General Anesthesia Linked to Language Problems in Children

msn10 · Jan 13, 2014

You need to "walk the walk" otherwise you just do not understand.

Walk what walk? That of research? Walked down that path quite a bit.

What don't I understand? Developmental delays in children? I do not believe anyone on this thread is an expert in that field so no one can talk to it then.

nomadcrna, DNP, CRNA, NP · Jan 13, 2014

That of being a CRNA to understand and be able to make comments on various issues. It is very apparent when a non-CRNA posts something. Many times it is very off base.

If you do not understand the "walk the walk" if you want to "talk the talk", well I can't help you.

msn10 · Jan 13, 2014

That of being a CRNA to understand and be able to make comments on various issues. It is very apparent when a non-CRNA posts something. Many times it is very off base.
If you do not understand the "walk the walk" if you want to "talk the talk", well I can't help you.

Funny, I thought this site was called "Allnurses"

The "walk and talk" here is research. I am qualified in that respect. I did not, at any time, talk about delivering an anesthetic, I talked about the rigor and the validity of a study, which I am very qualified to do.

allnurses Guide · Jan 13, 2014

I didn't say it was in that specific area, but I do research. I was trying to say that I disagreed with the process of the study. It should have been a before and after, not a comparative study to fully reveal the effects of said anesthetics.
You are talking about 2 different things. CRNA's (or very few of them) have ever created pharmaceuticals. However, the difference is that I the ones I know in research (and yes I do know some very well), I respect and work with well.
Teen pregnancy | IRP Poverty Dispatch
2nd paragraph - honored by the White House. And I didn't say it decrease the percentage, it decreased the raw number. But I do stand corrected, it was 47% decrease in 5 years, 50% decrease in 7 years.
I have never said that I do not value CRNA's, but rather I value CRNA's and MD's at the same time. You saying that I degrade CRNA's on every post is not only completely ridiculous, but it is the pot calling the kettle black. When someone gets a DNAP, they also very often teach. I cannot imagine learning from someone who is so quick to condemn and make fun of others. Instead of at least trying to see other points of view, you look for the item in a discussion and pounce. You love winning an argument, that is clear, but I have tried many times to talk with you. If I have ever made you feel like I was disrespectful to you or any other CRNA, it was not my intention, but after reading your replies to any of us who are not CRNA's, it seems as if you strive to belittle. My entire point about my research was to point out that I can read a research article, regardless of the type of medicine, and understand the rigor, the process, and if it is really a article that shows significance. I live part-time in the world of t-tests, factorial design, and IRB's and the other half in the hospital. I am well respected by my peers (as I am sure you are too) as I actively conduct and implement research with the input of many disciplines. You clearly have no respect for anything I do or anyone else who respectfully questions your posts. However, I respect the amount of work you have put into you DNP, I respect the time it takes to become one, and I respect the work that you and many others in anesthesia do as well. But telling my that I "lack of understanding of this problem or the complexities of this issue that I come to expect from someone outside of anesthesia/surgery" is very disrespectful. Learning delays were not discovered by those in anesthesia, the idea came about from pediatricians, child psychologists , neurologists, and others who's interest in this topic was published back in the late 1900's and early 2000's. Anesthesia is only recently been involved in the conversation. Again, it is a collaborative discussion with multiple disciplines involved.

1. Are you saying you have done a thorough literature review on this subject and you are now able to provide your expert opinion? This is one article of many and the overall theme is the same.

2. How do you know what research CRNAs do and do not do? You make a lot of assumptions with the assumption that is usually in favor of exactly what comes out of the ASA propaganda machine. I do know CRNAs that have studied pharmeceuticals and have researched developing pharmaceuticals, but just like are MDA counterparts our research is usually clinically focused. MDAs are often given IMHO unfair advantage in being given the time and resources to do research through a combination of facility policies and reimbursement regulations.

3. You assume that you work very well with the CRNAs that you know and you are respected, but maybe that is only your perception. The same goes for anyone including myself. You really do not know what is said or not said about you behind closed doors.

4. You are not a CRNA, but you continually make assumptions about CRNAs and post on a forum designed for CRNAs and then you complain when you are called out about it. Who is the hypocrite here? You do not see me going into forums that I have no knowledge of and pretending to be a subject matter expert. You can read research. That is great, but that still gives you no practical knowledge. You do not do anesthesia, you have not done research in this area, you have a fundamental lack of ASA/PS categories, a lack of knowledge of common surgeries in pediatrics and a lack of knowledge in many other basic anesthesia/surgery details.

5. Your comments about trying to decrease anesthesia/surgery is what was being discussed and it shows a complete lack of understanding of the situation. It is also off-track of the original subject, if you want to discuss decreases in surgery then post an article about the benefits of decreasing surgery and start another topic thread. This topic is about the anesthesia problems on developing brains.

allnurses Guide · Jan 13, 2014

Funny, I thought this site was called "Allnurses"
The "walk and talk" here is research. I am qualified in that respect. I did not, at any time, talk about delivering an anesthetic, I talked about the rigor and the validity of a study, which I am very qualified to do.

Yes, but this a CRNA forum with a discussion about an anesthetic phenomeon that you have no direct working knowledge of and neither are you a subject matter expert on the subject. So, why be offended when someone points out the obvious lack of your understanding on the subject.

msn10 · Jan 13, 2014

Yes, but this a CRNA forum with a discussion about an anesthetic phenomeon that you have no direct working knowledge of and neither are you a subject matter expert on the subject. So, why be offended when someone points out the obvious lack of your understanding on the subject.

'

Yet you have no problem with non-CRNA's who post on these threads, as long as they agree with you.

You are not a CRNA, but you continually make assumptions about CRNAs

And you are not a researcher but continually belittle those of us who are.

Yes, but this a CRNA forum with a discussion about an anesthetic phenomeon that you have no direct working knowledge of and neither are you a subject matter expert on the subject.

And you have no working knowledge of research as you have not conducted it yourself.

The discussion was the research article that you posted. I said that in this particular study, comparing 2 separate groups is less valid than doing an interventional study in which a group of children were administered the tests before and after a general anesthetic. Even the researchers in the study had a hard time coming to a conclusion after assessing only 104 kids. Now does this add to the discussion and should more research be done? No question.

Again, I think your obstinance towards anyone's opinion who does not provide anesthesia is limiting and close minded. You may be an expert in your field, no one is questioning that, but anesthesia research is still done using the same protocols and systems that are used throughout nursing and medicine. You have twisted what I have said in the past, used that perception against me in anything I said in the present and made up your mind. So be it, you will never agree with anything I say.

Again the purpose of Allnurses is for nurses to share ideas across disciplines, just like we are doing in healthcare, otherwise we would all go to our respective corners and operate in silos which is destructive to the culture of healthcare.

allnurses Guide · Jan 13, 2014

'
Yet you have no problem with non-CRNA's who post on these threads, as long as they agree with you.
And you are not a researcher but continually belittle those of us who are.
And you have no working knowledge of research as you have not conducted it yourself.
The discussion was the research article that you posted. I said that in this particular study, comparing 2 separate groups is less valid than doing an interventional study in which a group of children were administered the tests before and after a general anesthetic. Even the researchers in the study had a hard time coming to a conclusion after assessing only 104 kids. Now does this add to the discussion and should more research be done? No question.
Again, I think your obstinance towards anyone's opinion who does not provide anesthesia is limiting and close minded. You may be an expert in your field, no one is questioning that, but anesthesia research is still done using the same protocols and systems that are used throughout nursing and medicine. You have twisted what I have said in the past, used that perception against me in anything I said in the present and made up your mind. So be it, you will never agree with anything I say.
Again the purpose of Allnurses is for nurses to share ideas across disciplines, just like we are doing in healthcare, otherwise we would all go to our respective corners and operate in silos which is destructive to the culture of healthcare.

I do have problem with people who post on here trying to claim to be subject matter experts when they are not no matter their background.

I claim to be nothing other than I have posted.

This study is one of many in this area, and was posted because it was recently published in one anesthesia journal or another.

You were called out for your lack of knowledge in ASA/PS classifications and your bandaid solution to this problem. You didn't even start to critique the value of the article until you called out on those other issues.

You are the one that is always claiming CRNAs don't do research and the benefits of the ACT practice. The first is incorrect and the second IMO has no benefit when compared to other types of practices except for making MDAs richer off the labor of CRNAs and AAs.

Just because I disagree with you has no bearing on how I feel about other researchers from other disciplines.

msn10 · Jan 13, 2014

I do have problem with people who post on here trying to claim to be subject matter experts when they are not no matter their background.

I never said I was a subject matter expert, I am a research expert. I was assessing the validity of the process.

You didn't even start to critique the value of the article until you called out on those other issues.

You need to reread my first post, that is exactly what I was saying. Great research identifies variables. The first article you referenced did not address certain variables that can change the whole complexity of the research. I never said that anesthesia didn't cause developmental delay in children, I said the article did not do a before and after comparison which is completely different than comparing 2 independent groups. If the researchers wanted a more reliable study, they should have done an interventional or pre-/post test study.

You were called out for your lack of knowledge in ASA/PS classifications and your bandaid solution to this problem.

I don't know how I could be called out on a statement I never expressed. All I said was that your idea and my idea of "healthy" are different. Healthcare does not revolve around ASA/PA classifications as it was created to assess the degree of a patient's sickness prior to an anesthetic or surgery. Health in most civilized countries is defined as the absence of disease. When a person gets surgery, they have some type of disease or dysfunction, even at the ASA PS1 level otherwise they would not need surgery except for surgeries like circumcisions which are a preference, not a need.

You are the one that is always claiming CRNAs don't do research

Always? I simply said they aren't doing the drug invention, chemists are. I currently have a number of CRNA's involved in the project I am working on. One of our deans is a CRNA, PhD. I would never say that they don't do research because it is simply not true.

IMO has no benefit (ACT) when compared to other types of practices except for making MDAs richer off the labor of CRNAs and AAs.

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ACT has nothing to do with this thread. We have both gone off topic.

nomadcrna, DNP, CRNA, NP · Jan 13, 2014

Sorry but this last post was pretty ridiculous. " no working knowledge of research", Really?

I just don't know where to begin. Sorry but this truly shows your complete lack of knowledge of advanced practice.

Do you understand what evidenced based medicine is?

Do you understand that DNP/DNAP are taught to be experts in judging research. Experts in utilization of research and evidence based medicine.

Even masters prepared advanced practice clinicians are experts in evidence based medicine. It is what we base our whole practice on.

msn10 · Jan 13, 2014

Sorry but this truly shows your complete lack of knowledge of advanced practice.
Do you understand what evidenced based medicine is?
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I find that to be a ridiculous statement as I teach RN's and APN's at the university level, I am very aware of EBP.

Also, just because someone is an APN, it doesn't mean they are experts in judging research. It takes at least 5 years of actively utilizing research in one's practice to be an expert. Our university sees DNP curriculum as: The DNP prepares graduates to practice at the most advanced level of nursing and to evaluate current practice approaches, to appraise evidence, and to use this knowledge to create clinical strategies that improve practice and health outcomes. The education itself does not make one an expert, work experience does.

Let me rephrase my statement as it wasn't clear. WTBCRNA does not have working knowledge of how to conduct an entire research study, he said it himself. I wasn't challenging his ability to read an article, I was trying to express one statement about the need for a different type of process for the study he quoted in the beginning. I then made the comment that anyone on a collaborative holistic team would make - instead only looking at the agent that causes learning dysfunction in children, lets look at why so many kids are getting surgeries they don't need. No better way to avoid surgical complications than to prevent surgeries if possible. If you or WTBCRNA did not like that answer, then a mere "You make a good point about the research process, but we still need to address the cause of the learning dysfunction" would have sufficed. Again, it has turned into a "I am a CRNA so I know all and you know nothing" type of thread.

The one thing I am certain of after dealing with him is that out of the 2 of us, I know a great deal more about professional collaboration. True professionals do not treat others with such distain and disrespect. If they disagree, they do it in a civilized and thoughtful manner. If one is an expert in an area, and the other is not, then a respectful discussion should begin. If he is truly a DNP, then part of the education is to teach others as well. WTBCRNA does not teach, he posts articles and then when someone says something that may be different or unclear, he pounces. With so many snarky responses to so many different individuals, I believe it is done for sport.

allnurses Guide · Jan 14, 2014

I find that to be a ridiculous statement as I teach RN's and APN's at the university level, I am very aware of EBP.
Also, just because someone is an APN, it doesn't mean they are experts in judging research. It takes at least 5 years of actively utilizing research in one's practice to be an expert. Our university sees DNP curriculum as: The DNP prepares graduates to practice at the most advanced level of nursing and to evaluate current practice approaches, to appraise evidence, and to use this knowledge to create clinical strategies that improve practice and health outcomes. The education itself does not make one an expert, work experience does.
Let me rephrase my statement as it wasn't clear. WTBCRNA does not have working knowledge of how to conduct an entire research study, he said it himself. I wasn't challenging his ability to read an article, I was trying to express one statement about the need for a different type of process for the study he quoted in the beginning. I then made the comment that anyone on a collaborative holistic team would make - instead only looking at the agent that causes learning dysfunction in children, lets look at why so many kids are getting surgeries they don't need. No better way to avoid surgical complications than to prevent surgeries if possible. If you or WTBCRNA did not like that answer, then a mere "You make a good point about the research process, but we still need to address the cause of the learning dysfunction" would have sufficed. Again, it has turned into a "I am a CRNA so I know all and you know nothing" type of thread.
The one thing I am certain of after dealing with him is that out of the 2 of us, I know a great deal more about professional collaboration. True professionals do not treat others with such distain and disrespect. If they disagree, they do it in a civilized and thoughtful manner. If one is an expert in an area, and the other is not, then a respectful discussion should begin. If he is truly a DNP, then part of the education is to teach others as well. WTBCRNA does not teach, he posts articles and then when someone says something that may be different or unclear, he pounces. With so many snarky responses to so many different individuals, I believe it is done for sport.

Yep, my professional collaboration skills are so bad the military keeps promoting me, putting me in charge, asking my expert opinion, and giving me USAF scholarships. That sounds just like someone who doesn't know anything about professional relationships/collaboration. Now who is being arrogant and condescending. I do not have to agree with you or be amenable to your posts. Just because someone does not perform research does not mean they are not subject matter experts, and just because someone does research does it make them qualified in all things research related.

msn10 · Jan 15, 2014

Now who is being arrogant and condescending.

I am not trying to be either, I am making a judgment based on how you "talk" to me and others.

No you do not have to agree with me, but your livid and harsh responses will never produce a thoughtful discussion. Sarcasm, belittling, and name calling will automatically cause defensiveness. My inter professional assessment was made based on how you respond to those that even slightly question your posts. If you speak to people at work who disagree with you the way you do to people on this site who have a different opinion, then it is difficult for me to understand how you work collaboratively.

You say you are in the military. I guess my lived experience with military personnel is different. I grew up in a military family, and I always admired the discipline my dad, grandfathers, and nephews had for civilians even when they disagreed with them. Even if someone made a derogatory comment about the military, they always showed restraint in their words and actions. I like to think I learned a lot from them and applied it to the workforce and in interactions with others. I am not a CRNA, but I am a nurse with advanced nursing degrees who teaches APN's who go into anesthesia. Just as you deserve to treated with respect for your service and training, I deserve the same as well.