Dominant In-Plane Symmetric Elastoresistance in CsFe_{2}As_{2}.

We study the elastoresistance of the highly correlated material CsFe_{2}As_{2} in all symmetry channels. Neutralizing its thermal expansion by means of a piezoelectric-based strain cell is demonstrated to be essential. The elastoresistance response in the in-plane symmetric channel is found to be large, while the response in the symmetry-breaking channels is weaker and provides no evidence for a divergent nematic susceptibility. Rather, our results can be interpreted naturally within the framework of a coherence-incoherence crossover, where the low-temperature coherent state is sensitively tuned by the in-plane atomic distances.

Imaging orbital-selective quasiparticles in the Hund's metal state of FeSe.

Strong electronic correlations, emerging from the parent Mott insulator phase, are key to copper-based high-temperature superconductivity. By contrast, the parent phase of an iron-based high-temperature superconductor is never a correlated insulator. However, this distinction may be deceptive because Fe has five actived d orbitals while Cu has only one. In theory, such orbital multiplicity can generate a Hund's metal state, in which alignment of the Fe spins suppresses inter-orbital fluctuations, producing orbitally selective strong correlations. The spectral weights Zm of quasiparticles associated with different Fe orbitals m should then be radically different. Here we use quasiparticle scattering interference resolved by orbital content to explore these predictions in FeSe. Signatures of strong, orbitally selective differences of quasiparticle Zm appear on all detectable bands over a wide energy range. Further, the quasiparticle interference amplitudes reveal that [Formula: see text], consistent with earlier orbital-selective Cooper pairing studies. Thus, orbital-selective strong correlations dominate the parent state of iron-based high-temperature superconductivity in FeSe.

Common variants in DLG1 locus are associated with non-syndromic cleft lip with or without cleft palate.

Non-syndromic cleft lip with or without cleft palate (nsCL/P) is a common craniofacial anomaly with a complex and heterogeneous aetiology. Knowledge regarding specific genetic factors underlying this birth defect is still not well understood. Therefore, we conducted an independent replication analysis for the top-associated variants located within the DLG1 locus at chromosome 3q29, which was identified as a novel cleft-susceptibility locus in our genome-wide association study (GWAS). Mega-analysis of the pooled individual data from the GWAS and replication study confirmed that common DLG1 variants are associated with the risk of nsCL/P. Two single nucleotide polymorphisms (SNPs), rs338217 and rs7649443, were statistically significant even at the genome-wide level (Ptrend = 9.70E-10 and Ptrend = 8.96E-09, respectively). Three other SNPs, rs9826379, rs6805920 and rs6583202, reached a suggestive genome-wide significance threshold (Ptrend < 1.00E-05). The location of the strongest individual SNP in the intronic sequence of the gene encoding DLG1 antisense RNA suggests that the true causal variant implicated in the risk of nsCL/P may affect the DLG1 gene expression level rather than structure of the encoded protein. In conclusion, we identified a novel cleft-susceptibility locus at chromosome 3q29 with a DLG1 as a novel candidate gene for this common craniofacial anomaly.

Hedgehog Spin-Vortex Crystal Antiferromagnetic Quantum Criticality in CaK(Fe_{1-x}Ni_{x})_{4}As_{4} Revealed by NMR.

Two ordering states, antiferromagnetism and nematicity, have been observed in most iron-based superconductors (SCs). In contrast to those SCs, the newly discovered SC CaK(Fe_{1-x}Ni_{x})_{4}As_{4} exhibits an antiferromagnetic (AFM) state, called hedgehog spin-vortex crystal (SVC) structure, without nematic order, providing the opportunity for the investigation into the relationship between spin fluctuations and SC without any effects of nematic fluctuations. Our ^{75}As nuclear magnetic resonance studies on CaK(Fe_{1-x}Ni_{x})_{4}As_{4} (0≤x≤0.049) revealed that CaKFe_{4}As_{4} is located close to a hidden hedgehog SVC AFM quantum-critical point (QCP). The magnetic QCP without nematicity in CaK(Fe_{1-x}Ni_{x})_{4}As_{4} highlights the close connection of spin fluctuations and superconductivity in iron-based SCs. The advantage of stoichiometric composition also makes CaKFe_{4}As_{4} an ideal platform for further detailed investigation of the relationship between magnetic QCP and superconductivity in iron-based SCs without disorder effects.

Spectral Evidence for Emergent Order in Ba_{1-x}Na_{x}Fe_{2}As_{2}.

We report an angle-resolved photoemission spectroscopy study of the iron-based superconductor family, Ba_{1-x}Na_{x}Fe_{2}As_{2}. This system harbors the recently discovered double-Q magnetic order appearing in a reentrant C_{4} phase deep within the underdoped regime of the phase diagram that is otherwise dominated by the coupled nematic phase and collinear antiferromagnetic order. From a detailed temperature-dependence study, we identify the electronic response to the nematic phase in an orbital-dependent band shift that strictly follows the rotational symmetry of the lattice and disappears when the system restores C_{4} symmetry in the low temperature phase. In addition, we report the observation of a distinct electronic reconstruction that cannot be explained by the known electronic orders in the system.

[Anesthesia problem cards-indispensable yet problematic : Nationwide survey on experiences from clinical practice]. / Der Anästhesieausweis ­ unverzichtbar, aber problematisch : Deutschlandweite Umfrage zu Erfahrungen aus der klinischen Anwendung.

BACKGROUND: Anesthetic procedures may lead to severe and potentially life-threatening complications (e. g. difficult airway, allergic reactions, malignant hyperthermia). Most complications can be avoided in future anesthetic procedures with adequate preparation (e. g. awake intubation, trigger-free anesthesia). In Germany, anesthesia problem cards were introduced two decades ago to identify patients at risk and to increase patient safety by creating a standardized documentation system for anesthesia-related complications. The purpose of our study was to evaluate the utility and problems of anesthesia problem cards in clinical practice. MATERIAL AND METHODS: All registered members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Professional Association of German Anesthesiologists (BDA) (n = 19,042) were invited to participate in an online survey on patient safety. A subsection of the survey focused specifically on anesthesia problem cards and their utility in clinical practice (e. g. field of application, issuing procedures, benefits and problems). RESULTS: The survey subsection on anesthesia problem cards was completed by 1783 participants. Most agreed that anesthesia problem cards are a useful tool to increase patient safety (n = 1502; 84.2%) and that they are routinely issued after the occurrence of anesthesia-related complications (n = 1664, 93.4%). One of the major problems noted was that patients frequently forget to bring their anesthesia problem cards when presenting for the preanesthetic assessment. This was observed by 1457 participants (81.7%). Furthermore, the information provided on anesthesia problem cards may be inadequately phrased (n = 874; 49.0%) or illegible (n = 833; 46.7%). In addition, the space for individual comments or problem solutions is insufficient (n = 811; 45.5%). Replacements for lost anesthesia problem cards with identical informational content can be issued in only 41.9% (n = 747) of the participants' departments. CONCLUSION: Anesthesia problem cards are considered a useful tool to increase patient safety and are frequently issued in clinical practice; however, in the document's current form its full potential for risk minimization cannot be exploited. Structural changes are required to increase documentation quality and reproducibility. Concerning its informational content, the spectrum of included complications and their individual solutions need to be expanded to meet the requirements of modern anesthetic practice.

Effect of Biaxial Strain on the Phase Transitions of Ca(Fe_{1-x}Co_{x})_{2}As_{2}.

We study the effect of applied strain as a physical control parameter for the phase transitions of Ca(Fe_{1-x}Co_{x})_{2}As_{2} using resistivity, magnetization, x-ray diffraction, and ^{57}Fe Mössbauer spectroscopy. Biaxial strain, namely, compression of the basal plane of the tetragonal unit cell, is created through firm bonding of samples to a rigid substrate via differential thermal expansion. This strain is shown to induce a magnetostructural phase transition in originally paramagnetic samples, and superconductivity in previously nonsuperconducting ones. The magnetostructural transition is gradual as a consequence of using strain instead of pressure or stress as a tuning parameter.

Origin of the Resistivity Anisotropy in the Nematic Phase of FeSe.

The in-plane resistivity anisotropy is studied in strain-detwinned single crystals of FeSe. In contrast to other iron-based superconductors, FeSe does not develop long-range magnetic order below the tetragonal-to-orthorhombic transition at T_{s}≈90 K. This allows for the disentanglement of the contributions to the resistivity anisotropy due to nematic and magnetic orders. Comparing direct transport and elastoresistivity measurements, we extract the intrinsic resistivity anisotropy of strain-free samples. The anisotropy peaks slightly below T_{s} and decreases to nearly zero on cooling down to the superconducting transition. This behavior is consistent with a scenario in which the in-plane resistivity anisotropy is dominated by inelastic scattering by anisotropic spin fluctuations.

[A Germany-wide survey on anaesthesia in thoracic surgery]. / Deutschlandweite Umfrage zur Thoraxanästhesie.

BACKGROUND/OBJECTIVE: This study's objective was to evaluate current thoracic anaesthesia practice in Germany and to quantify potential differences depending on the hospital's level of care. MATERIALS AND METHODS: A four-part online survey containing 28 questions was mailed to all anaesthesiology department chairs (n = 777) registered with the German Society of Anaesthesiology and Intensive Care Medicine. RESULTS: The general response rate was 31.5 % (n = 245). High monthly volumes (>50 operations/month) of intrathoracic procedures, performed by specialized thoracic surgeons are mostly limited to hospitals of maximum care, university hospitals, and specialized thoracic clinics. In hospitals with a lower level of care, intrathoracic operations occur less frequently (1-5/month) and are commonly performed by general (69.3 %) rather than thoracic surgeons (15.4 %). Video-assisted thoracic surgeries are the most invasive intrathoracic procedures for most hospitals with a low level of care (61.5 %). Extended resections and pneumonectomies occur mainly in hospitals of maximum care and university hospitals. Thoracic anaesthesia is primarily performed by consultants or senior physicians (59.9 %). The double lumen tube (91.4 %) is the preferred method to enable one-lung ventilation (bronchial blockers: 2.7 %; missing answer: 5.9 %). A bronchoscopic confirmation of the correct placement of a double lumen tube is considered mandatory by 87.7 % of the respondents. Bronchial blockers are available in 64.7 % of all thoracic anaesthesia departments. While CPAP-valves for the deflated lung are commonly used (74.9 %), jet-ventilators are rarely accessible, especially in hospitals with a lower level of care (15.4 %). Although general algorithms for a difficult airway are widely available (87.7 %), specific recommendations for a difficult airway in thoracic anaesthesia are uncommon (4.8 %). Laryngeal mask airways (90.9 %) and videolaryngoscopy (88.8 %) are the primary adjuncts in store for a difficult airway. While hospitals with a lower level of care admitted patients routinely (92.3 %) to an intensive care unit after thoracic surgery, larger clinics used the postanaesthesia recovery room (12.5 %) and intermediate care units (14.6 %) more frequently for further surveillance. Thoracic epidural catheters (85.6 %) are predominantly chosen for peri- and postoperative analgesia, in contrast to paravertebral blockade (single shot: 8.6 %; catheter: 8.0 %) (multiple answers possible). Ultrasound is generally accessible (84.5 %) and mostly employed for the placement of central venous (81.3 %) and arterial (43.9 %) lines as well as a diagnostic tool for pulmonary pathology (62.0 %). CONCLUSION: The study reveals considerable differences in the anaesthetic practice in thoracic surgery. These focus mostly on the postoperative surveillance, the availability of bronchial blockers, and the use of regional anaesthetic techniques. Furthermore, it is evident that specific algorithms are needed for the difficult airway in thoracic anaesthesia. A recommendation for the high-tech work environment of thoracic anaesthesia could enhance the structural quality and optimize patient outcomes. Independent of a hospital's level of care, uniform requirements could help establish national quality standards in thoracic anaesthesia.

Origin of the tetragonal-to-orthorhombic phase transition in FeSe: a combined thermodynamic and NMR study of nematicity.

The nature of the tetragonal-to-orthorhombic structural transition at T_{s}≈90 K in single crystalline FeSe is studied using shear-modulus, heat-capacity, magnetization, and nuclear magnetic resonance measurements. The transition is shown to be accompanied by a large shear-modulus softening, which is practically identical to that of underdoped Ba(Fe,Co)_{2}As_{2}, suggesting a very similar strength of the electron-lattice coupling. On the other hand, a spin-fluctuation contribution to the spin-lattice relaxation rate is only observed below T_{s}. This indicates that the structural, or "nematic," phase transition in FeSe is not driven by magnetic fluctuations.

Infrared Study of the Spin Reorientation Transition and Its Reversal in the Superconducting State in Underdoped Ba(1-x)K(x)Fe(2)As(2).

With infrared spectroscopy we investigated the spin-reorientation transition from an orthorhombic antiferromagnetic (o-AF) to a tetragonal AF (t-AF) phase and the reentrance of the o-AF phase in the superconducting state of underdoped Ba(1-x)K(x)Fe(2)As(2). In agreement with the predicted transition from a single-Q to a double-Q AF structure, we found that a distinct spin density wave develops in the t-AF phase. The pair breaking peak of this spin density wave acquires much more low-energy spectral weight than the one in the o-AF state which indicates that it competes more strongly with superconductivity. We also observed additional phonon modes in the t-AF phase which likely arise from a Brillouin-zone folding that is induced by the double-Q magnetic structure with two Fe sublattices exhibiting different magnitudes of the magnetic moment.

Nematic susceptibility of hole-doped and electron-doped BaFe2As2 iron-based superconductors from shear modulus measurements.

The nematic susceptibility, χφ, of hole-doped Ba(1-x)K(x)Fe2As2 and electron-doped Ba(Fe(1-x)Co(x))2As2 iron-based superconductors is obtained from measurements of the elastic shear modulus using a three-point bending setup in a capacitance dilatometer. Nematic fluctuations, although weakened by doping, extend over the whole superconducting dome in both systems, suggesting their close tie to superconductivity. Evidence for quantum critical behavior of χφ is, surprisingly, only found for Ba(Fe(1-x)Co(x))2As2 and not for Ba(1-x)K(x)Fe2As2--the system with the higher maximal Tc value.

Quality of post-operative patient handover in the post-anaesthesia care unit: a prospective analysis.

BACKGROUND: Anaesthesiology plays a key role in promoting safe perioperative care. This includes the perioperative phase in the post-anaesthesia care unit (PACU) where problems with incomplete information transfer may have a negative impact on patient safety and can lead to patient harm. The objective of this study was to analyse information transfer during post-operative handovers in the PACU. METHODS: With a self-developed checklist including 59 items the information transfer during post-operative handovers was documented and subsequently compared with patient information in anaesthesia records during a 2-month period. RESULTS: A total number of 790 handovers with duration of 73 ± 49 s was analysed. Few items were transferred in most of the cases such as type of surgery (97% of the cases), regional anaesthesia (94% of the cases) and cardiac instability (93% of the cases). However, some items were rarely transferred, such as American Society of Anesthesiologists physical status (7% of the cases), initiation of post-operative pain management (12% of the cases), antibiotic therapy (14% of the cases) and fluid management (15% of the cases). There was a slight correlation between amount of information transferred and duration of post-operative handovers (r = 0.5). CONCLUSION: The study shows that post-operative handovers in the PACU are in most cases incomplete. It appears useful to optimise the post-operative handover process, for example by implementing a standardised handover checklist.

[Preoperative risk evaluation of adult patients prior to elective non-cardiac surgery: follow-up survey of the recommendations published in 2010]. / Präoperative Risikoevaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen: Follow-up-Umfrage zu den 2010 publizierten Empfehlungen.

BACKGROUND: The joint recommendations of the German Societies of Anaesthesiology and Intensive Care Medicine, Surgery and Internal Medicine on preoperative evaluation of adult patients prior to elective, non-cardiac surgery published in November 2010 were the first practical and comprehensive guidelines for preoperative evaluation available to anesthetists in Germany. AIM: This study was carried out to analyze the state of implementation of these guidelines into clinical practice as well as changes in strategies for assessing perioperative risk from the viewpoint of anesthesia personnel in Germany. MATERIAL AND METHODS: A 25-item questionnaire concerning general characteristics of workplaces, cognizance, reasonability and convenience of the joint recommendations was developed as an online survey. Furthermore, changes in strategies for preoperative evaluation were polled. RESULTS: A total of 1,840 anesthetists completed the questionnaire. The results showed that 84.2 % were acquainted with the joint recommendations, 57.3 % evaluated them as completely reasonable and 18.2 % as partly reasonable. A total of 71.4 % indicated that the joint recommendations were implemented completely or partly in their department strategies for preoperative evaluation. From the viewpoint of personnel, anamnesis and physical examination were performed more frequently by 25.7 % while routine diagnostic testing was ordered less frequently by 39.1 %. Advantages by implementing the joint recommendations (e.g. simplification for medical staff and patients, decrease of costs, reduction of radiological examinations) were seen by 45.5 %. Problems, such as increasing expenditure of time and personnel due to implementation were mentioned by 20.3 %. CONCLUSION: The joint recommendations are well known and positively rated among anesthetists in Germany responding to the questionnaire reflecting an effective implementation process over the last 2 years. The anesthetists who completed the questionnaire stated that the use of the recommendations leads to a more reasonable approach in preoperative risk evaluation which contributes to an increase in patient safety and satisfaction.

J-2156, a small molecule somatostatin type 4 receptor agonist, alleviated hindpaw hypersensitivity in the streptozotocin-induced rat model of painful diabetic neuropathy but with a 2-fold decrease in potency at an advanced stage in the model, mimicking morphine.

There is a large unmet need for novel pain-killers to improve relief of painful diabetic neuropathy (PDN). Herein, we assessed the efficacy of the somatostatin type 4 (SST4) receptor agonist, J-2156, for relief of PDN in rats. Diabetes was induced with streptozotocin (STZ; 70 mg/kg) and bilateral hindpaw hypersensitivity was fully developed by 8-week post-STZ. In the intervals, 8-12-weeks (morphine-sensitive phase; Phase 1) and 16-18-weeks (morphine-hyposensitive phase; Phase 2) post-STZ, rats received a single dose of intraperitoneal (i.p.) J-2156 (10, 20, 30 mg/kg), gabapentin (100 mg/kg i.p.), subcutaneous morphine (1 mg/kg) or vehicle. Hindpaw withdrawal thresholds (PWTs) were assessed using von Frey filaments pre-dose and at regular intervals over 3-h post-dose. In Phase 1, J-2156 at 30 mg/kg evoked significant anti-allodynia in the hindpaws with maximal effect at 1.5 h compared with 1 h for gabapentin and morphine. The durations of action for all three compounds were greater than 3 h. The corresponding mean (±SEM) extent and duration of anti-allodynia (ΔPWT AUC) for gabapentin did not differ significantly from that for J-2156 (30 mg/kg) or morphine. However, in Phase 2, the ΔPWT AUC for morphine was reduced to approximately 25% of that in Phase 1, mirroring our previous work. Similarly, the mean (±SEM) ΔPWT AUC for J-2156 (30 mg/kg) in Phase 2 was approximately 45% of that for Phase 1 whereas for gabapentin the mean (±SEM) ΔPWT AUCs did not differ significantly (p > 0.05) between the two phases. Our findings further describe the preclinical pain relief profile of J-2156 and complement previous work in rat models of inflammatory pain, neuropathic pain and low back pain. SST4 receptor agonists hold promise as novel therapeutics for the relief of PDN, a type of peripheral neuropathic pain that is often intractable to relief with clinically used drug treatment options.

Evidence of strong correlations and coherence-incoherence crossover in the iron pnictide superconductor KFe2As2.

Using resistivity, heat-capacity, thermal-expansion, and susceptibility measurements we study the normal-state behavior of KFe2As2. Both the Sommerfeld coefficient (γ≈103 mJ mol(-1) K(-2)) and the Pauli susceptibility (χ≈4×10(-4)) are strongly enhanced, which confirm the existence of heavy quasiparticles inferred from previous de Haas-van Alphen and angle-resolved photoemission spectroscopy experiments. We discuss this large enhancement using a Gutzwiller slave-boson mean-field calculation, which shows the proximity of KFe2As2 to an orbital-selective Mott transition. The temperature dependence of the magnetic susceptibility and the thermal expansion provide strong experimental evidence for the existence of a coherence-incoherence crossover, similar to what is found in heavy fermion and ruthenate compounds, due to Hund's coupling between orbitals.

Long-term effects of a perioperative safety checklist from the viewpoint of personnel.

BACKGROUND: While positive short-term effects of the use of safety checklists have previously been reported by personnel, it is unclear to which extent these effects are maintained for a long-term period. The aim of the present study was to evaluate perioperative safety standards and the quality of interprofessional cooperation from the viewpoint of the involved personnel for up to 2 years following the introduction of a safety checklist. METHODS: A survey of 99 co-workers in the departments of anaesthesiology and traumatology was conducted using a 19-point questionnaire concerning perioperative safety-relevant aspects and the quality of interprofessional cooperation before and at 3, 18, and 24 months after the introduction of a safety checklist. RESULTS: Verification of written consent for surgery (P < 0.01), clear marking of the surgical site (P < 0.01), and time management (P < 0.05) were rated more positively over time by the anaesthesiologists and nurses. Items involving communication were rated less positively after 18 and 24 months than at 3 months. Orthopaedic surgeons rated being better informed about the patients (P < 0.05), the planned operation (P < 0.01), and the assignment of tasks during surgery (P < 0.01) progressively more positively over the time. CONCLUSIONS: Some positive effects concerning the perioperative organisation and management were rated more positively even 2 years after checklist implementation. However, interprofessional communication and cooperation did not show long-term improvement from staff members' point of view. Probably longer lasting effects for the latter aspects could be achieved by repeated instruction and communication training.

The implementation of a perioperative checklist increases patients' perioperative safety and staff satisfaction.

BACKGROUND: The implementation of the 'Surgical Safety Checklist' caused a significant reduction in the incidence of complications and mortality among patients undergoing surgery. The aim of the present study was to evaluate perioperative safety standards and the quality of interprofessional cooperation before and after the introduction of a safety checklist from staff members' point of view. METHODS: Employees' attitude concerning safety-relevant aspects of the perioperative period, work processes, and quality of interprofessional cooperation was surveyed before and 3 months after introducing an adapted form of the 'Surgical Safety Checklist' by a 19-item questionnaire. RESULTS: After the implementation of the checklist, the cognizance of the names and functions of the individual operating room (OR) staff members, verification of the patient's written consent for surgery, indication for antibiotics before the surgical incision, and the quality of interprofessional cooperation were rated more positively. Traumatology physicians were more convinced that all artifacts had been removed from the surgical field. Finally, communication about intraoperative complications had improved. CONCLUSIONS: Our attitude surveys demonstrate that from the OR staff's perspective, in the perioperative setting, safety-relevant factors can be handled significantly better and with greater awareness by implementing a safety checklist as proposed by the World Health Organization.

[Quality management in acute pain therapy: results from a survey of certified hospitals]. / Qualitätsmanagement in der Akutschmerztherapie : Ergebnisse einer Befragung TÜV-zertifizierter Kliniken.

AIM: Systems for and methods of quality management are increasingly being implemented in public health services. The aim of our study was to analyze the current state of the integrated quality management concept "quality management acute pain therapy" of the TÜV Rheinland® (TÜV) after a 5-year project period. MATERIAL AND METHODS: General characteristics of the participating hospitals, number of departments certified by the TÜV and implementation of structures and processes according to the TÜV guidelines were evaluated by a mail questionnaire. Furthermore, positive and negative aspects concerning the effects of certification were evaluated by the hospitals' representatives of certification. RESULTS: A total of 36 questionnaires were returned. Since 2006 the number of certified hospitals (2011: n = 48) and surgical departments (2011: n = 202) has increased continuously. The number of certified medical departments is low (2011: n = 39); however, in the last 3 years, it has increased by about 200-300% annually. Standard operative procedures for pain therapy and measurement of pain intensity at regular intervals were implemented in all certified clinics (100%). Although 41% take part in the benchmarking project QUIPS (Quality Improvement in Postoperative Pain Therapy), 24% do not systematically check the quality of the outcome of pain management. Acceptance of the new pain therapy concepts among nursing staff was rated positively (ratio positive:negative 16:1); however, acceptance among physicians was rated negatively (1:15). CONCLUSION: Certification by the TÜV leads to sustainable implementation of quality management principles. Future efforts should focus on better integration of physicians in acute pain therapy and the development of an integrated tool to measure patients' outcome.

[Preoperative risk evaluation of adult patients for elective, noncardiac surgical interventions. Results of an on-line survey on the status in Germany]. / Präoperative Risikoevaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen. Ergebnisse einer Onlinebefragung zum Status in Deutschland.

BACKGROUND: While assessing the medical history and physical examination are the cornerstones of preoperative risk evaluation, the importance of "routine" testing has been critically discussed in recent studies. The joint recommendations of the German Societies of Anaesthesiology and Intensive Care Medicine, Surgery and Internal Medicine for preoperative evaluation of adult patients prior to elective, non-cardiac surgery, which were published in November 2010, are the first comprehensive practice guidelines for preoperative evaluation in Germany. Aim of this study was to analyze former strategies for assessing perioperative risk at anaesthesia departments in Germany. METHODS: A 29-item questionnaire concerning general hospital characteristics, strategies for preoperative evaluation and cognizance of the joint recommendations was developed as an online survey. In particular the reasons for technical assessment were surveyed (i.e. routine, patient age or pre-existing conditions, risk of operation being performed). In certain questions multiple answers were permitted. All hospitals with departments of anaesthesiology in Germany were included. Data are presented as percentages. RESULTS: A total of 396 hospitals (35.6%) completed the questionnaire. Physical examination is not performed regularly (37%) but only when indicated by the medical history. Criteria for performing preoperative electrocardiograms are comorbidities of the cardiovascular (80.1%) and pulmonary systems (42.2%) as well as patient age (52.8%) and as routine measures (10.1%). Laboratory testing was performed as a routine (43.2%) because of patient age (52.8%) or pre-existing conditions (37.3%). Preoperative chest x-ray was carried out when the medical history or physical examination suggest intrathoracic pathologies (81.3%) or was based on patient age (35.9%). The majority of hospitals (89.1%) plan to implement the joint recommendations for preoperative evaluation in the future. CONCLUSION: According to the joint recommendations preoperative testing is more and more directed to patients with an increased perioperative risk which is clinically indicated by medical history and physical examination. However, routine or age-related medical testing is still a frequently used strategy. German medical societies should focus on advanced implementation strategies to change current practices in order to avoid unnecessary diagnostic procedures and to increase patient safety and satisfaction.