Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie最新文献

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.

The implementation of equal opportunities is a challenge for the staff of an anaesthesia department. At the Department of Anaesthesiology and Intensive Care Medicine at Hannover Medical School, a local Gender Equality plan has been implemented to create a secure and transparent framework for reconciling scientific and clinical careers with family responsibilities. Today, family and career should be equally compatible for men and women. Unfortunately, in medical professions it is often still an either/or decision. At the same time, it is important to offer an attractive workplace in view of the increasing shortage of qualified staff. In order to provide equal opportunities for all employees and to increase satisfaction, it is necessary for employers to address the issues of equality and work-life balance, to identify challenges and to create structures for improvement.

The administration of muscle relaxants has been used in anesthesia for decades and continues to play an important role in modern anaesthesia. Special patient populations, such as infants or very young patients require adapted use. The article discusses the specifics of muscle relaxant administration in these patient groups.

The correct use of muscle relaxants and neuromuscular monitoring during anesthesia has been subject of controversial discussions for decades. Particularly important in clinical practice are identification and management of residual neuromuscular blockages and avoidance of associated complications. Despite the differences in the molecular mechanisms of action between depolarizing and non-depolarizing muscle relaxants the blockade of the postsynaptic nicotinic acetylcholine receptor remains a common ending pathway. Due to its unfavorable side effect profile, succinylcholine should only be used in justified exceptional cases. The use of muscle relaxants generally reduces the complication rate in airway management. However, even the single use of muscle relaxants increases the likelihood of postoperative pulmonary complications. These complications associated with the use of muscle relaxants, such as residual neuromuscular blockade, must be anticipated. The application of guideline-based approaches, including continuous neuromuscular monitoring and the application of muscle relaxant reversal agents, may significantly reduce the rate of adverse events associated with the use of muscle relaxants.