides a good place to start for those returning to the ICU.The Standards for Accreditation of Nurse Anesthesia Programs Practice Doctorate was adopted by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) in January 2015. Balancing academic and clinical preparation for doctoral students, preparation for the National Certification Examination, and requirements for scholarly work represents a major challenge for students, faculty, and programs. With most nurse anesthesia programs having transitioned to the practice doctorate, the COA was in a pivotal position to examine the current state of scholarly work and to produce a white paper to guide programs' development of criteria for scholarly work. To inform the guidance contained in the white paper, nurse anesthesia educators provided input via a survey, a focus group at the 2019 Assembly of Didactic and Clinical Educators meeting, and an active discussion and question-and-answer session during the Assembly. A call for comments was also sent to stakeholders for review and comment on the draft white paper. The guidance set forth in the white paper in no way supersedes institutional and/or other accreditor requirements. The aim of this guidance is to aid nurse anesthesia programs in successfully managing scholarly project curriculum. This article provides an overview of the project.A high prevalence of undiagnosed obstructive sleep apnea (OSA) exists in patients receiving sedation for gastrointestinal laboratory (GI lab) procedures, with potentially serious adverse events associated with untreated OSA. This quality improvement project aimed to identify patients at high risk of OSA and evaluate their risk of intraprocedure airway maneuvers and adverse events in a GI lab. In the GI lab, nurses administered and documented the STOP-BANG questionnaire as part of their pre-procedure assessment of 80 patients presenting for elective procedures. The occurrence of airway maneuvers and adverse events during the procedures was measured using a checklist given to nurse anesthetists as they brought patients to the postprocedure area. Patients with STOP-BANG scores below 5 and with scores of 5 and above were compared. Descriptive and inferential statistics were used to analyze differences in patient outcomes. Patients with high STOP-BANG scores had an increased need for airway maneuvers and higher occurrence of adverse events (P=.05). These results support the use of STOP-BANG as a pre-procedure risk assessment tool. Anesthesia professionals can anticipate intraprocedure airway interventions, consider preemptive interventions in a GI lab, and be more vigilant when caring for patients with high STOP-BANG scores at high risk of undiagnosed OSA.Patients undergoing craniotomy are at increased risk of intravascular volume changes due to the use of mannitol. This quality improvement project was conducted to implement a standardized goal-directed fluid therapy (GDFT) protocol using a dynamic physiologic measure in an attempt to maintain euvolemia in patients undergoing craniotomy with mannitol administration. An evidence-based GDFT protocol was integrated into an existing neurosurgical protocol. Anesthesia providers were asked to implement the protocol in patients who met the screening criteria. A preimplementation and postimplementation record review was conducted to compare outcomes of the intervention with standard practice. Primary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, serum lactate levels, and the total amounts of intraoperative crystalloid and colloid administered between the preimplementation and postimplementation groups. Of 95 patients who met the screening criteria, 51 (54%) had full protocol compliance. There was no significant difference between groups in ICU LOS (P=.700), hospital LOS (P=.948), serum lactate levels (P=.484), or the total amount of intraoperative crystalloid administered (P=.122). The postimplementation group had significantly more colloid administered than the preimplementation group (P=.004). DubsIN1 A lack of provider compliance with the protocol may have affected these results. Further refined quality improvement cycles are warranted.Volatile anesthetic agents act as greenhouse gases. Low-flow anesthesia techniques (≤1 L/min) are associated with lower costs. Decreasing volatile anesthetic delivery provides safe and effective strategies for anesthesia providers to decrease costs and reduce environmental pollution. This evidence-based project aimed to estimate cost savings and reduction in the environmental release of anesthetic gases, under simulated lower fresh gas flow (FGF) practices. For each surgical case, the exhaled anesthetic gas percent and FGF data were used to calculate the volume of fluid volatile anesthetic. The fluid volatile anesthetic for each case was then estimated using simulated FGFs. Changes in volatile agent cost and environmental release of anesthetic gases were predicted. Sevoflurane was the most commonly used volatile agent. The mean FGF for cases using sevoflurane was 2.5 L/min. The simulated FGF of 1 L/min FGF across all agents predicted a 48% ($50,892) reduction in costs of volatile anesthetics and a 42% (33 metric tons of carbon dioxide equivalent) decrease in carbon emissions. Simulated low-flow anesthesia demonstrated cost savings and environmental conservation. Project findings align with current literature showing that lowering FGFs represents an area of cost containment and an opportunity to lessen the environmental impact of anesthesia.Ketamine is a well-known anesthetic that has been used since the 1970s. Despite its ubiquitous use as a postoperative analgesic, no studies have described dosing differences between opioid-tolerant (OT) and nonopioid-tolerant (NOT) patients or determined optimal dosing. The primary aim of this study was to assess whether OT and NOT patients had significant differences in ketamine infusion dosing requirements. We also aimed to measure the overall incidence of psychotomimetic adverse effects associated with low-dose ketamine infusions. We hypothesized that NOT patients would have lower ketamine infusion dosing requirements and a higher incidence of psychotomimetic adverse effects compared with OT patients. We performed a retrospective chart review and showed that the percentages of OT and NOT patients experiencing psychotomimetic adverse effects were similar (15.5% vs 15.3%; P=.93) and that increasing age was the only factor associated with increased odds of experiencing a psychotomimetic adverse effect potentially associated with ketamine (odds ratio, 1.29 [95% CI, 1.11-1.50]; P=.001). Optimal subanesthetic ketamine infusion dosing could not be established, and further research in this area may be warranted.Perioperative pulmonary aspiration (PPA) is a major cause of morbidity and mortality. During anesthesia, airway reflexes become depressed, placing patients at risk of PPA. Gastric ultrasonography (GUS) can be used to qualitatively differentiate between solids, liquids, and empty gastric contents. The purpose of this study was to determine the sensitivity and specificity of GUS in identifying gastric contents after participants were randomly assigned to consume 1 donut, drink 360 mL of water, or remain fasted (n=60 each group). Ultrasonography was performed by a blinded scanner, and qualitative findings were recorded by 2 sonography examiners and the primary scanner. Findings from the water group included a sensitivity of 95% to 100% and specificity of 87.5% to 90% for identification of liquids. Interrater reliability results yielded an intraclass correlation coefficient (ICC)=.781 for the solid group; ICC=.950 for the fluid group; and ICC=.761 for the fasted group. Statistically significant differences were found for the effect that body mass index classifications had on sensitivity and specificity of GUS for predicting gastric content. Results of this study demonstrated that GUS is highly sensitive, specific, and reliable with low false-positive and false-negative rates in the identification of fluid gastric content.

Chronic pain is a common cause of health-related incapacity for work among people in the UK. Individualised placement and support is a systematic approach to rehabilitation, with emphasis on early supported work placement. It is effective in helping people with severe mental illness to gain employment, but has not been tested for chronic pain.

To inform the design of a definitive randomised controlled trial to assess the clinical effectiveness of individualised placement and support for people unemployed because of chronic pain.

A mixed-methods feasibility study comprising qualitative interviews and focus groups with key stakeholders, alongside a pilot trial.

Primary care-based health-care professionals, employment support workers, employers, clients who participated in an individualised placement and support programme, and individuals aged 18-64 years with chronic pain who were unemployed for at least 3 months.

An individualised placement and support programme integrated with a personalised, responllenging and methods for achieving this would need to be developed. The intervention has been manualised.

Current Controlled Trials ISRCTN30094062.

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in

 ; Vol. 25, No. 5. See the NIHR Journals Library website for further project information.

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 5. See the NIHR Journals Library website for further project information.Previous systematic reviews and meta-analyses of cross-sectional data assessing the effect of cannabis on cognitive functioning and intelligence show inconsistent results. We hypothesized that frequent and dependent cannabis use in youth would be associated with Intelligence Quotient (IQ) decline. This study is a systematic review and meta-analysis. We searched Embase, PubMed and PsychInfo from inception to 24 January 2020. We included studies with non-treatment seeking samples and pre- and post-exposure measures of IQ. We requested data from authors if summary data was not available from published work. We preregistered our review with PROSPERO (ID no. CRD42019125624). We found seven cohort studies including 808 cases and 5308 controls. We found a significant effect for the association between frequent or dependent cannabis use in youth and IQ change, Cohen's d = -0.132 (95% CI -0.198 to -0.066) p less then 0.001. Statistical heterogeneity between studies was also low at I2 = 0.2%. Study quality was moderate to high. This translates to an average decline of approximately 2 IQ points following exposure to cannabis in youth. Future studies should have longer periods of follow up to assess the magnitude of developmental impact.