Category Archives: Anesthesiology

American Society of Anesthesiologists Selects Executive Search Firm Spencer Stuart to Find Next Chief Executive Officer – Newswise

Newswise CHICAGO Today, the American Society of Anesthesiologists (ASA), announced that Spencer Stuart, a leading global executive search firm, will lead the search to hire ASAs next Chief Executive Officer (CEO), starting in April 2023. ASAs current CEO, Paul Pomerantz, FACHE, will retire at the end of his contract in April 2024, after 11 years of distinguished leadership at the Society.

Spencer Stuart led our successful CEO Search in 2012 and we are anticipating another extensive, competitive, and rigorous selection process to find the most qualified candidate to become ASAs next CEO, said ASA President Michael W. Champeau, M.D., FAAP, FASA.

Dr. Champeau established an Ad Hoc Committee on CEO Search to work with Spencer Stuart to identify and vet candidates for the CEO position, and to ensure an appropriate succession plan is in place for a smooth transition of leadership for ASAs 56,000 members and staff. A second committee, comprised of voting members of the Board of Directors, will make the final selection.

I take this aspect of my legacy as president extremely seriously as I recognize the importance of our CEO recruitment and selection process to the future of our society, said Dr. Champeau. I am confident that Spencer Stuart and our ad hoc committee will find ASAs next extraordinary leader.

About the American Society of Anesthesiologists Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on Twitter.

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American Society of Anesthesiologists Selects Executive Search Firm Spencer Stuart to Find Next Chief Executive Officer - Newswise

More Physicians Pivot Their Careers to Find Balance and Happiness – Medscape

Sometimes the day-in and day-out of running a private practice, taking calls at all hours, or dealing with insurers can be too much.

This is one of the revelations in Medscape's 2023 Physician Lifestyle & Happiness Report, which showed that physicians were happier before the pandemic and that 53% of those surveyed would be okay earning less pay if it meant they could have better work-life balance. In addition, the American Medical Association reports that 1 in 5 physicians plan on leaving their practices within 2 years.

If you're worried that changing careers might mean a dip in compensation, read on to learn more about four physicians who made a change and are making more money and feel more in control of their work-life balance.

While Allison Anderson, MD, still practices anesthesiology in Redlands, California, she recently pivoted from a shareholder-owned practice to join a large corporate anesthesia practice, which gives her time and space to expand into a coaching practice, which fulfills her.

Dr Allison Anderson

"I went from living in my hometown and working at a hospital where I knew everyone to living in a different state and essentially starting over in terms of my relationships with colleagues," says Anderson, a board-certified cardiothoracic anesthesiologist and certified life coach who specializes in coaching married couples.

"I sometimes miss the close-knit group I had worked with for so long, but I love my coaching business and the way I can truly help people change their lives."

Anderson adds that there are many overlapping qualities between her work as a physician and her calling as a coach.

"Coaching has the heart of service that drew me to medicine, but without all of the red tape," she says. "It's the perfect extension of what I set out to do all those years ago when I decided to become a physician serve those around me."

When asked for career advice for physicians looking to become more fulfilled, Anderson says, you get to decide what works for you. For example, do you want to go part-time, work reduced hours, or set up your practice differently? "Just because you've been at a certain hospital for a long time and have seniority, it doesn't mean you can't decide to make a change."

There are many possibilities within and outside of medicine that you can choose, and you don't have to settle for less. "You made it all the way through medical school and residency. If you can do that, you can do anything," Anderson says.

Dana Canuso, DPM, a podiatric surgeon in Marlton, New Jersey, says she doesn't miss her old life. After practicing for 5 years, she started an antifungal product line. Then, when the pandemic began, she switched gears again and started a house call business in which she hired other podiatrists to make house calls.

Dr Dana Canuso

"I feel like I'm helping so many more people than I could have in my practice when I could see 30 people max per day," says Canuso, the mom of two kids, aged 9 and 14. "Now I have doctors seeing way more patients than I ever could and I create products that are helping people, too."

Canuso says it's scary taking a step away from medicine. "To do what I'm doing, you have to have business acumen, but it's worth it to achieve a feeling of balance," she says. "I'm glad I had my medical training it helps with everything I do today, and that training is never going to go to waste for any doctor who wants to switch gears."

When Annie Fenn, MD, watched her mother go through an Alzheimer's diagnosis, she decided to walk away from her work as an ob/gyn turned culinary instructor to become an expert on the scientific study of nutrition and dementia.

Dr Annie Fenn

"Even though I loved my practice, I was itching to use a different part of my brain," says Fenn, who is based in Jackson Hole, Wyoming. "I was worn down by the hours, lack of sleep, and lack of a creative outlet."

Always a passionate home cook, Fenn dreamed of attending culinary school. So, a few months after retiring from her clinical practice, she attended culinary school and then became a culinary instructor at her local community college.

"Then, when my mother was diagnosed, I decided to combine my medical background with my new culinary skills to get the word out that eating a certain way can reduce Alzheimer's risk," she says. She is now the founder of Brain Health Kitchen, a cooking school focused exclusively on evidence-based lifestyle factors to prevent Alzheimer's. She is also the author of The Brain Health Kitchen: Preventing Alzheimer's Through Food.

She now hosts brain health retreats and frequently travels as a guest chef at wellness centers and cooking schools.

"More than 1000 students have attended my cooking classes, and many more have attended my online webinars," she says. "Students tell me the classes have changed their lives. Many have had family members with Alzheimer's, and now, instead of fearing cognitive decline, they have specific tools to significantly reduce their risk."

Fenn acknowledges that it was nerve wracking to give up her steady income as a busy, well-established ob/gyn. "But once my mother was diagnosed with Alzheimer's, I became completely galvanized by my mission to help others reduce their risk with food and lifestyle," she says. "This passion for giving back has been the driving force behind my business, and it can be the same for any other doctor who wants to make a pivot."

Switching careers came easily to Turner Osler, MD. The University of Vermont physician started his career as an academic trauma surgeon, a career that blended a mix of surgery, research, and teaching. However, it was only when he got a master's degree in biostatistics and shifted to conducting epidemiologic research full time that his third act came to him.

Dr Turner Osler

As it happened, the life of an epidemiologist required sitting at a desk far more than he was accustomed to, and it soon became apparent that he needed a better sitting solution. When he didn't find the chair of his dreams, he came up with one.

"Our team of MDs, designers, and bodywork experts created not just a new chair but an entirely new way to sit that worked with the body rather than against it," he says. "Looking back, 'chair designer' isn't at all the third career I would have predicted for myself. My slide into entrepreneurship was unexpected, a passion project that got out of hand and turned into a startup."

Second acts after a medical career can be difficult because medicine is a demanding career that doesn't easily accommodate other pursuits, says Osler. "That's why I suggest keeping up with interests and developing new ones whenever the opportunity arises.

"It's hard to guess what pursuit will turn into a second act, so the more interests you have, the more opportunities you'll find. I always say that passion is something that you have to bring with you to the table. Otherwise, you'll wind up with just another job."

Lambeth Hochwald is a New York Citybased journalist who covers health, relationships, trends, and issues of importance to women. She's also a longtime professor at NYU's Arthur L. Carter Journalism Institute.

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More Physicians Pivot Their Careers to Find Balance and Happiness - Medscape

Faculty of medicine researchers received Research Excellence … – UBC Faculty of Medicine

Faculty of medicine researchers are among the UBC recipients of Research Excellence Clusters funding for 2023/24.

These clusters are inter-departmental networks of researchers at UBC who collectively represent leaders in a particular field of study.

The 38 clusters funded in 2023/24 on the Vancouver campus includes 15 clusters in the second year of their current award. Funding is awarded through Grants for Catalyzing Research Clusters (GCRC) competitions.

Clusters are recognized as either established or emerging depending on multiple factors relating to their developmental stage and funding requirements.

Action on SepsisMark Ansermino, Department of Anesthesiology, Pharmacology & Therapeutics

BC Diabetes Research NetworkBruce Verchere, Departments of Pathology & Laboratory Medicine and Surgery

BCREGMEDMike Underhill, Department of Cellular & Physiological Sciences

Data Science and HealthAnita Palepu, Department of Medicine

Dynamic Brain Circuits in Health and Disease Research Excellence ClusterTim Murphy, Department of Psychiatry

Resuscitating More Patients from Sudden Unexpected Death: Transformative ResearchJim Christenson, Department of Emergency Medicine

The Social Exposome ClusterMichael Kobor, Department of Medical Genetics

Womens Health Research ClusterElizabeth Rideout, Department of Cellular & Physiological Sciences

AATHEN The UBC Advanced Angiotensin Therapeutics NetworkPascal Bernatchez, Department of Anesthesiology, Pharmacology & Therapeutics

BC Pediatric Eating Disorders Research ClusterJennifer Coelho, Department of Psychiatry

Cancer Prevention Research Cluster (CPRC)Trevor Dummer, School of Population and Public Health

Centre for Research on Equity and Justice in Perinatal ServicesSaraswathi Vedam, Midwifery Program, Department of Family Practice

Collaborative Entity for ceREBrovasculaR Ischemia (CEREBRI)Mypinder Sekhon, Division of Critical Care Medicine, Department of Medicine

Climate Change Health Effects, Adaptation, and ResiLience (HEAL)Chris Carlsten, Respiratory Medicine Division, Department of Medicine

Immunotherapeutics ClusterKelly McNagny, Department of Medical Genetics, School of Biomedical Engineering

MATRIX-N: Multidisciplinary Alliance for Translational Research and Innovation in NeuropsychiatryAnthony Phillips, Department of Psychiatry

The Cluster in Vision Research: From Molecules to Behavior to SocietyJoanne Matsubara, Department of Ophthalmology and Visual Sciences

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Faculty of medicine researchers received Research Excellence ... - UBC Faculty of Medicine

Two Columbia Scientists Receive Hirschl Trust Research Awards – Columbia University Irving Medical Center

Iok In Christine Chio, PhD, and Oliver Clarke, PhD, both early-career investigators at Columbia University Vagelos College of Physicians and Surgeons, were awarded 2023 Hirschl Trust Research Awards by the Irma T. Hirschl Trust Research Scientist Program. Each investigator will receive a grant of $200,000 over five years to conduct novel high-risk, high-reward research that furthers new scientific knowledge, with the goal of improving patient care.

Since 1972, the Irma T. Hirschl Trust Research Scientist Program has provided support to junior biomedical research scientists at Columbia. VP&S is one of six academic medical centers in New York that receive funding from the Irma T. Hirschl Trust, which has supported more than 100 Hirschl Trust Research Scientists at VP&S.

Assistant Professor of Genetics & Development (in the Institute for Cancer Genetics)

Chio studies pancreatic ductal adenocarcinoma (PDAC), which is the third leading cause of cancer death in the United States. The lethality of pancreatic cancer is due largely to the advanced disease stage at the time of diagnosis and its profound resistance to existing therapies.

Targeted therapy is a cornerstone of precision medicine and is the focus of the majority of anti-cancer drug development. However, in the context of pancreatic cancer, no chemical inhibitors exist for the most common KRAS mutations even though it is well established that the oncogenic KRAS promotes drug resistance.

Thus, a detailed understanding of the role of specific genetic lesions and their signaling surrogates in the initiation and progression of pancreatic cancer is critical to improving treatment efficacy and patient outcome for this disease. Using genetically engineered mouse models and ex vivo culture systems, Chio seeks to understand the basic mechanisms underlying PDAC biology so that vulnerabilities can be identified and tested for therapeutic intervention.

Assistant Professor of Physiology & Cellular Biophysics (in Anesthesiology and the Irving Institute for Clinical and Translational Research)

Intracellular calcium signaling, mediated by release of calcium from intracellular stores, is involved in many fundamental biological processes, including the coupling of nervous excitation to muscle contraction. One of Clarkes research goals is to understand the mechanism by which intracellular calcium release is triggered, modulated, and terminated. He and his collaborators use X-ray crystallography and cryo-electron microscopy to investigate the structure and dynamics of the molecular machines involved in such processes, including the ryanodine receptor.

Clarke and others have described structures of the isolated ryanodine receptor in various statesclosed, open, and bound to activating ligands. One of the key issues Clarke seeks to address is the skeletal muscle ryanodine receptor in the context of both the transmembrane protein binding partners around it and the cell as a whole.

The ultimate goal of Clarkes research is a structural understanding of how the voltage-gated Ca2+ channels on the plasma membrane mechanically couple to the ryanodine receptor and directly control gating of the receptor and how adjacent ryanodine receptors at the terminal cisternae interact with one another and signal cooperatively.

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Two Columbia Scientists Receive Hirschl Trust Research Awards - Columbia University Irving Medical Center

Ketamine & esketamine in reducing suicidal ideation | NDT – Dove Medical Press

1Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, Peoples Republic of China; 2School of Nursing, Southwest Medical University, Luzhou, Peoples Republic of China

Correspondence: Xiao-Bin Wang, Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, Peoples Republic of China, Tel +86 13708280087, Fax +86 830-3161222, Email [emailprotected]

Purpose: Suicide is a major public health concern with currently no validated and efficacious treatments approved. Preliminary evidence suggests that intravenous ketamine has rapid and sustained antidepressant effects, making it a candidate with therapeutic potential for depressed patients at risk for suicide. We conducted a meta-analysis to evaluate the efficacy of ketamine and esketamine in reducing suicidal ideation (SI), as well as their respective onset and duration of action.Data Sources: We searched PubMed, Embase, Ovid, Cochrane, and Web of Science databases for studies published from inception to September 29, 2022.Study Eligibility Criteria: We conducted a systematic review of all parallel randomized controlled trials (RCTs) examining the effect and duration of ketamine or esketamine on SI. Our primary outcome measure was the Suicide Scale score, which was measured using the Scale for Suicidal Ideation (SSI), Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory (BDI), or Modified Scale for Suicidal Ideation (MSSI). To obtain effect sizes (Cohens d), we calculated the difference in Suicide Scale scores before and after administration in each group.Results: Our study showed that intravenous sub-anesthetic doses of ketamine and intranasal inhaled esketamine had a significant anti-SI effect. Specifically, ketamine produced a large degree of anti-SI effect within the 4 6 hours (Cohens d = 1.16, 95% CI: 0.50, 1.81) and a medium-large degree in the 24 hours (Cohens d = 0.95, 95% CI: 0.48, 1.41). Esketamine, on the other hand, produced a small-medium degree of anti-SI effect within the 4 6 hours timeframe (Cohens d = 0.26, 95% CI: 0.09, 0.44) and the 24 hours (Cohens d = 0.30, 95% CI: 0.17, 0.47).Conclusion: Intravenous sub-anesthetic doses of ketamine and intranasal inhaled esketamine could reduce SI within 4 hours and last for 24 hours.

The World Health Organization (WHO) recently reported that although the global suicide rate has fallen sharply since 2000, it has risen in some regions, such as the United States, where suicide rates for men and women have increased by 26% and 38%, respectively.1 This demonstrates that suicidal behavior remains a global health problem that places a huge economic and emotional burden on the world.2 Suicidal behavior includes suicidal ideation (SI), suicide plan, and suicide attempt. Among them, SI is the most sensitive predictor.3 Current treatment for patients with acute SI usually consists of cognitive behavioral therapy, psychological treatment, and medication-assisted treatment, which have been proven to be effective in reducing SI.46 However, their efficacy in crisis situations has yet to be determined. It has been suggested that patients with major depression or SI may require rapid-acting anti-SI medications for effective treatment.7

Recent studies have found that the commonly used anesthetic ketamine has rapid and long-lasting antidepressant and anti-SI effects, making it a hot topic. Ketamine has multiple effects by binding to NMDA, AMPA, GABA receptors, and various ion channels.8 However, a proportion of patients with major depressive disorder (MDD) have psychotic features, such as bipolar disorder, presenting as psychotic treatment-resistant depression (TRD) and unresponsive to recommended therapeutic interventions. Fortunately, ketamine appears to ameliorate the symptoms of depression at subanesthetic doses among individuals with MDD.9 This follows extensive research on the racemic ketamine as well as (R)-ketamine (arketamine) and (S)-ketamine (esketamine) enantiomers. Consequently, esketamine was recently approved by the US Food and Drug Administration (FDA) for the acute management of MDD, depressive symptoms in adults with MDD with acute SI or behavior (MDSI), and as an adjunctive psychiatric indication for the treatment of MDD with a psychiatric emergency (MDD-PE).10,11 Several RCTs and meta-analysis have reported that ketamine and esketamine have a good safety and tolerability profile in MDD or TRD, with rapid and effective antidepressant and anti-SI effects.1214 Given the findings of the above mentioned studies, there is growing interest in exploring whether ketamine and esketamine can be used to rescue patients with acute SI.

However, evidence-based treatments on the role of ketamine and esketamine in reducing SI and suicidal behavior remain inadequate. Therefore, we performed a meta-analysis to assess the effect of ketamine/esketamine on SI by comparing the degree of remission of SI in patients in the intervention and control groups.

The protocol for this study is registered with PROSPERO (CRD42022363936). We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines and searched the PubMed, Embase, Ovid, Cochrane, and Web of Science databases for MeSH terms ketamine or esketamine and suicidal ideation (Supplementary Material). We searched for studies published from inception to September 29, 2022. In addition to open-label trials and crossover trials, any double-blind clinical trial evaluating ketamine versus placebo could initially be included.

We only included parallel RCTs. The included population consisted of men and women between the ages of 18 and 80 years. Patients had a clinically assessed Suicide Scale (SSI/BDI) and Depression Scale (HAMD/MARDS) or a history of MDD with clinically significant SI consistent with a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) diagnosis. Psychiatric illness (such as schizophrenia or schizoaffective disorder), acute medical comorbidities, and serious substance use disorders (ketamine or other substances) were exclusion criteria.

If study data are incomplete, we will contact the corresponding author for additional information. After removing duplicates and carefully reading the full text, we ultimately included 17 RCTs for the study.1531 Two reviewers (CCC and NZ) independently screened the titles, abstracts, and full texts against the eligibility criteria. A consensus was reached through follow-up discussions.

We assessed the anti-SI effect of ketamine/esketamine by comparing whether patients in the intervention group experienced greater declines in scores than those in the control group. The 17 included RCTs used the MADRS, MARDS-ITEM-10, QIDS-SR, SSI, MSI, BDI, BSS, BHI, C-SSRS, HDRS, and HAMD-ITEM-24 scale score to assess patient SI. We calculated baseline minus endpoint values for each group of Suicide Scale score in all included RCTs and extracted data as mean standard deviation (MD SD). When study authors provided MD and SD change values in graphical form, we collected data using GetData software. Meanwhile, when the MD and SD change scores were not provided by the study authors, we calculated the MD and SD of the mean change in depression scores using the following formulas:

The data conversion formulas we used are all from Luo.32 Articles will be excluded if the research does not contain available data or computations.

We assessed risk of bias by using the Cochrane Collaborations risk-of-bias tool,33 which examines potential selection bias, performance bias, detection bias, attrition bias, reporting bias, and other biases. Two reviewers (CCC and NZ) independently assessed the risk of bias of each included trial, and we consulted a third reviewer (XBW) to resolve any disagreements.

All statistical analyses were performed using R version 4.2.1. Given that the scales used to assess changes in SI varied across studies, we used Cohens d as an indicator of effect size to compare all studies based on the same measure to measure changes in SI comparing baseline and endpoint. All studies compared relative efficacy using different drug/dose/duration pooled effect sizes. The combined effect size results are shown in a forest plot. For Cohens d score, d < 0.2, 0.20.8, d > 0.8 means small, medium, and large effects.

Heterogeneity was quantified using the I2 statistic. For the I2 statistic, 25% = low heterogeneity, 50% = moderate heterogeneity, and 75% = high heterogeneity.34 In this study, we used afixed-effects model for studies with I2<50% and arandom-effects model for studies with I2>50%. When results showed high levels of heterogeneity, sensitivity analyses and meta-regression were used to examine sources of heterogeneity. We plotted funnel plots and assessed their symmetry using Eggers test for publication bias.35

The process of including studies is shown in the PRISMA flowchart (Figure 1). An initial search identified 377 publications. In addition, 5 studies from other sources were identified. After removing 112 duplicate articles, there were 270 remaining articles, of which 152 were excluded because they did not meet the RCT study design, and 32 were excluded because their abstracts did not match their titles. In the end, 29 articles were read and evaluated in their entirety. Seven publications were removed after full-text screening because complete data were not available, and five review articles were removed because full text was not available. We used the remaining 17 articles for further analyses.

Figure 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) study selection flow diagram.

The pooled total sample of all RCTs included 1224 participants (n = 615 received racemic ketamine/esketamine, n = 609 received saline or midazolam). Fourteen studies in the ketamine and control groups used DSM-IV/DSM-V diagnosed or previously diagnosed depression, 2 studies used SSI/BSI > 3 as inclusion criteria, and 1 study included cancer patients with depression. In terms of scales, 12 studies administered multiple SI scales (Beck Suicidal Ideation Scale-BSS/I; Suicidal Ideation Scale-SSI; Columbia Suicide Severity Rating Scale-c-SSRS; Beck Despair Scale-BHI), and 7 trials used single items from the Depression Inventory (item 10 on the Montgomery-sberg Depression Rating Scale [MADRS]; item 3 on the 17-item Hamilton Depression Rating Scale [HAM-D]; item 12 on the Quick Inventory of Depressive Symptomatology-Self Report [QIDS-SR]; and/or item 9 on the Beck Depression Inventory [BDI]). In terms of administration, 12 studies used intravenous (IV) ketamine, 3 studies used intranasal inhaled (IN) esketamine, 1 study used IN ketamine and 1 study used oral (PO) and intramuscular (IM) ketamine. All 12 studies in the IV ketamine group received 0.5 mg/kg IV ketamine. The IN esketamine group used esketamine 80 mg and 1 study used IN ketamine 40 mg. The remaining 2 studies used 1 mg/kg PO ketamine or 0.5 mg/kg IM. In the control group, 8 studies were given midazolam, 8 studies were given the same volume of normal saline, and 1 study compared by electroconvulsive shock therapy . The general characteristics of the included studies are listed in Table 1.

Table 1 Summary of Study Characteristics

The results of the Cochrane risk of bias assessment are shown in Figure 2. The overall quality of the studies included in the meta-analysis was classified as moderate to high quality.

Figure 2 No significant high risk of bias assessed by Cochrane bias tool.

Figure 3 is a forest plot of the total effect size across all studies, with an overall heterogeneity of I2 = 87%, which is highly heterogeneous. Due to the significant heterogeneity across these studies, we performed subgroup analysis, sensitivity analysis, and meta-regression analysis to explore the sources of heterogeneity.

Figure 3 All studies were included, grouped by degree of heterogeneity. Cohens d changes between ketamine/esketamine-treated and control group. Squares indicate effect sizes for individual arithmetic cases, diamonds indicate effect sizes for combined results.

We used sensitivity analysis (Figure 4) and meta-regression (Figure 5) with random-effects models to examine sources of heterogeneity. Sensitivity analysis results showed that three studies15,25,30 had a significant effect on the overall effect size. Meta-regression results indicated that there was also significant heterogeneity between studies using the MSSI scale and other studies, so we performed separate subgroup analysis for these 3 studies. Heterogeneity between the remaining 14 studies and this subset of 3 studies was 0% (P>0.05), and it can be assumed that there is no heterogeneity among these studies. Despite strong heterogeneity among some studies, we observed in the sensitivity analysis that excluding these 3 studies alone had no significant effect on the total effect size (Cohens dsum = 0.72, 95% CI: 0.36, 1.07). Furthermore, the design and population of these studies did not differ significantly from other studies. Meanwhile, we also plotted funnel plots and used Eggers test to assess publication bias. The asymmetry of the funnel plot can be observed in Figure 6, and we calculated P = 0.6056 (t = 0.53, df = 18) using Eggers method, indicating that none of the included RCTs had significant publication bias. For these reasons, instead of excluding these 3 studies, we subsequently performed subgroup analysis to avoid heterogeneity, and we do not discuss heterogeneity in the subsequent forest diagrams.

Figure 4 Sensitivity analysis revealed that 3 studies (Abbar 2022/ Pathak 2021/HU 2015) had a insignificant effect on the overall effect size.

Figure 5 Meta-regression identified 3 studies as a source of heterogeneity.

Figure 6 The standard error of the funnel plot was observed by Cohens d.

In conclusion, various ketamine/esketamine regimens remain moderately effective against the effects of SI. We did not analyze these 3 studies individually in subsequent subgroups (However, sensitivity analyses and meta-regressions were also performed for each subgroup and reached the same conclusions).

The forest plot (Figure 3) summarizing the anti-SI effect size of ketamine and esketamine for all administration and time points. The primary efficacy endpoint was improvement in SI compared with control groups. We analyzed 3 studies with large heterogeneity between different groups. Results showed that ketamine/esketamine had a medium effect on reducing the suicide scores compared with midazolam or placebo (Cohens d = 0.72, 95% CI: 0.36, 1.07). It has been shown to have anti-SI effects.

We divided ketamine group into 3 subgroups according to time point (46 hours, 24 hours, >24 hours) and esketamine into 2 subgroups (46 hours, 24 hours). The time effect of anti-SI ketamine/esketamine was analyzed by comparing the difference in treatment effect at each time point. The forest plot of the ketamine group in Figure 7 showed that ketamine produced a large degree of anti-SI effect in both the 46 hours subgroup (Cohens d = 1.16, 95% CI: 0.50, 1.81) and a medium-large degree of the 24 hours subgroup (Cohens d = 0.95, 95% CI: 0.48; 1.41). In the 24 hours-7 days subgroup (Cohens d=2.01, 95% CI: 0.31, 4.33), the relationship between ketamine and SI was not statistically significant. Figure 8 demonstrate the effect sizes of esketamine at 4-6 hours (Cohens d = 0.26, 95% CI: 0.09, 0.44) and 24 hours (Cohens d = 0.30, 95% CI: 0.13, 0.47).

Figure 7 Forest plot showing all ketamine studies grouped by timepoint. Cohens d changes between ketamine-treated and control group. Squares indicate effect sizes for individual arithmetic cases, diamonds indicate effect sizes for combined results.

Figure 8 Forest plot showing all esketamine studies grouped by time. Cohens d changes between esketamine-treated and control group. Squares indicate effect sizes for individual arithmetic cases, diamonds indicate effect sizes for combined results.

We performed subgroup analysis according to different methods of administration (0.5 mg/kg IV ketamine or IN esketamine 80 mg/40 mg) with a duration of action of 4hours/24hours. Two studies on intramuscular/oral ketamine were not included because the number of similar studies was too small. Figure 9 summarizes the effect sizes. The effect size for all responses for all methods used was Cohens d = 0.81 (95% CI, 0.41, 1.21). The effect size was large for IV ketamine 4 hours/24 hours (Cohens d = 0.96, 95% CI: 0.48, 1. 44) and medium-small for IN esketamine (Cohens d = 0.30, 95% CI: 0.13, 0.47).

Figure 9 Includes forest plots for all studies, grouped by drug.

According to the results of the meta-analysis, the sub-anesthetic dose of ketamine infusion can significantly reduce SI in patients compared with midazolam/saline. The effects first appeared within 4 hours of administration and lasted for 24 hours, providing evidence of the rapid effects of ketamine on mood. However, ketamine had no statistically significant effect after 24 hours, suggesting that the effect may be transient, and other authors have reported similar results.3638 But there are also studies showing that ketamine can rapidly reduce SI in depressed patients within 1 day and 1 week.39,40 The antidepressant effect of ketamine was reported to start after 2 hours and last for 1 week. Combined with results from other meta-analysis, the anti-SI and antidepressant effects of ketamine and esketamine appear to be synchronous.41 This is because when SI decreased, depression scores also decreased. However, the mechanisms underlying ketamines anti-SI and antidepressant effects are unclear, and there is no evidence that ketamines anti-SI effects depend on its antidepressant effects. Whether ketamines effects on SI are partially independent of its effects on mood remains to be determined. Therefore, whether ketamine has long-term anti-SI effects after 24 hours requires further study.

We included 4 studies of IN esketamine in addition to IV ketamine. Back in 2019, the FDA approved IN esketamine to treat patients with depression, with a statement that it could be used in severely depressed patients with significant SI. Esketamine also has some anti-SI effects. However, esketamine is not independently approved as an anti-SI drug. There have been few studies using esketamine alone to reduce SI, so its use/dose, onset/maintenance duration, and effectiveness compared with IV ketamine are unclear. According to our limited data, IN esketamine 40/84 mg showed a small-to-medium effect on SI within 24 hours (Cohens d = 0.30, 95% CI: 0.13, 0.47). The use and dosage of esketamine in 4 studies were consistent with guideline recommendations, and despite some limitations, we can still conclude that 40/84 mg esketamine administered within 24 hours has some anti-SI effect. However, it is important to emphasize that although the effect size of sub-anesthetic doses of IV ketamine was greater than that of IN esketamine, we cannot conclude that sub-anesthetic doses of IV ketamine over 24 hours were superior to IN esketamine because of the lack of RCTs directly comparing the effectiveness of them.

Combining studies of forest plots, we identified large heterogeneity (I2 = 87%). To explore the sources of heterogeneity, we applied sensitivity analysis and meta-regression and identified several study design features that explained the significant heterogeneity within and between studies. Double blinding is one of the basic principles of RCTs, and the Pathak 2021 study only treated single-blind patients, so poor study design may be a source of heterogeneity. The Abbar 2022 study had a large effect on the overall effect size, but we cannot simply treat it as a source of heterogeneity. This is because this was a large, multicentre study involving seven French academic hospitals. The inclusion criteria for the study were very strict, and all patients were admitted with SI. In contrast, most other studies included patients with MDD or abnormal suicide scores, which could explain their heterogeneity. However, the rigorous research design and large sample size of this study may better reflect the anti-suicide effect of ketamine. In contrast to other experimental studies, HU included IV escitalopram 10mg daily and escitalopram 10mg daily + IV ketamine 0.5 mg/kg as inclusion criteria for MDD patients and controls.30 Because escitalopram has antidepressant effect, it acts synergistically with ketamine to enhance efficacy. This could explain the heterogeneity of the studies. In conclusion, although the three studies produced a greater impact on the total effect size. But these studies had a relatively complete study design and meet the inclusion criteria, ultimately, we approached these studies by only going to subgroup analysis.

Although ketamine infusion is generally safe for MDD, some safety concerns such as arterial hypertension, dissociation, and simulated mental activity can be observed in studies.42 This has raised concerns about the safety of ketamine in treating depressed patients with these psychiatric and somatic comorbidities. Szarmach conducted an observational study of IV ketamine in TRD patients with mild cardiovascular disease, epilepsy, metabolic derangements, and other somatic comorbidities. An observational study of IV ketamine in TRD with comorbidities such as epilepsy and metabolic disorders has shown increased HR and RR during treatment but no worsening of the cardiovascular, metabolic, or epilepsy-related disease.43 The side effects were mild or moderate, well tolerated, and transient and all side effects disappeared within 4 hours after administration. Similar conclusions were also drawn from the study by Short.44 Psychotic depression is a subtype of MDD characterized by mood-related hallucinations or delusions. The lifetime prevalence of MDD with psychotic features ranges from 0.35% to 1% in the general population.45 Although treatments are approved for MDD associated with psychiatric disorders, some TRD patients do not respond to recommended therapeutic interventions.46 Wegielnik included patients with MDD and psychiatric illness or bipolar disorder and found that ketamine had good safety and efficacy for TRD patients with major depressive disorder and psychiatric comorbidity.11 TRD with psychotic comorbidities was safe and well tolerated, consistent with previous results.47 Based on the above studies, the safety of using ketamine for depression in specific populations also seems reasonable. This group of patients may benefit more from ketamine than conventional drugs, but large clinical trials are still needed to confirm this.

In addition to ketamine, traditional antidepressants also show some anti-SI effects.48 Although the mechanism of anti-SI of traditional antidepressants has not been confirmed, the combined use of ketamine/esketamine may produce synergistic effects through different mechanisms of action, resulting in superior clinical efficacy. As noted above, the combination of escitalopram with ketamine resulted in a larger effect size for this study, suggesting that the combination of old and new drugs exerted a stronger anti-SI effect. This also provides a basis for combining ketamine with other drugs. We believe that it is difficult to treat suicidal behavior or SI with one drug alone. However, the combination of drugs can both enhance the treatment effect and reduce the dose of individual drugs, thereby reducing the side effects of the drugs, perhaps also accelerating the onset of action or prolonging the maintenance of ketamine and esketamine. Therefore, we hope that more studies on ketamine/esketamine combined with other anti-suicide drugs will be conducted in the future to further reduce the global suicide rate and ease the social burden.

In summary, current research on anti-SI still has many deficiencies. Our results demonstrate the therapeutic potential of ketamine and esketamine on SI and provide evidence-based medical evidence for the treatment of anti-SI.

Our meta-analysis has some limitations. First, the number of included RCTs was insufficient to allow us to draw strong conclusions about differences in efficacy of different doses/durations, especially for esketamine. In addition, two studies of esketamine were ASPIRE I and ASPIRE II studies, and the other study was conducted by the same team, which may increase the risk of publication bias. Second, there is a lack of RCTs of ketamine versus esketamine, making it difficult to directly compare the efficacy and safety of ketamine versus esketamine. Third, the inclusion criteria of existing studies were all based on MDD. Due to the homogeneity of the inclusion criteria, we could not ascertain from the included studies the anti-SI effect and safety of ketamine/esketamine in patients with other somatic comorbidities/psychiatric comorbidities (bipolar disorder/compulsive-compulsive disorder). Equally, the inclusion criteria for RCTs in this article did not specify gender/age for screening. Therefore, more RCTs are needed to investigate how the antidepressant effects and anti-SI of ketamine or esketamine differ in these populations. Fourth, the current tools for measuring the level of SI are scales such as SSI/BSI/BHI. Due to scale inconsistency, multiple scales could be used to address SI across multiple RCT outcomes. The scoring standards/total scores of different scales are different, the comparison between samples is difficult, and the heterogeneity between groups increases. Although the short-term effects of ketamine and esketamine on SI were assessed in the included RCTs, long-term use of these drugs predisposes to certain medical conditions (mental disorders, cystitis). Therefore, finding potent metabolites or important antidepressant targets of ketamine or esketamine or the mechanism of their antidepressant/anti-SI effects is of great significance for the development of safer drugs in the future.

In conclusion, our meta-analysis supports that intravenous sub-anesthetic doses of ketamine and intranasal inhaled esketamine have the effect on anti-SI within 4 hours and last for 24 hours. These results suggest that ketamine/esketamine holds promise as a potential fast-acting therapy for patients at risk of suicide. However, the side effects limit its clinical application. It is urgent to further study the anti-SI/depression mechanism of ketamine/esketamine, minimize its side effects, and provide new options for acute anti-SI clinical application.

This work was supported by the Department of Science & Technology of Sichuan Province (Grant No. 2020YJ0493, 2022YFS0632), and the scientific research project of the Luzhou municipal governmentSouthwest Medical University (2021LZXNYD-Z06).

The authors report no conflicts of interest in this work.

1. World Health Organization. World Health Statistics 2022: Monitoring Health for the Sdgs, Sustainable Development Goals. Geneva: World Health Organization; 2022.

2. World Health Organization. Preventing suicide: a global imperative. World Health Organization; 2014. Available from: http://www.who.int/iris/handle/10665/131056. Accessed March 6, 2023.

3. Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA. Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry. 1990;147(2):190195. doi:10.1176/ajp.147.2.190

4. Miller JN, Black DW. Bipolar disorder and suicide: a review. Curr Psychiatry Rep. 2020;22(2):6. doi:10.1007/s11920-020-1130-0

5. Serafini G, Costanza A, Aguglia A, et al. Overall goal of cognitive-behavioral therapy in major psychiatric disorders and suicidality: a narrative review. Med Clin North Am. 2023;107(1):143167. doi:10.1016/j.mcna.2022.05.006

6. Klonsky ED, May AM, Saffer BY. Suicide, suicide attempts, and suicidal ideation. Annu Rev Clin Psychol. 2016;12:307330. doi:10.1146/annurev-clinpsy-021815-093204

7. Malhi GS, Bassett D, Boyce P, et al. Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders. Aust NZ J Psychiatry. 2015;49(12):10871206. doi:10.1177/0004867415617657

8. Zanos P, Moaddel R, Morris PJ, et al. NMDAR inhibition-independent antidepressant actions of ketamine metabolites. Nature. 2016;533(7604):481486. doi:10.1038/nature17998

9. Bahji A, Vazquez GH, Zarate CJ. Comparative efficacy of racemic ketamine and esketamine for depression: a systematic review and meta-analysis. J Affect Disord. 2021;278:542555. doi:10.1016/j.jad.2020.09.071

10. Ohnishi T, Wakamatsu A, Kobayashi H. Different symptomatic improvement pattern revealed by factor analysis between placebo response and response to Esketamine in treatment resistant depression. Psychiatry Clin Neurosci. 2022;76(8):377383. doi:10.1111/pcn.13379

11. Gauszko-Wgielnik M, Chmielewska Z, Jakuszkowiak-Wojten K, Wiglusz MS, Cubaa WJ. Ketamine as add-on treatment in psychotic treatment-resistant depression. Brain Sci. 2023;13(1):142. doi:10.3390/brainsci13010142

12. Serafini G, Howland RH, Rovedi F, Girardi P, Amore M. The role of ketamine in treatment-resistant depression: a systematic review. Curr Neuropharmacol. 2014;12(5):444461. doi:10.2174/1570159X12666140619204251

13. Ortiz V, Costa CR, Fofo H, Fernandez SP, Barik J. Nicotinic receptors promote susceptibility to social stress in female mice linked with neuroadaptations within VTA dopamine neurons. Neuropsychopharmacol. 2022;47(9):15871596. doi:10.1038/s41386-022-01314-4

14. Fedgchin M, Trivedi M, Daly EJ, et al. Efficacy and safety of fixed-dose esketamine nasal spray combined with a new oral antidepressant in treatment-resistant depression: results of a randomized, double-blind, active-controlled study (TRANSFORM-1). Int J Neuropsychopharmacol. 2019;22(10):616630. doi:10.1093/ijnp/pyz039

15. Pathak U, Ahuja S, Dwivedi R, et al. Antisuicidal efficacy of ketamine infusion in suicidal patients of depressive disorder. Indian J Psychiat. 2021;63(5):483. doi:10.4103/indianjpsychiatry.indianjpsychiatry_80_21

16. Kheirabadi D, Kheirabadi GR, Mirlohi Z, Tarrahi MJ, Norbaksh A. Comparison of rapid antidepressant and antisuicidal effects of intramuscular ketamine, oral ketamine, and electroconvulsive therapy in patients with major depressive disorder. J Clin Psychopharm. 2020;40(6):588593. doi:10.1097/JCP.0000000000001289

17. Price RB, Iosifescu DV, Murrough JW, et al. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety. 2014;31(4):335343. doi:10.1002/da.22253

18. Keilp JG, Madden SP, Marver JE, et al. Effects of ketamine versus midazolam on neurocognition at 24 hours in depressed patients with suicidal ideation. J Clin Psychiatry. 2021;82:6. doi:10.4088/JCP.21m13921

19. Canuso CM, Singh JB, Fedgchin M, et al. Efficacy and safety of intranasal esketamine for the rapid reduction of symptoms of depression and suicidality in patients at imminent risk for suicide: results of a double-blind, randomized, placebo-controlled study. Am J Psychiatry. 2018;175(7):620. doi:10.1176/appi.ajp.2018.17060720

20. Ionescu DF, Fu D, Qiu X, et al. Esketamine nasal spray for rapid reduction of depressive symptoms in patients with major depressive disorder who have active suicide ideation with intent: results of a phase 3, double-blind, randomized study (ASPIRE II). Int J Neuropsychoph. 2021;24(1):2231. doi:10.1093/ijnp/pyaa068

21. Fu DJ, Ionescu DF, Li X, et al. Esketamine nasal spray for rapid reduction of major depressive disorder symptoms in patients who have active suicidal ideation with intent: double-blind, randomized study (ASPIRE I). J Clin Psychiatry. 2020;81:3. doi:10.4088/JCP.19m13191

22. Sinyor M, Williams M, Belo S, et al. Ketamine augmentation for major depressive disorder and suicidal ideation: preliminary experience in an inpatient psychiatry setting. J Affect Disord. 2018;241:103109. doi:10.1016/j.jad.2018.07.073

23. Murrough JW, Soleimani L, Dewilde KE, et al. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med. 2015;45(16):35713580. doi:10.1017/S0033291715001506

24. Grunebaum MF, Galfalvy HC, Choo TH, et al. Ketamine for rapid reduction of suicidal thoughts in major depression: a midazolam-controlled randomized clinical trial. Am J Psychiatry. 2018;175(4):327335. doi:10.1176/appi.ajp.2017.17060647

25. Abbar M, Demattei C, El-Hage W, et al. Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial. BMJ. 2022:e067194. doi:10.1136/bmj-2021-067194

26. Fan W, Yang H, Sun Y, et al. Ketamine rapidly relieves acute suicidal ideation in cancer patients: a randomized controlled clinical trial. Oncotarget. 2017;8(2):23562360. doi:10.18632/oncotarget.13743

27. Grunebaum MF, Ellis SP, Keilp JG, et al. Ketamine versus midazolam in bipolar depression with suicidal thoughts: a pilot midazolam-controlled randomized clinical trial. Bipolar Disord. 2017;19(3):176183. doi:10.1111/bdi.12487

28. Hochschild A, Keilp JG, Madden SP, Burke AK, Mann JJ, Grunebaum MF. Ketamine vs midazolam: mood improvement reduces suicidal ideation in depression. J Affect Disorders. 2022;300:1016. doi:10.1016/j.jad.2021.12.055

29. Ionescu DF, Bentley KH, Eikermann M, et al. Repeat-dose ketamine augmentation for treatment-resistant depression with chronic suicidal ideation: a randomized, double blind, placebo controlled trial. J Affect Disord. 2019;243:516524. doi:10.1016/j.jad.2018.09.037

30. Hu YD, Xiang YT, Fang JX, et al. Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study. Psychol Med. 2016;46(3):623635. doi:10.1017/S0033291715002159

31. Domany Y, Mccullumsmith CB. Single, fixed-dose intranasal ketamine for alleviation of acute suicidal ideation. an emergency department, trans-diagnostic approach: a randomized, double-blind, placebo-controlled, proof-of-concept trial. Arch Suicide Res. 2022;26(3):12501265. doi:10.1080/13811118.2021.1878078

32. Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018;27(6):17851805. doi:10.1177/0962280216669183

33. Higgins JP, Altman DG, Gtzsche PC, et al. The Cochrane collaborations tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. doi:10.1136/bmj.d5928

34. Cochrane handbook: general methods for Cochrane reviews; 2023. Available from: https://handbook-5-1.cochrane.org/chapter_9/9_5_heterogeneity.html. Accessed March 6, 2023.

35. Sterne J, Savovi J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898

36. Abdallah CG, Roache JD, Gueorguieva R, et al. Dose-related effects of ketamine for antidepressant-resistant symptoms of posttraumatic stress disorder in veterans and active duty military: a double-blind, randomized, placebo-controlled multi-center clinical trial. Neuropsychopharmacol. 2022;47(8):15741581. doi:10.1038/s41386-022-01266-9

37. Xiong J, Lipsitz O, Chen-Li D, et al. The acute antisuicidal effects of single-dose intravenous ketamine and intranasal esketamine in individuals with major depression and bipolar disorders: a systematic review and meta-analysis. J Psychiatr Res. 2021;134:5768. doi:10.1016/j.jpsychires.2020.12.038

38. Averill LA, Averill CL, Gueorguieva R, et al. mTORC1 inhibitor effects on rapid ketamine-induced reductions in suicidal ideation in patients with treatment-resistant depression. J Affect Disord. 2022;303:9197. doi:10.1016/j.jad.2022.01.104

39. Wilkinson ST, Ballard ED, Bloch MH, et al. The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis. Am J Psychiatry. 2018;175(2):150158. doi:10.1176/appi.ajp.2017.17040472

40. Witt K, Potts J, Hubers A, et al. Ketamine for suicidal ideation in adults with psychiatric disorders: a systematic review and meta-analysis of treatment trials. Aust NZ J Psychiatry. 2020;54(1):2945. doi:10.1177/0004867419883341

41. Marcantoni WS, Akoumba BS, Wassef M, et al. A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 - January 2019. J Affect Disord. 2020;277:831841. doi:10.1016/j.jad.2020.09.007

42. Daly EJ, Trivedi MH, Janik A, et al. Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA Psychiat. 2019;76(9):893903. doi:10.1001/jamapsychiatry.2019.1189

43. Szarmach J, Cubaa WJ, Wodarczyk A, Gauszko-Wgielnik M. Somatic comorbidities and cardiovascular safety in ketamine use for treatment-resistant depression. Medicina. 2021;57:3. doi:10.3390/medicina57030274

44. Short B, Fong J, Galvez V, Shelker W, Loo CK. Side-effects associated with ketamine use in depression: a systematic review. Lancet Psychiat. 2018;5(1):6578. doi:10.1016/S2215-0366(17)30272-9

45. Jskelinen E, Juola T, Korpela H, et al. Epidemiology of psychotic depression - systematic review and meta-analysis. Psychol Med. 2018;48(6):905918. doi:10.1017/S0033291717002501

46. Rothschild AJ. Challenges in the treatment of major depressive disorder with psychotic features. Schizophr Bull. 2013;39(4):787796. doi:10.1093/schbul/sbt046

47. Souza-Marques B, Telles M, Leal GC, et al. Esketamine for unipolar major depression with psychotic features: a retrospective chart review and comparison with nonpsychotic depression. J Clin Psychopharmacol. 2022;42(4):408412. doi:10.1097/JCP.0000000000001571

48. Yang P, Yang M, Li P, et al. A meta-analysis of 5-hydroxytryptamine receptor 1B polymorphisms with risk of major depressive disorder and suicidal behavior. Front Psychiatry. 2021;12:696655. doi:10.3389/fpsyt.2021.696655

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Brian Shinault, CEO of American Strategic Partners, Supports Permanently Removing Physician Supervision o – Benzinga

March 14, 2023 10:00 AM | 3 min read

Washington, DC March 14, 2023 --(PR.com)-- Brian Shinault, CEO of American Strategic Partners, released the following statement in support of permanently removing physician supervision of Certified Registered Nurse Anesthetists (CRNAs).

American Strategic Partners will join the American Association of Nurse Anesthesiology (AANA) in lobbying the Biden Administration and the 118th Congress to pass and enact H.R. 833 as law. The bipartisan Save Americas Rural Hospitals Act (H.R. 833) provides enhanced payments to rural healthcare providers to help ensure the viability of these important local healthcare facilities. H.R. 833 also includes a provision to permanently remove physician supervision of Certified Registered Nurse Anesthetists (CRNAs) under Medicare Part A conditions of participation and a provision to include non-medically directed CRNA services as a mandatory benefit under the Medicaid program.

Read the bill here.

American Strategic Partners has thoroughly investigated this issue by interviewing with doctors in diverse medical practices throughout the United States and researching data. Moreover, American Strategic Partners has engaged with representatives of the AANA and studied their data prepared in support of this issue.

Our findings have determined that it is imperative and not an option that the temporary pause on this regulation due to the public health emergency be deemed permanent by law. Research has shown that rural communities are in dire need and the Save Americas Rural Hospitals Act comes at a time when rural hospitals and health centers are facing unprecedented challenges and are struggling to keep their lights on and serve their communities. According to the National Rural Health Association, more than 170 rural hospitals across the country have closed their doors since 2005, and 453 rural hospitals are currently operating at levels like those that have shut down during the last decade, meaning they are vulnerable for closure. This is forcing patients to travel further to get the care they need and leaving others to put off necessary healthcare. According to the AANA, CRNAs are the primary providers of anesthesia care in rural settings and have been instrumental in delivering care during the pandemic to patients where they live and when they need it. In many medical settings, CRNAs serve as the sole anesthesia provider in rural hospitals, affording these facilities the capability to provide many necessary procedures.

The importance of CRNA services in rural areas was highlighted in a recent survey that examined the relationship between socioeconomic factors related to geography and insurance type and the distribution of anesthesia provider type. The study correlated CRNA services with lower-income populations and correlated anesthesiologist services with higher-income populations.

Of importance to the implementation of public benefit programs in the U.S., the study also showed that compared with anesthesiologists, CRNAs are more likely to work in areas with lower median incomes and larger populations of citizens who are unemployed, uninsured, and/or Medicaid beneficiaries.

For more information on this issue, contact American Strategic Partners or via linkedin.com/in/brian-shinault-jd-70a038b4.

Sources:https://www.congress.gov/bill/118th-congress/house-bill/833?(H.R. 833);https://www.aana.com/news (02-23-2023/newsroom press release)https://www.semanticscholar.org/paper/geographical-imbalance-of-anesthesia-providers-and-liao-quarishi/77112f1f7ca09a86142b4f5e7c065ae9a073dec2

Contact Information:American Strategic PartnersBrian Shinault202-487-1884Contact via EmailAmericanStrategicPartners.com

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