Asymmetry in patient-related information disrupts pre-anesthetic patient briefing.

BACKGROUND: If one party has more or better information than the other, an information asymmetry can be assumed. The aim of the study was to identify the origin of incomplete patient-related preoperative information, which led to disruptions and losses of time during pre-anaesthetic patient briefing. We hypothesized that lower employees' educational level increases the amount of disruptive factors. METHODS: A prospective observational study design was used. Patient selection was depending on the current patient flow in the area of the clinic for pre-anesthetic patient briefing. Data were collected over a period of 8 weeks. A stopwatch was used to record the time of disruptive factors. Various causes of time losses were grouped to facilitate statistical evaluation, which was performed by using the U-test of Mann and Whitney, Chi-square test or the Welch-t-test, as required. RESULTS: Out of 221 patients, 130 patient briefings (58.8%) had been disrupted. Residents were affected more often than consultants (66% vs. 47%, p = 0.008). Duration of disruptions was independent of the level of training and lasted about 2,5 minutes and 10% of the total time of patient briefing. Most time-consuming disruptive factors were missing study results, incomplete case histories, and limited patient compliance. CONCLUSIONS: Disruptions during pre-anesthetic patient briefings that were caused by patient-related information asymmetry are common and account for a significant loss of time. The resultant costs justify investments in appropriate personnel allocation.

Chemically induced pheochromocytomas in rats: mechanisms and relevance for human risk assessment.

Pheochromocytomas are tumors originating from chromaffin cells of the adrenal medulla, which have been observed in numerous carcinogenicity studies. The authors have evaluated pheochromocytoma concurrence with other effects and the possible mechanisms, in order to assess the relevance of such data for the classification of carcinogenic effects and their relevance to humans. The evaluation revealed that pheochromocytomas occur with relatively higher frequency in male rats, especially when the following conditions are involved: hypoxia, uncoupling of oxidative phosphorylation, disturbance in calcium homeostasis, and disturbance of the hypothalamic endocrine axis. The underlying biochemical mechanisms suggest that other substances that interfere with these biochemical endpoints also produce pheochromocytomas. Such endpoints include enzymes involved in catecholamine synthesis, receptor tyrosine kinase (RET), hypoxia-inducible factor (HIF), succinate dehydrogenase, fumarate hydratase, and pyruvate dehydrogenase. To date, there is no indication that the substances inducing pheochromocytomas in animal experiments also induce corresponding tumors in humans. Because the mechanisms of action identified in rats are to be expected in humans, pheochromocytomas may be induced after exposure conditions similar to those used in the animal studies. Whether hereditary mutations represent a risk factor in humans is not clear. Pheochromocytomas that occur in animal experiments currently appear to have little relevance for conditions at the work place. When sufficiently documented and evaluated, such secondary pheochromocytomas are not relevant for classification and human risk assessment.

Evaluation of OECD screening tests 421 (reproduction/developmental toxicity screening test) and 422 (combined repeated dose toxicity study with the reproduction/developmental toxicity screening test).

The Advisory Committee on Existing Chemicals (BUA) of the Federal Republic of Germany convened a panel with expertise in reproductive and developmental toxicology to evaluate the OECD Screening Tests 421 (Reproduction/Developmental Toxicity Screening Test) and 422 (Combined Repeated Dose Toxicity Study with the Reproduction/Developmental Toxicity Screening Test) with respect to their ability to unmask any potential toxic effects on reproduction. The original assignment for that panel was to "validate" those screening tests. However, the panel members recognized beforehand that this was actually an impossible task because of lack of a sufficient database. Only five chemicals with known reproductive toxicity had been examined following the OECD Screening Test Guidelines 421 or 422. A comparison of these test results with those of the definitive OECD Test Guidelines 414, 415, 416, or additional investigations could, therefore, only have been made with this very limited number of chemicals that had also undergone evaluation by one of the test guidelines cited. In each case biological properties relevant to reproductive toxicity were also indicated by the OECD Screening Tests 421 or 422. This communication reviews the main differences in study design of OECD Screening Test Guidelines 421 and 422 compared to those definitive test guidelines of similar study design for reproduction or developmental toxicity (especially with the one-generation study, OECD Test Guideline 415). The very limited possibilities of detecting late postnatal and postlactational manifestations are emphasized, as is the low statistical power of the OECD Screening Tests 421 and 422. Furthermore, the very limited ability to unmask teratogenicity is delineated. The outcome of screening tests was evaluated based on the results of 57 studies conducted according to the OECD Test Guideline 421 or 422. The test results were categorized according to the incidence of toxic effects on reproduction in the parent animals or their offspring and related to general toxic effects. Based on the ranking of these results, recommendations regarding setting rational priorities for further evaluations of existing chemicals' reproductive hazards are made. In general, the reviewer panel supports the OECD position that the screening tests are useful for initial hazard assessment and can contribute to the decision-making process on setting priorities for further test requirements. The panel also agrees with the OECD statement that the OECD Screening Tests 421 and 422 are neither an alternative to definitive tests (i.e., OECD Test Guidelines 414, 415, and 416) nor are they intended as their replacement.