Josh L.Ac.

Being a patient advocate also means looking out for the patient's best interests, especially when they contradict their wishes (e.g., opiates for FM).

It's one of those Worsley / Lonny Jarrett / 5 Element classifications. I hardly use "Classical Five Element" acupuncture since I think of all the styles of acupuncture that I've seen, it is the most "forced" in terms of making reality fit theory, but the whole constitutional diagnosis thing is fun. I've been doing acupuncture for 5 years, although now I am in school for anesthesia. Since my wife also is an acupuncturist [with completely different views, BTW] there isn't enough money in it for both of us. Plus I "resonate" more with biomedical theories. The national licensing boards are very simple and the NCCAOM does allow acupuncturists with less formalized training to sit for the exam. I would be concerned if an individual goes through their entire training with just 1 mentor, but if they can pass the boards, then it demonstrates that they have at least be exposed to a fair degree of information.

It is an error to assume that a master's degree-level (or beyond) acupuncture training program focuses only on the didactic aspect of acupuncture and ignores the "spirit" of the medicine, and it is a logical fallacy to conversely conclude that a "barefoot doctor" training program is better because of the training avoids standardized tests. One of the biggest ramifications of playing acupuncture without a solid foundation is that it leaves the practitioner much more open to be seduced by their own personal anecdote. It is always difficult to determine if A caused B or if it merely preceded it. Without a strong acupuncture foundation, this determination becomes much more challenging. Bonus points if you can guess my "Five Element" diagnosis.

Nurses shouldn't be doing acupuncture unless they have completed a master's degree program (even if legally they can). Three years of solid acupuncture training is just the tip of the iceberg and you would be doing your future patients a disservice by selling yourself as an acupuncturist to them. A patient advocate would refer to an appropriate practitioner instead of pretending to be a competent provider.

While that is true that you can have any kind of bachelor's degree for AA school, the basic science prerequisites for AA school meet and exceed the classes nurses take as a part of their BSN.

That's why I like pain scales that illustrate the patient's functional ability instead of the patient's "perception" of what their pain should rate (look under "Activity Tolerance Scale") : While all the advocacy literature states we should completely believe the patient's report of their pain, we need to have some way to verify what we are being told. If the patient can walk and talk without any distress, then they aren't a "12 out of 10".

Methadone for fibromyalgia? Wonderful.

Only applied to UMKC's anesthesiologist assistant program with a 3.3 science GPA and 29 MCAT, interviewed, and accepted. Start in January 09 and currently reviewing Lange's Pharmacology chapters on anesthetics. Several guys I completed my accelerated BSN program with applied to CRNA schools, one was accepted locally, another was wait-listed. If my friend and I run into each other at the hospital, we've talked about going "West Side Story" on each other for our own amusement.

While CRNA's can practice independently in some locations, in the metro center I live the only place CRNA's function in that manner is outside of hospitals or out in the rural areas. In order for decentralized anesthesia to replace the ACT model in the hospitals here, there would have to be evidence of benefit (in terms of cost and safety) versus the status quo. In addition, with the large midlevel anesthesia provider deficit, I doubt AA's will have to worry about getting jobs in the near or distant future...despite the wishes and advertising of the AANA.

So is there any research showing decentralized anesthesia is more cost-effective and as safe as anesthesia delivered by the ACT model?

So it is cheaper for 4 rooms to be run by individual CRNA's and anesthesiologists than it is for one anesthesiologist to supervise 4 rooms run by midlevel's that are paid 1/2 to 1/3 their salary? It might be cheaper if all the rooms are run by CRNA's that are paid 1/2 what an anesthesiologist makes and no anesthesiologists are used... Hey wait, there it is.

I had a BS in biology and went into an accelerated BSN program, but instead of applying to CRNA school, I applied and was accepted into AA school. If you plan on working in the city under the ACT model and live near one of the 5 schools, then AA school is an option. My accelerated BSN GPA was very high but didn't help much with my application since they focused more on my pre-med prerequisites. I also had to do a crash prep for the MCAT and scored fairly well, although I was tempted to retake to see how I could have done with a more intensive prep. But like I said, if you didn't plan on doing locums to rake in the cash and plan on working under the ACT model, live near one of the five AA schools, and plan on practicing in one the states that AA's or licensed (or work in the VA system), then AA school could be an option.

Or if you plan on working in a major metropolitan center where most midlevels practice under the ACT model, then the term assistant is just semantics and rhetoric. To be honest, do you really think a couple of years of ICU plus 2.5 years of CRNA school makes the average CRNA the equivalent of an anesthesiologist?

I think that HCA hospitals in the greater KC area are all increasing their wages for staff nurses, although it is taking many months to get it finalized [back pay, anyone?]. I work outpatient pain management, so my experience is fundamentally different than the majority of the nurses that work in my hospital. We do make a ton of money for the hospital and still have some problems getting staffing, although I do understand the rationale that management makes that you need to show increased census month by month...although the lag sucks.

So the participants in the study we tested while taking a small oral dose of oxycodone, then titrated to a low level of transdermal fentanyl, then tested again with the results compared to their stats while being on oxycodone? Not meaning to be intentionally obtuse, but how would that design allow one to universalize the results to mean that people on low-dose opiates can function effectively and safely at their jobs?