Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Mar 2018
ReviewHow anesthetists manage growing demands with dwindling resources in German university hospitals: Overview and outlook.
As a central service provider in medical care, anesthetists manage the growing demand on medical services, thereby increasing specialization and patient morbidity. Various indicators and measurements have been used to match staff capacity, competence, and workload. It remains unclear whether the problems are due to real shortages or "just" to a wrong distribution. ⋯ The broad variety of hospitals' infrastructures requires different staff capacity and competence structures. Anesthetists need to take on a key role in redesigning hospital performance and staff management to ensure performance increases, patient safety, and bearable workloads. Optimal distribution of expertise and early counteraction for shortages in staff capacities and competences is needed.
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Best Pract Res Clin Anaesthesiol · Mar 2018
ReviewImproving female physician's careers in academic medicine: Chances and challenges.
University hospitals are involved in the care of critically ill patients, pregraduate and postgraduate education, and medical research with an increasing demand on physicians due to a higher burden of disease. The number of female physicians is increasing; however, young female physicians are less willing to work at university hospitals under the given conditions. They often do not find appropriate working conditions in mostly hierarchically structured university hospitals. ⋯ Gendered working conditions remain firmly fixed, and this is even more challenging - overt discrimination has been replaced by less visible mostly implicit stereotypes and prejudices against women. Having children is an additional "career stopper" for female physicians: those with children are less likely to be promoted and have a lower income. Regulatory measures should act in several directions: cultural gender equality policies, family support policies, and active work policies.
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A suitably skilled workforce that is of an appropriate size is essential for the provision of healthcare services. Anaesthetists play an essential role in a wide range of clinical areas, and effective workforce planning and training are essential in maintaining service provision. ⋯ Anaesthetic training in the UK has changed considerably over the last three decades, as working hours and experience have decreased. Training and assessment have evolved from an apprenticeship model to an active and highly regulated process with a number of stakeholders, although there is little evidence regarding the impact of these changes on clinical outcomes.
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Best Pract Res Clin Anaesthesiol · Dec 2017
ReviewStable anesthesia with alternative to opioids: Are ketamine and magnesium helpful in stabilizing hemodynamics during surgery? A systematic review and meta-analyses of randomized controlled trials.
The role of ketamine and magnesium in improving postoperative pain and diminish opioid consumption has been largely described. Synthetic opioids are known to provide hemodynamic stability when given for major noncardiac surgery. Definitive evidence on the role of ketamine and/or magnesium on intraoperative hemodynamic control would support their potential as alternatives to opioids during surgery. ⋯ In conclusion, these meta-analyses of nine trials confirm that ketamine and magnesium, differently but consistently, reduce hemodynamic variability during surgery and may be seen as complementary not only for pain control but also to provide stable anesthesia. This study supports the use of those drugs to control the sympathetic response to surgery in the context of opioid-free anesthesia.