ABSTRACT
74% of all hospitals had vacant positions in 2011, also departments of anaesthesiology and intensive care medicine. More than 50% of these departments work with locums. There are couple of reasons for the shortage of physicians. The consequences in anaesthesiology and intensive care medicine can result in qualitative and financial loss. To solve the shortage of physicians one has to solve the reasons. Main reasons are increasing feminization of medical profession and part-time-work, work-life-balance and a poor specialised education.
Subject(s)
Anesthesiology , Contract Services , Critical Care , Demography , Germany , Humans , National Health Programs , Personnel Management , Physicians , Sex Factors , WorkforceABSTRACT
The focus on the role of non-technical skills such as communication, dynamic decision making, situational awareness and teamwork in emergency medicine has gained importance over the past few years. Especially during time-critical and complex treatment of severely injured patients in a multidisciplinary and interprofessional trauma-team these factors play an important role for patient-safety and process optimization and are a key factor influencing the perceived quality of a given scenario by the team members. Thus, apart from medical expertise and technical excellence of single actors within a trauma team, non-technical skills need to be incorporated in trainings for trauma management. For the improvement of non-technical skills, particularly team communication and teamwork, a simulator-based training represents a valuable tool. The technical performance of portable manikin-based simulators has improved tremendously during the last decade, which facilitates realistic and true-to-life multidisciplinary team-training in trauma management.
Subject(s)
Emergency Medical Services/organization & administration , Emergency Medicine/education , Emergency Service, Hospital/organization & administration , Interdisciplinary Communication , Patient Care Team/organization & administration , Patient Simulation , Wounds and Injuries/therapy , Anesthesia , Clinical Competence , Humans , ManikinsABSTRACT
Neuromuscular disorders are rare and often not very well diagnosed diseases. They can be separated in prejunctional, junctional or postjunctional diseases. General anesthesia is connected with a higher risk, therefore regional anesthesia could often be regarded with favour and could be a safe alternative. Because of the lack of systematically studies and guidelines the decision choosing a regional anesthesia is always a risk-benefit-analysis. This and also the detailed preoperative neurological status must, because of forensic reason, exactly be documented.
Subject(s)
Anesthesia, Conduction , Anesthesia, General , Neuromuscular Diseases/complications , Anesthetics/adverse effects , Contraindications , Humans , Perioperative Care , Risk AssessmentABSTRACT
Paediatric neurosurgical procedures request special considerations for the anaesthetic management. Due to patients age and diagnostic findings certain therapeutic procedures are performed under anaesthetic care. Main reasons for craniotomy are hydrocephalus, intracranial tumors and craniofacial synostosis. Neurosurgical therapy of newborn children is related mostly to hereditary spinal dysraphism. In spinal surgery and specific intracranial procedures for monitoring reasons sensory and/or motor evoked potentials (SEP, MEP) are used to improve surgical outcome. Due to sensibility for anaesthetic drugs these techniques request sound knowledge of physiologic and pharmacologic interaction. Cerebrovascular malformations are today usually treated using radiologic interventional procedures. Operative access will be performed for selected cases additionally to embolization, but is associated with risk of massive bleeding. Severe traumatic craniocerebral injury leads to compromised cerebral blood flow and hypoxic ischemia. The article imparts funded knowledge of surgical as well as anaesthetic rationale and techniques in neuropaediatric therapies.
