Week in review July 10-14, 2023
Myron Yaster MD
To sleep perchance to dream
Myron Yaster MD, Sapna Kudchadkar MD PhD, and Razvan Azamfirei MS
Original article
Dulko E, Jedrusiak M, Osuru HP, Atluri N, Illendula M, Davis EM, Beenhakker MP, Lunardi N. Sleep Fragmentation, Electroencephalographic Slowing, and Circadian Disarray in a Mouse Model for Intensive Care Unit Delirium. Anesth Analg. 2023 Jul 1;137(1):209-220 PMID: 37192134
Sleep disturbances are very common in the intensive care unit (ICU) and are considered an important risk factor for delirium and the need for extremely high doses of sedatives and analgesics to produce immobility. Sleep in critically ill patients is often fragmented with frequent arousals. Critically ill patients often display temporal discordance between their sleep-wake activity and environment light cues, such that up to 50% of their total sleep can occur during the daytime. Patients’ inability to synchronize their sleep-wake rhythm with environmental lights is a common phenotypic expression of circadian disarray in the ICU. Today’s PAAD provides an animal model to study this.
Sustainability and Reporcessing Single Use OR Items
Shiu-Yi (“Emily”) Chen MD and Galixy Li MD
Original article
Vukelich D. It's time for hospital workers to identify and eliminate roadblocks to reprocessing! ASA Monitor June 2023, Vol. 87, 20. https://doi.org/10.1097/01.ASM.0000938816.88765.15. Accessed 06/28/2023
To curtail human-derived climate change and GHG emission, we need to recognize the circular economy involving environmentalism and medical device industry. We have the obligation to conserve resources and to reprocess FDA-regulated single-use device to reduce carbon footprint. We need to identify and to eliminate the roadblocks in MDR to help our planet and people.
Profits, Providers, and Private Companies: What Happens When Wall Street Owns Your Neonatal Care or Anesthesia Practice? Parts one and two
Myron Yaster MD and William Greeley MD, MBA
Original article
La Forgia A, Bond AM, Braun RT, Yao LZ, Kjaer K, Zhang M, Casalino LP. Association of Physician Management Companies and Private Equity Investment With Commercial Health Care Prices Paid to Anesthesia Practitioners. JAMA Intern Med. 2022 Apr 1;182(4):396-404. PMID: 35226052
Editorial
Francis J Crosson. Physician Management Companies-Should We Care? JAMA Intern Med. 2022 Apr 1;182(4):404-406. doi: 10.1001/jamainternmed.2022.0001. PMID: 35226040
Original article
Yu J, Tyler Braun R, Bond AS, La Forgia AM, RoyChoudhury A, Zhang M, Kim J, Casalino LP. Physician Management Companies and Neonatology Prices, Utilization, and Clinical Outcomes. Pediatrics. 2023 Apr 1;151(4):e2022057931. PMID: 36929378
Editorial
Scott A. Lorch, MD, MSCE. Profits, Providers, and Private Companies: What Happens When Wall Street Owns Your Neonatal Care. Pediatrics (2023) 151 (4): e2022060788. https://doi-org.proxy.hsl.ucdenver.edu/10.1542/peds.2022-060788
The title says it all. When private equity buys anesthesia practices, increases in prices did not show an improvement in resource utilization, readmissions, or clinical outcomes. In other words, there was a substantial increase in prices with no added value. We discuss why this is happening and what it means.
Reader response
Several readers responded to the articles on what happens when private equity buys an anesthesia practice and included a link to an article in the Washington Post that discussed what happened in Colorado when USAP obtained a 30% market share. Dr. Amr Abouleish discussed the implication of a 4 minute time difference if a pediatric fellowship trained anesthesiologist provided anesthesia compared to a non fellowship trained general anesthesiologist. Dr. Chris Sutton commented on single use medical items and waste