Der Anaesthesist
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The expected cost-explosion in transfusion medicine (increasing imbalance between donors and recipients, treatment of transfusion-associated complications) increases the socio-economic significance of the development of safe and effective synthetic oxygen carriers as an alternative to the transfusion of allogeneic red blood cells. Currently two types of artificial oxygen carriers have been tested for safety and efficacy in cases of severe anemia otherwise requiring transfusion. Solutions based on human or bovine hemoglobin (HBOC) possess vasoconstrictor properties in addition to their oxygen transport capacity. ⋯ Due to their particulate nature (emulsion droplets) PFCs may only be infused in low doses to avoid overload and malfunction of phagocytic cells of the reticulo-endothelial system. As part of a multimodal blood conservation program (including normovolemic hemodilution and hyperoxia) the low-dose administration of Oxygent effectively increases intraoperative anemia tolerance. Although reduction of perioperative allogeneic blood transfusion has already been demonstrated for HBOC and PFC, the global clinical establishment of artificial oxygen carriers is not to be expected in the near future.
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Management means developing, shaping and controlling of complex, productive and social systems. Therefore, operating room managers also need to develop basic skills in financial and managerial accounting as a basis for operative and strategic controlling which is an essential part of their work. ⋯ Since hospitals need to implement a strategy to reach their business objectives, the performance measurement system has to be individually adapted to the strategy of the hospital. In this respect the navigation system developed by Gälweiler is compared to the "balanced score card" system of Kaplan and Norton.
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In parallel with Austria's entry into the European Union, the examination system for both general practitioners and specialists at the end of their training was changed from voluntary to mandatory. Subsequent changes in laws and directives in Austria constituted the basis for the development of specific examination guidelines for each medical sub-specialty. ⋯ Because of transitional regulations the actual number of candidates for the oral examination currently lies way below the expected number of 80-100. The decision to demand positive performance in the part 1 examination for the European Diploma of Anaesthesiology has, however, already proven that this type of combined examination system is of a high standard and will produce properly qualified specialists in anaesthesiology.
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Comparative Study Clinical Trial
[Accuracy of pulse contour cardiac index measurements during changes of preload and aortic impedance].
Cardiac index obtained by arterial pulse contour analysis (CI(PC)) demonstrated good agreement with arterial or pulmonary arterial thermodilution derived cardiac index (CI(TD), CI(PA)) in cardiac surgical or critically ill patients. However as the accuracy of pulse contour analysis during changes of the aortic impedance is unclear, we compared CI(PC), CI(TD) and CI(PA) during changes of preload and the aortic impedance as occurring during sternotomy. ⋯ Pulse contour analysis derived CI(PC) accurately reflects thermodilution derived CI(TD) or CI(PA) during changes of preload and the aortic impedance as occurring during sternotomy.