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Operating Opinions
A forum for discussion on recent news regarding OR nurses.
Tuesday, December 16, 2014

UCLA researchers are now able to access previously unreachable areas of the head and neck with an advanced robotic surgical technique used in tandem with chemotherapy or radiation. The new approach, developed  by Dr. Abie Mendelsohn, UCLA Jonsson Comprehensive Cancer Center member and director of head and neck robotic surgery at UCLA, facilitates operating in the parapharyngeal space, which is lined with several large blood vessels, nerves, and complex facial muscles, making access to this area highly invasive or impossible.

“This is a revolutionary new approach that uses highly advanced technology to reach the deepest areas of the head and neck,” said Mendelsohn. “Patients can now be treated in a manner equivalent to that of a straightforward dental procedure and go back to leading normal, healthy lives in a matter of days with few or even no side effects.”

Mendelsohn was able to refine and advance transoral robotic surgery via the da Vinci Surgical Robot, allowing 3D imaging tools the ability to reach the parapharyngeal space along with other areas of the head and neck previously difficult to reach.

Source: [BioSciTech]
 
 
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Tuesday, December 02, 2014

 
According to a recent study surveying over 3 million patients who received general anesthesia, approximately 1 in 19,600 patients wake up during surgery. Researchers found that certain operations require "lighter" anesthesia, such as with emergency C-sections, which carry an accidental awareness rate of 1 in 670.
 
"Patients who were told about awareness before surgery were prepared and not distressed when they experienced it," said professor Jaideep Pandit, consultant anesthetist at Oxford University Hospitals and lead author of the study. "Nerve stimulators, which measure the extent of paralysis, should be used throughout surgery to ensure that doctors only use the minimum amount of paralytic required," Pandit added.
 
Patients described pain, hallucinations, paralysis, choking, and near-death experiences during waking. Although these episodes were not lengthy, almost half of all patients who were awake during surgery experienced adverse psychological effects, including PTSD and depression. 

 
Via [CNN]
 
 
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Wednesday, November 19, 2014

A new rule issued by the Centers for Medicare and Medicaid Services (CMS) last month is changing 10- and 90-day global payments to zero-day payments, much to the chagrin of U.S. surgeons. The new regulations, released on October 31, replace all procedure payments (including services the day before surgery, the day of surgery, and either 10- or 90-days after surgery) with reimbursement codes only for services done on the day of the operation. Every other service will now be billed for separately.

"Because the typical number and level of postoperative visits during global periods may vary greatly across Medicare practitioners and beneficiaries, we believe that continued valuation and payment of these face-to-face services as a multi-day package may skew relativity and create unwarranted payment disparities within...fee-for-service payment," CMS wrote.

Organizations including The American College of Surgeons have expressed their concern for the new rule, as CMS has not detailed how they plan on implementing a transition for the revamped coding system. How do you think this new rule could have been handled more efficiently?

[Via Medpage]

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Tuesday, November 11, 2014
Lawmakers in New York City are debating whether or not they should make it easier for transgender men and women to change the gender listed on their birth certificates. If approved, the new rule would abolish the current requirement for transgender individuals to have gender-reassignment surgery in order to update important personal documents. 

A 2008 survey of over 7,000 transgender patients found that only 20% of transexual women claimed to have had genital removal surgery, whereas only 2% of transexual men said they had male genitals created. While some claim the cost of the surgery is too high, other transexual men and women do not see a need for genital modification, which can be associated with adverse side effects.

If all goes as planned, transgender men and women will only have to submit a form via a healthcare professional stating that they are indeed the gender they claim to be. What are your thoughts on this new rule?
 
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Wednesday, October 22, 2014

The AORN recommends perioperative nursing teams take standard, contact, and droplet precautions when handling patients suspected of or known to have Ebola hemmorrhagic fever (HF). In addition, perioperative nursing teams should add airborne precautions to the list when an aerosol-generating procedure is involved, which includes the use of an airborne infection isolation room and respiratory protection similar to a National Institute for Occupational Safety and Health (NIOSH)-certified, fit-tested N95 filtering face piece respirator.

The CDC suggests that positive airway pressure respirators and elastomeric respirators are not approved, as these devices may not filter exhaled air and could further contribute to air contamination in the OR. (The issue with these respirators is still being evaluated by Occupational Safety and Health Administration and NIOSH.) The CDC also suggests OR nurses use "a US Environmental Protection Agency-registered hospital disinfectant with a label claim for a non-enveloped virus" for cleaning surfaces while caring for Ebola patients.

The CDC's Ebola Hemorrhagic Fever guidelines are frequently being updated as new information is acquired, and healthcare professionals are advised to stay abreast of the most recent updates found here.

For a comprehensive list of personal protective equipment for caring for patients with Ebola HF, click here.

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About the Author

Elizabeth M. Thompson
Elizabeth M. Thompson is the Editor-In-Chief of OR Nurse 2012. She is also a Nursing Education Specialist at the Mayo Clinic in Rochester, Minnesota.

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