Current opinion in anaesthesiology
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To present the pharmacologic and biologic profile of levosimendan and discuss potential indications in the treatment of sepsis and septic shock, with a special focus on myocardial and pulmonary dysfunction. ⋯ There is increasing evidence that levosimendan exerts beneficial effects in the treatment of sepsis-induced myocardial and pulmonary dysfunction. Future large-scale multicenter clinical trials are now needed to clarify whether levosimendan improves the overall outcome of patients with sepsis and septic shock.
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Curr Opin Anaesthesiol · Apr 2008
ReviewThe anesthesiologist in prehospital and hospital emergency medicine.
The German emergency medical system is different from the Anglo-American system. Emergency medicine is no distinct specialty in Germany. Physicians are involved in prehospital emergency medicine. This review highlights the historic development of prehospital and hospital emergency medicine in Germany and describes future trends. ⋯ Economic and quality arguments have initiated the development of departments for emergency medicine in Germany. In the future, this will lead to new qualification criteria for physicians working in these departments.
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Being critical in terms of time and complexity, emergency medicine is exposed to an emerging imperative for quality improvement strategies. We review current concepts and recent advances in the management of quality in emergency medicine. ⋯ According to the available evidence, more performance improvement strategies need to be tested to delineate which process changes would be most effective in improving patient outcome in emergency medicine.
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Updates on developments in critical incident monitoring in anaesthesia, and assesses its role in improving patient safety. ⋯ Critical incident monitoring is a valuable tool in ensuring patient safety due to its low cost and the ability to provide a comprehensive body of detailed qualitative information. The qualitative information gathered can be used to develop strategies to prevent and manage existing problems, as well as to plan further initiatives for patient safety. Novel approaches should complement existing methods to achieve better results. The development of a culture which emphasises safety should go hand in hand with current audit activities.
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This review summarizes the knowledge of error and of critical incident reporting systems in general and especially in emergency medicine. ⋯ The first step in avoiding fatalities in emergency medicine is to accept that errors do occur. The next question is how to prevent errors in medicine and not to search for personal mistakes. We need a culture of error and not a culture of blame. Critical incidents occur in all ranges of medical hierarchical structures. We have to accept the presence of mistakes and we need to recognize them every day to protect our patients.