Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie最新文献

In the course of climate change, doctors will not only be confronted with heat-related consequences, but also with the emergence of infectious diseases caused by previously tropical pathogens in temperate climate zones.Fortunately, the topics of sustainability and climate change are also becoming increasingly important in discussions in the healthcare sector, which accounts for 4.4% of global greenhouse gas emissions. The topic of hygienically safe sustainability in healthcare facilities is highly complex due to the large number of possible adjustments, but also offers a great deal of potential.Numerous measures can be implemented without any restrictions in terms of hygiene requirements or occupational safety.It is not always the large investments that make their contribution to reducing CO₂-emissions - many smaller measures can also be implemented without high costs, but with great sustainability potential. Similar to hand hygiene compliance, behavior modification by each individual plays a decisive role in the implementation of such projects. There is great practical savings potential, for example, in the indication-based use of disposable medical gloves, the hygienically safe handling of medication or the decision between reusable and disposable medical products, just to name a few items discussed in the article.

With the end of the pandemic in April 2023 the whole learning environment had run through some major changes. The act of normal teaching was not that easy anymore during the pandemic. The size of a class had to be cut down to a size that fits the hygienic guidelines. Therefore, methods like blended learning and virtual classrooms came to life stronger than before. The methods were not new but never before needed in such a strong matter. Due to the experience with these methods of education, teaching and learning stayed different. Topics like virtual reality and even augmented reality stayed and are to some point part of the educational system nowadays. Due to the pandemic, it may seem that these new kinds of methods are worse compared to the ones we are used to but several studies can prove the opposite.The University Hospital Würzburg (UKW) has adapted to these kinds of changes. Every specialist training was formed to fit the necessary changes during the pandemic. It was not easy to keep up good practical education with the correct distance measurement, open windows for fresh air every 45 minutes or an FFP2 mask for protection. The rest of the close to 190 trainings held in the rooms of the academy of the UKW had to be cancelled or cut down to a group size allowed. Most of the known digital teaching and learning system that were installed at that time remained and are in use.

There are numerous reports from patients concerning perceptions during deep unconsciousness, be it general anaesthesia, cardiopulmonary resuscitation or intensive care and coma treatment. These experiences can cause considerable traumatisation. The most stressful experience is apparently not feeling pain, but the lack of communication, i.e. being recognised and being able to express oneself. Although there are already indications of positive effects of positive communication during general anaesthesia, these findings have not yet markedly changed the way we deal with the unconscious.

The treatment of transgender individuals presents a multifaceted challenge for those involved in emergency and rescue services, encompassing not only medical but also social aspects. Despite the increasing importance of healthcare for transgender individuals in Germany over recent years, there remains significant uncertainty among healthcare professionals in addressing the needs of this population. This uncertainty can result in transgender individuals delaying access to the healthcare system due to previous negative experiences, thereby increasing the risk of receiving suboptimal medical care.Ambiguities exist regarding gender-specific health issues and the appropriate use of pronouns and names. Surveyed participants have expressed a desire for more training opportunities in this area. Enhanced training of emergency services personnel is essential for fostering a better understanding of gender-specific health concerns. Additionally, there is a notable lack of specific guidelines for the treatment of transgender individuals within both emergency services and emergency rooms. Establishing specific treatment guidelines can enhance the safety of healthcare workers and consequently improve the medical care provided to transgender individuals.The objective of this CME article is to outline the key aspects of emergency medical care for transgender individuals, aiming to reduce uncertainties among emergency service personnel and enhance the quality of medical care for this group.

Errors in the use of medical devices are common and pose a threat to patient safety. The field of anaesthesiology is particularly affected by this issue, as many of the medical devices used in this field are directly responsible for the monitoring and maintenance of a patient's vital functions during anaesthesia. To minimize application errors, instruction in the use of medical devices has been legally required since 1985. Inadequate instructions can put the patient as well as the user at risk. Training courses that provide users with information on the safe use of medical devices significantly improve patient safety. The traditional instruction concept has limitations in its ability to adequately train employees on the use of medical devices. The digital device instruction project presented in this article aims to address this issue by providing medical device instructions at any time, thus increasing the safety of the operation of medical devices.

Although evacuations of hospitals are considered rare events, they might be more frequent than often thought. Recent research revealed 158 evacuations of hospitals in the USA within 17 years (mean 9.3/year). Leading causes for evacuations might be natural disasters, technical issues or man-made threats like bomb or active shooter events. Evacuations of hospitals are resource-intensive and might be time-critical. Logistical and coordination challenges for efficient deployment of rescue personnel and material must be met. Management of these situations requires efficient leadership and coordination between hospital employees and rescue organizations such as fire departments or emergency medical services. Therefore, a robust concept for evacuation of hospitals is needed. Our publication describes hospital evacuations and appropriate concepts in Germany.

The transformation of time-bound and procedure-oriented specialist medical postgraduate training towards a competency-based approach (competency-based medical education, CBME) has been demanded for several years. Many frameworks, like the CANMEDs (Canadian Medical Education Directives for Specialists) describe competencies that should be acquired by each physician. In Germany, the medical council has recently obligated a competency-based postgraduate training. Although the idea of CBME emphasizes the learning process at the working place, CBME has also been criticized to be too theoretical and detached from the clinical working practice. To close this gap, the concept of Entrustable Professional Activities (EPA) has been introduced. An EPA describes concrete clinical tasks that are successively entrusted to the trainee. The decision to entrust a task is supported by the sum of workplace-based assessments.Sustainable implementation of competency-based training requires close collaboration among all involved individuals and institutions. Furthermore, continuous feedback and open dialogue are crucial for identifying challenges and areas for improvement. The success of CBME hinges on the collective effort of all stakeholders to create a framework to enhance specialty training and an overall advancement in the field. This cooperative approach is essential to successfully translate the theoretical foundations of competency-based teaching into clinical practice and ensure high-quality specialty training.

The administration of neuromuscular blocking agents has been used in anesthesia for decades and continues to play an important role in modern anesthesia. Special patient populations, such as very young or very old patients, require adapted use. The following article discusses the specifics of neuromuscular blocking agents administration in geriatric patients.