The American Association of Nurse Anesthetists has a long history of providing peer support for its members with substance use disorder (SUD). The American Association of Nurse Anesthetists' Peer Assistance Advisors Committee (PAAC) is a group of certified registered nurse anesthetist volunteers who strive to promote the awareness of SUD through education and research and provide support to certified registered nurse anesthetists and students with this disease. During the committee's 33-year history, educational outreach to nurse anesthesia educational programs and anesthesia workplaces has expanded, the peer support network has been strengthened, resources and guidelines have been developed, and research related to SUD has been conducted in an effort to accomplish these goals. Although faced with challenges along the way, the PAAC's dedication and commitment to the association and members have helped overcome these challenges as well as strengthen the program. Through its generous catalog of online resources, peer support network, and helpline, the PAAC continues to provide help to those in need.

This qualitative inquiry explored factors that protect recovering anesthetic opioid-dependent nurse anesthetists from relapse after their return to anesthesia practice. Practicing nurse anesthetists in recovery from potent opioids were recruited through online advertising and individually interviewed over the telephone. The interview consisted of open-ended questions that aided description of personal experience of individual factors. Content analysis of the interviews revealed an overarching theme of a commitment to the recovery process, which provided the foundational protective element against relapse. Within this context, two major thematic factors emerged: personal factors and external factors. Personal factors came from within the individual and included such features as removing the obsession to use, self-realization, inner strength, and seeing the future. External factors were external to the individual and described as time away from practice, state regulatory agency involvement, and talking with significant others. Although the Twelve-Step process was not a factor per se, it was credited by all participants as the structure on which their recovery was built. This process provided mechanisms for developing the motivation and learning the tools necessary to maintain their sobriety.

Abuse and dependency on potent opioids have long been recognized as problems among nurse anesthetists and anesthesiologists. Research has provided insight into the incidence of abuse, risk factors associated with this type of dependency, identification of an impaired provider, treatment for abuse and dependency, and prevention strategies. Although several factors influence the development of abuse and dependency, access to potent opioids likely has a large role. This access also makes returning to practice while in recovery extremely difficult because the temptation for relapse continually surrounds a recovering anesthesia provider. There is research supporting successful reentry of anesthesia providers into the practice of anesthesia; however, research also reveals high relapse rates among anesthesia providers who return to the practice of anesthesia. This article reviews the literature regarding opioid abuse and dependency among nurse anesthetists and anesthesiologists and offers implications for future research.

Through this qualitative study we explored the patient/provider relationships of rural HIV-infected women. Thirty-nine women from rural Alabama were recruited to participate in one of four focus groups. The focus groups were audiorecorded, and the participants were asked to complete surveys measuring patient/provider trust. The verbatim-transcribed audio recordings were analyzed using content analysis. The participants' descriptions of their relationships with health care providers were represented by three major thematic categories: caring, informative, and competent. These findings provide a foundation for further research on the role of patient/provider relationships in the health outcomes of HIV disease in rural, resource-poor settings.

Imaging studies offer unique information about neural activity of the brain. This article provides evidence of alterations in neural functioning of the addicted brain through a review of imaging research that focuses on addiction or associated phenomena. In order to understand the significance of these studies, an overview of the reward system is provided, as well a description of common imaging techniques used to study the brain.

Despite the wide availability of effective treatments for HIV disease, many HIV-infected individuals are not in care, and HIV-infected women, particularly those residing in resource-poor areas, may have greater difficulty accessing HIV care than men. The purpose of this research was to explore perceived barriers to care experienced by HIV-infected women living in the Deep South region of the United States. Qualitative research methods were used to generate in-depth descriptions of women's experiences in accessing HIV care. Participants (N = 40) were recruited from 4 community-based HIV service organizations to participate in focus groups. Sessions lasted approximately 2 hours and were audio recorded. Verbatim transcripts, demographic data, and observational notes were subjected to content analysis strategies that coded the data into categories. Five categories of barriers to HIV care were identified as follows: personal, social, financial, geographic/transportation, and health system barriers. Implications of the findings for future research and practice are discussed in this study.

Retention in HIV medical care has been recognized as critical for long-term favorable clinical outcomes among HIV-positive patients. However, relatively little is known about specific factors related to HIV medical care adherence among HIV-positive women in rural areas in the United States, where the epidemic is rapidly growing among minorities and women. The objective of the current study was to assess barriers and facilitators to HIV clinic visit adherence among HIV-positive women in the rural southeastern region of the United States. Forty HIV-positive women were recruited from four outpatient clinics providing services to HIV-positive patients residing in 23 predominately rural counties in Alabama. Four focus groups were conducted ranging from 5 to 16 participants each. Content analysis was used to analyze and interpret the data. Data coding and sorting was conducted using QRS NVivo 8 software. Participants were predominately African American (92.3%) ranging in age from 29 to 69 years (mean = 46.1 years). On average, participants reported living with HIV for 8.8 years. Factors that impacted participants' ability to maintain clinic visit appointments included personal, contextual, and community/environmental factors that included: patient/provider relationships, family support, access to transportation, organizational infrastructure of the health care facility visited and perceived HIV stigma within their communities. The current study highlights the myriad of retention-in-care barriers faced by HIV-positive women living in rural areas in the southeastern United States. Innovative multilevel interventions that address these factors are sorely needed to increase long-term retention-in-care among HIV-positive women residing in rural areas.

Droperidol has been an efficacious, inexpensive butyrophenone used since the early 1970s to prevent or treat postoperative nausea and vomiting. Because of reports of sudden cardiac death in patients receiving droperidol, the US Food and Drug Administration (FDA) recently placed significant restrictions on its administration. These restrictions have essentially removed droperidol from use. Haloperidol is another butyrophenone with antiemetic properties but without the FDA restrictions. This article reviews the literature regarding haloperidol and supports its use as a safe substitute for droperidol in the prevention and treatment of postoperative nausea and vomiting.