Best practice & research. Clinical anaesthesiology
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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.
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Education is a core activity of academic departments but pressure from universities to maximize research income and research productivity, and from hospitals to deliver a more efficient clinical service, has pushed the importance of education into third place in many departments. Academic departments of anaesthesia can make significant contributions to undergraduate teaching. Students appreciate the one-to-one teaching which they receive from anaesthetists and the range of practical skills which they can learn. ⋯ Teaching methods are changing, and there are opportunities to exploit e-learning on Intranet sites, and anaesthesia simulators, in both undergraduate and postgraduate education. Clinical governance issues and increasing scrutiny by authorities which fund teaching or set professional standards have resulted in demands for evidence that educational objectives are being met and that assessment systems are robust. There is a recognition that education has a cost, and resources are available from universities and hospitals to support the teaching activities of academic departments of anaesthesia.
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Best Pract Res Clin Anaesthesiol · Sep 2002
Anaesthetic team and the role of nurses--North American perspective.
Anaesthesia is an American invention but the development of anaesthesia practice took two paths at its inception. The American-based ether anaesthetic technique allowed for non-physician personnel to administer the drug. ⋯ This article discusses the historical events leading to the development of nurse anaesthesia practice in the USA. The current status of physician and nurse anaesthetist interactions--both harmonious and acrimonious--are presented.