German medical science : GMS e-journal
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To study the interaction of obesity and age in patients with multiple spine surgeries. ⋯ Obesity is associated with an increased number of previous spine surgeries in patients over 65 years of age undergoing lumbar surgery.
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Review Meta Analysis
Effects of CPAP-respiration on markers of glucose metabolism in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis.
Obstructive Sleep Apnoea Syndrome (OSAS) is a condition of obstruction, apneas and arousals while sleeping. It has been suggested that OSAS independently influences glucose metabolism. The main treatment for OSAS is continuous positive airways pressure (CPAP). ⋯ This systematic review does not support the hypothesis that OSAS independently influences glucose metabolism. Sufficiently powered, long-term randomised controlled trials defining changes of insulin resistance as primary endpoint are needed.
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Curriculum development for residency training is increasingly challenging in times of financial restrictions and time limitations. Several countries have adopted the CanMEDS framework for medical education as a model into their curricula of specialty training. The purpose of the present study was to validate the competency goals, as derived from CanMEDS, of the Department of Anaesthesiology and Intensive Care Medicine of the Berlin Charité University Medical Centre, by conducting a staff survey. These goals for the qualification of specialists stipulate demonstrable competencies in seven areas: expert medical action, efficient collaboration in a team, communications with patients and family, management and organisation, lifelong learning, professional behaviour, and advocacy of good health. We had previously developed a catalogue of curriculum items based on these seven core competencies. In order to evaluate the validity of this catalogue, we surveyed anaesthetists at our department in regard to their perception of the importance of each of these items. In addition to the descriptive acquisition of data, it was intended to assess the results of the survey to ascertain whether there were differences in the evaluation of these objectives by specialists and registrars. ⋯ We succeeded in validating the relevance of the adapted seven CanMEDS competencies for residency training within our institution. So far, many countries have adopted the Canadian Model, which indicates the great practicability of this competency-based model in curriculum planning. Roles with higher acceptance should be prioritised in existing curricula. It would be desirable to develop and validate a competency-based curriculum for specialty training in anaesthesiology throughout Germany by conducting a national survey to include specialists as well as registrars in curriculum development.
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Degenerative spine disorders are steadily increasing parallel to the aging of the population with considerable impact on cost and productivity. In this paper we study the prevalence and risk factors for multiple spine surgery and its impact on cost. ⋯ De novo spine surgery is associated with an increased incidence of additional spine surgery at the same or distant spine regions. Large prospective studies with extended follow-up periods and multifaceted cost-outcome analysis are needed to refine the appropriateness of spine surgery.
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The objective of this study was to determine the thermal injury fluid resuscitation protocols at intensive care units (ICUs) in the United Kingdom and Ireland. ⋯ There is substantial variation in the fluid resuscitation protocols for burns of ICUs in the British Isles. The different practices demonstrated in this survey may have important consequences as inadequate fluid resuscitation can limit perfusion to potentially recoverable burns, grafted tissue and body organs not directly injured.