Der Anaesthesist
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The aim of this study was to assess the efficacy, appropriateness and cost-effectiveness of a new working shift model for anesthesiologists complying with the European working time directive (EWTD) at the University Hospital of Tübingen (UKT), Germany 3 years after implementation ⋯ The newly designed shift model allowed a fair compliance with the EWTD in respect to AWTL and 10 h DWTL, although the calculated number of doctors to run the shift model could not be met in 2009 and 2010. Violations of the 10 h DWT limits were stable in 2009 and 2010; however the number of doctors exceeding the AWWT limits appeared to increase. The compliance with opt-out decreased from 2009 to 2010 and a high proportion of AWWTL violations resulted from the group of non-opt-out voters. The staff costs per hour PAA after implementation of the new shift model did not differ significantly from the year before although staffing costs increased by 7.2 % between 2007 and 2010. Costs increased by 162,454
/year for all PAA hours in 2010. Further evaluation of staff satisfaction with the new shift models is needed and already under way. -
The aim of this investigation was to describe the effects of standardization and central control of the processes involved in postoperative pain management from patient and employee perspectives. ⋯ The quality of care was improved by standardization of the postoperative pain management. The legal and practical ability of the nursing stuff to administer pain medication within well-defined margins reduced the dependence on the ward doctor and at the same time patient pain levels. Patients received analgesics more quickly and experienced increased effectiveness. These results should be an incentive to reconsider the importance of the organization of postoperative pain management, because the quality of care with all potential medical and economic advantages, can be easily optimized by such simple mechanisms. They also show that the quality assessment of acute pain and the selection of appropriate indicators need further development.
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Life-threatening pediatric emergencies are rare events in which precise, correct and fast drug dosing is essential. Intravenous drugs are most commonly dosed based on the child's weight in mg/kg. Numerous tools exist for aiding the physician in the error prone calculation, none of which meet all criteria for the perfect tool. Besides frequent training of practical skills and awareness of the problem of calculating the exact drug dose, it seems indispensable to have a localized tool at hand for these critical events.
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The first part of this overview on diagnostic tools for acid-base disorders focuses on basic knowledge for distinguishing between respiratory and metabolic causes of a particular disturbance. Rather than taking sides in the great transatlantic or traditional-modern debate on the best theoretical model for understanding acid-base physiology, this article tries to extract what is most relevant for everyday clinical practice from the three schools involved in these keen debates: the Copenhagen, the Boston and the Stewart schools. Each school is particularly strong in a specific diagnostic or therapeutic field. Appreciating these various strengths a unifying, simplified algorithm together with an acid-base calculator will be discussed.
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The determination of cerebral oxygen saturation (S(c)O(2)) by means of near-infrared spectroscopy allows non-invasive assessment of the cerebral oxygen delivery and demand ratio in the frontal cortex region. Studies in cardiac as well as non-cardiac patients have shown that maintaining S(c)O(2) in the preoperative range reduces the incidence of postoperative cognitive dysfunction and general morbidity; however, S(c)O(2) is not only reflective of cerebral but also of systemic oxygen balance, is inversely related to cardiopulmonary function and has prognostic relevance in cardiac surgery patients. This suggests that cerebral oximetry is not only useful for neurological but also for hemodynamic monitoring and preoperative risk stratification of cardiac surgery patients.