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Industrial vacuum pumps for air evacuation: physiologic basis and risk assessment.
For many years, non-surgical as well as surgical air evacuation (AEV) has been achieved through the use of industrial vacuum pumps. The clinical relevance of the technology has been debated. A review of the existing literature on the physiologic basis of AEV on the basis of peer-reviewed primary studies was performed. The issue of anesthesia-induced lung injury (ALI) during mechanical ventilation was also discussed. The potential impact of ventilator-associated pneumonia (VAP), which is one of the most common iatrogenic complications, was evaluated. Air evacuation is not currently recommended, but it is considered to be safe, provided that the following precautions are taken: the device is operated only by trained personnel; the lungs are empty of blood and secretions before beginning of AEV; spontaneous respiration is not impaired; no excess CO2 is provided (not more than 5% of normal PCO2); the minimum systolic blood pressure is at least 90 mmHg; good coordination between the systolic and diastolic blood pressure is maintained; and the patient is awake. At present, the evidence available in the literature is insufficient to support or refute the benefits of this technique in terms of clinical outcome or morbidity. In the future, better knowledge of the pathophysiology of lung injury and of the effect of ventilation-associated pulmonary injury on critical care outcome in the AEV vs. the routine AEV will provide sound rational basis for the role of AEV in patient management and AEV-associated ALI.More than three years ago the U.S. House of Representatives Committee on Veterans’ Affairs held hearings on the need for the VA to provide care to transgender veterans. The testimony below shows not only just how quickly things have moved, but also how incredibly disorganized VA has been in responding to that request.

Transgender policy recommendations resulting from the testimony, released in November 2016, included the following proposals:

The VA should provide healthcare for gender-confirmation surgery to transgender veterans who have been diagnosed with gender dysphoria,

This policy should be “effective on an expedited basis,” as described in a question posed to the VA by the House of Representatives Committee on Veterans’ Affairs,

This policy should be implemented in a way that “minimizes the disruption to patient care and medication management,” and

“The Secretary of Veterans

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M. Kamal CPA P.C.
70-17 37th Avenue Suite #2F, Jackson Heights, NY, 11372

M. Kamal CPA P.C.

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