Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2002
Evolution of the anaesthetic workload--the French experience.
The use of anaesthesia has shown major growth during the period 1975-1985. Increases safety in anaesthesia safety have permitted its use in surgery and in other exploratory procedures involving older patients and those with more severe clinical conditions. A survey, designed by the French Society of Anaesthesiologists, collected and analysed data relating to anaesthesia performed in France in 1996 from a representative sample collected in all French hospitals and clinics; the results of this survey were compared with an earlier survey performed in 1980. ⋯ The practice of epidural anaesthesia for deliveries has developed markedly in France during recent years, increasing from 1.5 to 51% of all deliveries between 1980 and 1996. This survey has offered an interesting overview of recent developments in anaesthesia--which are probably representative of the evolutionary trends in most industrialized countries. These changes can be summarized in three major points: (i) a global increase in the use of anaesthesia related to improvements in its safety; (ii) a significantly increased use of anaesthesia in elderly patients; and (iii) a marked increase in regional anaesthesia.
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Best Pract Res Clin Anaesthesiol · Sep 2002
The place of research and the role of academic anaesthetists in anaesthetic departments.
The specialty of anaesthesia developed because of its fundamental contribution to health care, including the prevention of pain from surgery, respiratory, and critical care medicine, cardiopulmonary resuscitation and pain medicine. Through these contributions anaesthesia became an important component of the medical profession. ⋯ The challenges to the anaesthetist-scientist include evaluation, funding, conflicts of interest, legal and fraud. The future of the anaesthetic profession is mainly with its intellectual resources, especially research as the basis of improved patient care, and to have a major impact on the future of medicine overall.
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Best Pract Res Clin Anaesthesiol · Sep 2002
Anaesthetic team and the role of nurses--European perspective.
The only evidence in favour of the provision of assistance for anaesthesiologists seems to be that single-handed anaesthesiologists generate higher anaesthetic mortality than does a team system. In mainland Europe, the independent scope of the practice of nurse anaesthetists has been constrained while possible new roles for nurses have been suggested in the United Kingdom. ⋯ To attract people of this calibre, their role will have to offer some degree of clinical autonomy over the management of general anaesthesia. Considerations of safety will constrain this autonomy but the introduction of a monitor of anaesthetic depth and sophisticated communication systems will relieve anxiety about this development.
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The development of the specialty of anaesthesiology in the USA over the last half-century has seen a significant growth in the number of anaesthesia departments and trainees. With no comprehensive national planning policy for physician human resources in existence, the number of anaesthesiologists has been determined by other things, such as market forces and capacities of the training programme. ⋯ The proliferation of anaesthesiologists has certainly been beneficial in terms of safety and access to anaesthesia care. However, the recent prospect of too many anaesthesiologists for the future has led to wide oscillations in the number of trainees and employment opportunities.
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Best Pract Res Clin Anaesthesiol · Sep 2002
The strict separation of clinical and academic budgets: an analysis at a German medical university department of anaesthesia.
In the past, cross-funding between medical and academic budgets has been commonly practiced at university medical departments in Germany. Recent developments have however, generated pressures to enforce the separation of funding for both areas, as intended by law, and to distribute them on the basis of performance. A pilot project at Münster University Hospital, initiated by the German Federal Ministry for Research and Education in 1998, is described here. The main aim of the project was to find ways of distinguishing between research and teaching areas, on the one hand, and health care on the other, in terms of documenting performance and itemizing costs.