The Anesthesiology Community's Approach to Opioid- and Anesthetic-abusing Personnel Time to Change Course

Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
Anesthesiology (Impact Factor: 5.88). 12/2008; 109(5):762-4. DOI: 10.1097/ALN.0b013e31818a3814
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    • "If replicated and/or confirmed in larger studies, the benefits suggested in this study would likely lead to mandatory naltrexone becoming a more universal component of physician health programs. With such policies in place, the concept of " one strike " may need to be revisited entirely (Berge, et al., 2008). Additionally, these data may generalize to other similar groups such as nurse anesthetists, retail pharmacists, or pain management physicians. "
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    ABSTRACT: Anesthesiologists with opioid use disorders are at high risk for relapse. In 2005, the impaired professionals monitoring program of the State of Florida implemented a policy whereby anesthesiologists referred for opiate use disorders were contractually obligated to take naltrexone for 2 years. Naltrexone ingestion was witnessed and verified via random urine drugs screens or administered via intramuscular injection. Charts were reviewed for the 11 anesthesiologists who underwent mandated pharmacotherapy with naltrexone, and 11 anesthesiologists who began monitoring immediately before implementation of this policy. Eight of 11 anesthesiologists who did not take naltrexone experienced a relapse on opiates. Only 1 of 11 anesthesiologists experienced a relapse on opiates after taking naltrexone, whereas another relapsed on an inhalant (nitrous oxide). It is noteworthy that 5 of the 11 anesthesiologists who took naltrexone had relapsed before naltrexone treatment, and 7 of the 11 anesthesiologists who did not take naltrexone experienced multiple documented relapses. Only 1 of the 11 anesthesiologists who did not take naltrexone successfully returned to the practice of anesthesiology. This individual suffered primarily from alcohol dependence, and suspected opiate abuse was never verified. Others who attempted return to anesthesiology (n = 7) suffered a relapse. In comparison, 9 of the 11 anesthesiologists who took naltrexone have returned to the practice of anesthesiology without a relapse (as verified by continued random urine and hair testing). Mandatory naltrexone treatment may provide anesthesiologists with an additional safeguard to successfully return to work.
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    ABSTRACT: This paper presents the maximum likelihood estimate of the time delay between two signals with random relative phase shift. The analysis applies for both broad-band and narrowband signals and incorporates a parametric representation of the spread of the phase variation which allows the examination of all cases ranging from uniformly distributed phase shift to known phase shift. A realization of the ML estimator is presented which illustrated the difference between optimum processing for random phase shift and no phase shift. The Cramer-Rao bound is also derived and the performance degradation is discussed.
    No preview · Conference Paper · May 1981
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    ABSTRACT: Pole-zero modeling of low-pass signals, such as an electromagnetic-scatterer response, is considered in this paper. It is shown by use of pencil-of-functions theorem that (a) the true parameters can be recovered in the ideal case (where the signal is the impulse response of a rational function H(z)), and (b) the parameters are optimal in the generalized least-squares sense when the observed data are corrupted by additive noise or by systematic error. Although the computations are more involved than in all-pole modeling, they are considerably less than those required in iterative schemes of pole-zero modeling. The advantages of the method are demonstrated by simulation example and through application to the electromagnetic response ofa scatterer. The paper also includes very recent and tantalizing results on a new approach to noise correction. In contradistinction with spectral subtraction techniques, where only amplitude information is emphasized (and phase is ignored), we propose a method that (a) estimates the sample variance for the particular data frame, and then performs the subtraction from the Gram matrix.
    Preview · Conference Paper · May 1981
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