Wiener medizinische Wochenschrift
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Wien Med Wochenschr · May 2020
Review[Anesthesiological perspectives on perioperative management in continuous subcutaneous insulin infusion (CSII): stop or continue?]
Perioperative handling of insulin pumps (CSII) is inconsistent. The aims of this study were a literature search addressing this clinical question, analysis of data found and a proposal for perioperative management recommendations for clinical practice. ⋯ Growing evidence for improved patient outcome with perioperative CSII usage warrants interdisciplinary transfer of knowledge and experiences on intensified insulin therapy and patient empowerment.
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Although ketamine has been known and clinically applied for a long time, questions still arise around the many possible indications in which the anesthetic and analgesic substance could be used. In particular, these questions relate to new indications in which ketamine is used in low subanesthetic doses. ⋯ Possible applications include the prevention of chronic postoperative pain as well as the treatment of neuropathic pain. With the treatment of refractory depression completely new therapeutic areas for ketamine could be established.
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Wien Med Wochenschr · Sep 2019
European Collaboration in Health Technology Assessment (HTA): goals, methods and outcomes with specific focus on medical devices.
The European Network for Health Technology Assessment (EUnetHTA) was founded to support efficient production and use of health technology assessments (HTAs) across Europe by reducing redundancies through collaboration. To facilitate collaboration, a range of practical tools, methods and process definitions were developed. The article describes when and how these tools and methods are used along the HTA process with specific focus on "other technologies", that is medical devices and non-pharmaceutical procedures. ⋯ The practical tools and the developed methods formed a basis for close collaboration among over 70 agencies at a European level. The activities of EUnetHTA laid a strong foundation for sustainable cooperation. In the long run, jointly produced assessments could realise economies of scale with improved quality, consistency and transparency for the health systems in Europe.
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Wien Med Wochenschr · Mar 2019
Review[Reduction the risk in pediatric anesthesia-what should we know-what should we do].
Pediatric anesthesia has always been conjuncted with higher risk than anesthesia for adults (JP Morray; Pediatric Anesthesia 2011;21:722-9). Not only the imminent critical events, but also, caused by recently published data, the theoretical neurotoxicity of anesthetic agents and a potencial negative influence of anesthetics on braindevelopement, are in the spotlight. Concerns about the neurodevelopement and the general warnings from the U. ⋯ Food and Drug Administration (FDA) for anesthesia in young children led to a worldwide discussion about safety in pediatric anesthesia (FDA Safety Anouncement 2017). Beside these theoretical risks, which are based only on animal research, we have to pay much more attention to the widely spread out poor quality of anesthesia in children. The following article should summarize the state of science about the risks and the opportunities to minimize them.
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Changes in medical curricula have led to a shift of focus in medical education. The goal was to implement a more practical approach to teaching and thereby create better doctors. However, the question of what makes a good doctor is not easy to answer. ⋯ The different stakeholders showed different ideas of the concept of a good doctor. Interestingly, patients had a stronger focus on communication skills, whereas doctors put more emphasis on medical skills. Balancing this discrepancy will be a challenge for future medical education.