Stentless vs. stented bioprosthesis for aortic valve replacement: A case matched comparison of long-term follow-up and subgroup analysis of patients with native valve endocarditis.

BACKGROUND: Current retrospective evidence suggests similar clinical and superior hemodynamic outcomes of the Sorin Freedom Solo stentless aortic valve (SFS) (LivaNova PLC, London, UK) compared to the Carpentier Edwards Perimount stented aortic valve (CEP) (Edwards Lifesciences Inc., Irvine, California, USA). To date, no reports exist describing case-matched long-term outcomes and analysis for treatment of native valve endocarditis (NVE). METHODS: From 2004 through 2014, 77 consecutive patients (study group, 59.7% male, 68.9 ± 12.5 years, logEuroSCORE II 7.6 ± 12.3%) received surgical aortic valve replacement (SAVR) with the SFS. A control group of patients after SAVR with the CEP was retrieved from our database and matched to the study group regarding 15 parameters including preoperative endocarditis. Acute perioperative outcomes and follow-up data (mean follow-up time 48.7±29.8 months, 95% complete) were retrospectively analyzed. RESULTS: No differences in early mortality occurred during 30-day follow up (3/77; 3.9% vs. 4/77; 5.2%; p = 0.699). Echocardiographic findings revealed lower postprocedural transvalvular pressure gradients (max. 17.0 ± 8.2 vs. 24.5 ± 9.2 mmHg, p< 0.001/ mean pressure of 8.4 ± 4.1 vs. 13.1 ± 5.9 mmHg, p< 0.001) in the SFS group. Structural valve degeneration (SVD) (5.2% vs. 0%; p = 0.04) and valve explantation due to SVD or prosthetic valve endocarditis (PVE) (9.1% vs. 1.3%; p = 0.04) was more frequent in the SFS group. All-cause mortality during follow-up was 20.8% vs. 14.3% (p = 0.397). When patients were divided into subgroups of NVE and respective utilized bioprosthesis, the SFS presented impaired outcomes regarding mortality in NVE cases (p = 0.031). CONCLUSIONS: The hemodynamic superiority of the SFS was confirmed in this comparison. However, clinical outcomes in terms of SVD and PVE rates, as well as survival after NVE, were inferior in this study. Therefore, we are reluctant to recommend utilization of the SFS for treatment of NVE.

[Shift- and Nightwork - a scientometric analysis]. / Schicht- und Nachtarbeit - eine szientometrische Analyse.

Economic restructuring processes in Germany require changes within all social and health care systems regarding night shiftwork. The aim of this paper was to analyse research results referring to shift- and nightwork using scientometric methods. A total of 3092 items could be detected. A constant increase in the number of publications per year since 1977, especially since 1990' was obvious. One third of the research results, a total of 884 articles could be assigned to the USA. Great Britain could be identified with 365 articles and France with 244 published articles. Sleep, Ergonomics and Chronobiology International are the most prolific journals. The Swedish scientist Torbjörn Akerstedt is to this date the most acclaimed researcher referring to his issue. He has written 105 articles about shift- and nightwork. He is not only a most efficient author, but also has the highest h-index [30]. Self-citations and multiple co-authorships distort parameters like impact factor and h-index enormously and should be regarded from a critical point of view.

Real time analysis of psychiatrists' workflow in German hospitals.

BACKGROUND: The increasing administrative workload of German psychiatrists has led to rising dissatisfaction among physicians. Previous studies have assessed job satisfaction by conducting surveys among medical professionals. However, to date, no objective work task analysis has been conducted to investigate the workflow of psychiatrists in Germany. AIM: The objective of this study was to evaluate physicians' workflow, to assess the level of work efficiency of German psychiatrists in a real time analysis. METHOD: A trained observer accompanied 24 psychiatrists throughout complete shifts. A mobile computer was used to record all tasks. All psychiatrists were observed for total of 980:04:15 h. RESULTS: The average psychiatrist's workday lasted 09:03:19 h (standard deviation, s=01:01:20 h). Internal communication was the most frequently observed main activity (mean=2:58:15 h; s=0:48:10 h). Psychiatrists spent on average 0:52:12 h a day on indirect patient care (s=0:32:50 h; 5.60%). All administrative tasks accounted for roughly 1 h of the average workday (s=0:17:58 h; 10.75%). During the wobservation period, physicians were interrupted 17.37 times a day on average (s=5.81). During the observational period, simultaneous activities were recorded for a total of 17:27:54 h. CONCLUSION: This research is the first to investigate workflow of psychiatrists in German hospitals. Their work was found to be mostly communicative, although administrative work also demanded much of their time. High rates of multitasking and interruptions in the workflow, as seen for the psychiatrists in this study, could lead to possible medical errors, making further investigation of current working conditions necessary.

Mobile Air Quality Studies (MAQS)-an international project.

Due to an increasing awareness of the potential hazardousness of air pollutants, new laws, rules and guidelines have recently been implemented globally. In this respect, numerous studies have addressed traffic-related exposure to particulate matter using stationary technology so far. By contrast, only few studies used the advanced technology of mobile exposure analysis. The Mobile Air Quality Study (MAQS) addresses the issue of air pollutant exposure by combining advanced high-granularity spatial-temporal analysis with vehicle-mounted, person-mounted and roadside sensors. The MAQS-platform will be used by international collaborators in order 1) to assess air pollutant exposure in relation to road structure, 2) to assess air pollutant exposure in relation to traffic density, 3) to assess air pollutant exposure in relation to weather conditions, 4) to compare exposure within vehicles between front and back seat (children) positions, and 5) to evaluate "traffic zone"-exposure in relation to non-"traffic zone"-exposure.Primarily, the MAQS-platform will focus on particulate matter. With the establishment of advanced mobile analysis tools, it is planed to extend the analysis to other pollutants including NO2, SO2, nanoparticles and ozone.

Observation and analysis of junior OB/GYNs' workflow in German hospitals.

PURPOSE: Over the past few years the numbers of German physicians choosing to work abroad or leaving the medical profession have been growing. Main reasons for physicians' dissatisfaction are the lack of autonomy and the subsequent workload. Studies have employed subjective instruments of evaluation to investigate levels of occupational stress. However, there is a lack of objective work task analysis. The aim of this study is to monitor the workflow of German obstetrician/gynecologists (OB/GYN) through an objective, computer-based analysis. METHODS: From 10/08 to 02/09 twenty OB/GYNs in three hospitals in Berlin were monitored (n=19 females, n=1 male, age 23-38 years). Each one of them was accompanied throughout three entire workdays. RESULTS: The junior physicians' average workday lasted 9:24:35 h (SD=01:05:07 h). During this time period, they spent an average of 02:41:56 h/day (SD=00:33:35 h) on internal communication (28.68%). On average 01:19:11 h (SD=00:55:15 h) were spent in the operating room (14.03%). An average total of 5:38:28 h (SD=00:11:22 h) were spent attending to indirect patient. CONCLUSIONS: The workflow is disorganized and full of interruptions, which could cause medical errors. Improving the physicians' work environment will likely require a reorganization of medical processes.