Discoveries of Distinction
"Discoveries of Distinction" highlights outstanding, timely, and innovative research on a range of important issues to CRNA professionals. All research studies presented in this column have been funded by the AANA Foundation or presented in the AANA Foundation
State of the Science Poster Session. These studies were originally recognized in the AANA NewsBulletin editions cited below.
For more information, please contact the AANA Foundation at foundation@aana.com.
July 2019
Type II Diabetes Mellitus: 
Relationships Between Preoperative
Physiologic Stress, Gastric Content
Volume and Quality and the Risk of
Pulmonary Aspiration
Primary Author:
Amy Reed, PhD, CRNA
Pulmonary aspiration is a potentially fatal anesthetic complication occurring when gastric contents enter the respiratory system. Current fasting guidelines aim to decrease the risk of pulmonary aspiration; however, these guidelines are for healthy individuals and fail to account for type II diabetes mellitus (DM II) patients (ASA, 2011).
Relationships Between Preoperative
Physiologic Stress, Gastric Content
Volume and Quality and the Risk of
Pulmonary Aspiration
Primary Author:
Amy Reed, PhD, CRNA
Pulmonary aspiration is a potentially fatal anesthetic complication occurring when gastric contents enter the respiratory system. Current fasting guidelines aim to decrease the risk of pulmonary aspiration; however, these guidelines are for healthy individuals and fail to account for type II diabetes mellitus (DM II) patients (ASA, 2011).
May 2019
Incidence and Risk Factors of 
Gastric-to-Pulmonary Aspiration
in Patients Undergoing Elective
Upper Gastrointestinal Endoscopy
Primary Author:
Kelsey Nelsen, BSN, RN, PHN
Coauthors:
Amy Gnagey, APRN, CRNA, DNAP
J. Kyle Bohman, MD
Oludare Olatoye, MD
Rochelle Molitor, MD
Nathan Smischney, MD
and Adam Jacob, MD
Gastric-to-pulmonary aspiration is a recognized risk during upper gastrointestinal endoscopy. The risk of aspiration is suspected to be significant in this population due to manipulation of the oropharynx and underlying gastrointestinal pathologies, but a thorough assessment of this risk is lacking.
Gastric-to-Pulmonary Aspiration
in Patients Undergoing Elective
Upper Gastrointestinal Endoscopy
Primary Author:
Kelsey Nelsen, BSN, RN, PHN
Coauthors:
Amy Gnagey, APRN, CRNA, DNAP
J. Kyle Bohman, MD
Oludare Olatoye, MD
Rochelle Molitor, MD
Nathan Smischney, MD
and Adam Jacob, MD
Gastric-to-pulmonary aspiration is a recognized risk during upper gastrointestinal endoscopy. The risk of aspiration is suspected to be significant in this population due to manipulation of the oropharynx and underlying gastrointestinal pathologies, but a thorough assessment of this risk is lacking.
March 2019
Running on EMPTY? Accuracy in Evaluating 
Gastric Ultrasound Images Before and
After Brief Training
Primary Author: Michele Ardigo DNP, CRNA
Co-authors:
Jonathan Kline, MSNA, CRNA
Brian Selai, MSN, CRNA
Marilyn A. Pugh, PhD
Ultrasound evaluation (UE) of gastric contents may represent an excellent quantitative diagnostic tool. Research has determined the use of gastric UE beneficial in determining gastric content.
Gastric Ultrasound Images Before and
After Brief Training
Primary Author: Michele Ardigo DNP, CRNA
Co-authors:
Jonathan Kline, MSNA, CRNA
Brian Selai, MSN, CRNA
Marilyn A. Pugh, PhD
Ultrasound evaluation (UE) of gastric contents may represent an excellent quantitative diagnostic tool. Research has determined the use of gastric UE beneficial in determining gastric content.
November 2018
The Effect of Data-Entry Template
Design and Anesthesia Provider
Workload on Documentation Accuracy,
Documentation Efficiency, and User-
Satisfaction
Primary Author: Bryan Anthony Wilbanks,
PhD, DNP, CRNA
This study used observational data collection and psychometric instruments (for perceived workload and user satisfaction) at three hospitals that each used different methods of data-entry for perioperative documentation (auto-filling with unstructured data, computerassisted data selection with semi-structured documentation, and paper-based documentation).
Design and Anesthesia Provider
Workload on Documentation Accuracy,
Documentation Efficiency, and User-
Satisfaction
Primary Author: Bryan Anthony Wilbanks,
PhD, DNP, CRNA
This study used observational data collection and psychometric instruments (for perceived workload and user satisfaction) at three hospitals that each used different methods of data-entry for perioperative documentation (auto-filling with unstructured data, computerassisted data selection with semi-structured documentation, and paper-based documentation).
July 2018
Development of a Training Program in 
Peripherally Inserted Central Catheter
Placement for Certified Registered
Nurse Anesthetists Utilizing an
N-of-1 Methodology
Primary Author:
Aaron Ostrowski, DNP, CRNA
Coauthors:
Suzanne Morrison, DNP, CRNA
John O’Donnell, DrPH, CRNA
Patients were waiting an average of 23 hours for reliable, long-term central venous access in our hospital, and expansion of the IV team service was not an option. A training program in the insertion of peripherally inserted central catheters (PICCs) for CRNAs was developed to provide another cost-effective resource in our hospital to meet patients’ needs.
Peripherally Inserted Central Catheter
Placement for Certified Registered
Nurse Anesthetists Utilizing an
N-of-1 Methodology
Primary Author:
Aaron Ostrowski, DNP, CRNA
Coauthors:
Suzanne Morrison, DNP, CRNA
John O’Donnell, DrPH, CRNA
Patients were waiting an average of 23 hours for reliable, long-term central venous access in our hospital, and expansion of the IV team service was not an option. A training program in the insertion of peripherally inserted central catheters (PICCs) for CRNAs was developed to provide another cost-effective resource in our hospital to meet patients’ needs.
March 2018
Perceptions of Acupuncture and Acupressure
by Anesthesia Providers: A Quantitative
Descriptive Study
Primary Author: Amanda Faircloth, PhD,
DNAP, CRNA
Coauthors: Arkadiy Dubovoy, MD; Chuck Biddle, PhD, CRNA; Diane Dodd-McCue, DBA; and John F. Butterworth IV, MD
This study assessed U.S. anesthesia providers’ perceptions of acupuncture and acupressure. After institutional review board approval, 96 anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical
centers, community hospitals, children’s hospitals, and veterans affairs hospitals) were selected for participation in an anonymous, pretested, online survey.
by Anesthesia Providers: A Quantitative Descriptive Study
Primary Author: Amanda Faircloth, PhD,
DNAP, CRNA
Coauthors: Arkadiy Dubovoy, MD; Chuck Biddle, PhD, CRNA; Diane Dodd-McCue, DBA; and John F. Butterworth IV, MD
This study assessed U.S. anesthesia providers’ perceptions of acupuncture and acupressure. After institutional review board approval, 96 anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical
centers, community hospitals, children’s hospitals, and veterans affairs hospitals) were selected for participation in an anonymous, pretested, online survey.
September 2017
Student Registered Nurse Anesthetists: 
The Impact of Structured High Fidelity
Simulation on Anesthesia Ready Time
Primary Author: Michele Ballister,
DNP, CRNA
Student registered nurse anesthetists (SRNAs) at a large academic medical center are limited in clinical training experiences due to the subjective observations of local anesthesia departments that SRNAs decrease OR efficiency because they require too much instruction. Utilizing the Iowa Model of Evidenced-Based Practice to Promote
Quality Care, the investigator inserted a six week structured simulation program into the nurse anesthesia curriculum prior to the SRNAs’ first clinical rotation.
The Impact of Structured High Fidelity
Simulation on Anesthesia Ready Time
Primary Author: Michele Ballister,
DNP, CRNA
Student registered nurse anesthetists (SRNAs) at a large academic medical center are limited in clinical training experiences due to the subjective observations of local anesthesia departments that SRNAs decrease OR efficiency because they require too much instruction. Utilizing the Iowa Model of Evidenced-Based Practice to Promote
Quality Care, the investigator inserted a six week structured simulation program into the nurse anesthesia curriculum prior to the SRNAs’ first clinical rotation.
July 2017
Differential Expression of 
Phosphorylated Mitogen-Activated
protein kinase (pMAPK) in the lateral
amygdala of mice selectively bred
for high and low fear
Primary Authors:
LTC Jennifer Coyner, PhD, CRNA
Coauthors:
Jennifer McGuire, PhD
Robert Ursano, MD, PhD
Clarissa Parker, PhD
Abraham Palmer, PhD
Luke R. Johnson, PhD
This research examines the cellular and molecular mechanisms that underlie conditioned fear learning in a mouse model of high and low fear. Individuals with posttraumatic stress disorder (PTSD) demonstrate a higher ‘fear load’ compared to individuals that do not have PTSD.
Phosphorylated Mitogen-Activated
protein kinase (pMAPK) in the lateral
amygdala of mice selectively bred
for high and low fear
Primary Authors:
LTC Jennifer Coyner, PhD, CRNA
Coauthors:
Jennifer McGuire, PhD
Robert Ursano, MD, PhD
Clarissa Parker, PhD
Abraham Palmer, PhD
Luke R. Johnson, PhD
This research examines the cellular and molecular mechanisms that underlie conditioned fear learning in a mouse model of high and low fear. Individuals with posttraumatic stress disorder (PTSD) demonstrate a higher ‘fear load’ compared to individuals that do not have PTSD.
May 2017
The Implementation of a High-Fidelity 
Simulation Process Improvement
Protocol Using Malignant Hyperthermia
Primary Authors:
Victoria Goode, PhD, CRNA
Coauthors:
Pamela DeGuzman, RN, PhD; Kenneth Scully, MS; Virginia Rovnyak, PhD; Ivora Hinton, PhD; Elizabeth Merwin, RN, PhD; Elayne Kornblatt Phillips, RN, MPH, PhD, FAAN
Patient safety and the delivery of quality care are major concerns for healthcare in the United States. Special populations (e.g., obese patients) need study in order to support patient safety, quantify risks, advance education for healthcare-workers, and establish healthcare policy.
Simulation Process Improvement
Protocol Using Malignant Hyperthermia
Primary Authors:
Victoria Goode, PhD, CRNA
Coauthors:
Pamela DeGuzman, RN, PhD; Kenneth Scully, MS; Virginia Rovnyak, PhD; Ivora Hinton, PhD; Elizabeth Merwin, RN, PhD; Elayne Kornblatt Phillips, RN, MPH, PhD, FAAN
Patient safety and the delivery of quality care are major concerns for healthcare in the United States. Special populations (e.g., obese patients) need study in order to support patient safety, quantify risks, advance education for healthcare-workers, and establish healthcare policy.
September 2016
Job Satisfaction, Burnout, and
Turnover Intention Among Certified
Registered Nurse Anesthetists
Primary Author: Joshua Lea, MS, MBA, CRNA
Coauthors: Christine Brown-Mahoney, PhD; Irene Jillson, PhD
Certified Registered Nurse Anesthetists (CRNAs) are essential
members of the surgical team, and demand for them is increasing as the United States tries to control healthcare costs. Despite the economic benefits of employing CRNAs, like other highly trained healthcare professionals, CRNAs are difficult and expensive to replace.
Turnover Intention Among Certified
Registered Nurse Anesthetists
Primary Author: Joshua Lea, MS, MBA, CRNA
Coauthors: Christine Brown-Mahoney, PhD; Irene Jillson, PhD
Certified Registered Nurse Anesthetists (CRNAs) are essential
members of the surgical team, and demand for them is increasing as the United States tries to control healthcare costs. Despite the economic benefits of employing CRNAs, like other highly trained healthcare professionals, CRNAs are difficult and expensive to replace.
July 2016
A Comparison of Epidural Strategies for Labor Analgesia
Primary Author: LT Katherine Kidde, BSN
Coauthors: LT Meredith Tverdosi, BSN, CDR; Mark Lenart MD, CDR; Johnnie Holmes, PhD, CRNA
Epidural analgesia provides safe and effective analgesia with a reduced side effect profile along with increased maternal participation in labor. While the number of women utilizing epidural analgesia for labor continues to grow, there is still a lack of evidence to support which infusion strategy is the most effective. The purpose of this study is to compare the effectiveness of three epidural infusion strategies for labor analgesia to test the hypothesis that a lower basal rate with a higher patient controlled bolus will result in lower drug consumption than the other two comparison regimens.
May 2016
The Effect of Ultrasound Guidance and Vessel Transduction on Central Venous Catheter Placement Complications Primary Author: Katherine Ojalvo, BSN, RN
Coauthors: Jennifer Cooley, BSN, RN; Karin Langford, BSN, RN
Based on recommendations from the National Institute of Health and Clinical Excellence, in 2011 Mayo Clinic Rochester instituted a policy mandating the use of ultrasounds for internal jugular central venous catheter placement in the operating room. In our study we compared rates of complications for central line insertion with and without ultrasound guidance between 2006 and 2012.
March 2016
A Study of Relationships Among Three Assessment Methods of Nurse Anesthetists Primary Author: Nicholas Gabriel, PhD, CRNA
Coauthors: Bernadette Henrichs, PhD, CRNA; Mary Blegen, PhD, RN; Susan Chapman, PhD, RN
A doctoral study to determine relationships between a written examination, self-assessment, and performance assessment in simulation of practicing nurse anesthetists (CRNAs).
The Efficacy of QuikClot Combat Gauze, Fluid Resuscitation and Movement on Hemorrhage Controlin a Porcine Model of HypothermiaPrimary Author: Brian Gegel, DNAP, CRNA
Coauthors: James Burgert, DNAP, CRNA; John Gasko, DNP, CRNA; Sabine Johnson, MS; Jennifer Florez, MSN, CRNA; Edward Dunton II, MSN, CRNA; Don Johnson, PhD, RN
This study was a prospective, between subjects, experimental design using Yorkshirecross swine randomly assigned to two groups; QuikClot Combat Gauze (QCG) (n=11) and control (n=11).
January 2016
Pharmacokinetics and Analgestic Properties of Inhaled Remifentanyl Primary Author: Tatjana Bevans, MSN, CRNA
Coauthors: Cassandra Rice, PhD; Derek Sakata MD; Chris Reilly, PhD
Patients could benefit from an inhaled opioid for pain management in a clinical setting. We investigated the bioavailability and efficacy of inhaled remifentanil in rats. We concluded that rapid profound analgesia was achieved, and remifentanil and metabolites were measurable in rat blood following pulmonary exposure to remifentanil.
The Non-Compete Cause and the CRNA: An Assessment of Knowledge, Perception, and Experience Primary Author: Briana Meseroll, DNP, CRNA
Coauthors: Nathaniel Apatov, PhD, CRNA; Carolyn Rutledge, PhD, FNP
Mounting economic pressures and the challenge to maintain competitive advantage have resulted in many healthcare entities to require their practitioners to enter into restrictive covenants such as non-compete clause (NCCs). Many student nurse anesthetists and practicing certified registered nurse anesthetists (CRNAs) are unaware of the non-compete clause in employee contracts. CRNAs are often surprised by the implication of signing a non-compete clause could have on their future abilities to successfully advocate for themselves and their profession, in order to best meet the needs of the population they serve. This study was completed using an anonymous, Web-based questionnaire distributed to students and CRNAs nationwide and demonstrated a significant knowledge gap in the nurse anesthesia community surrounding the NCC.