[Anesthesia Technical Assistants - a New Job Description in Health Care]. / Anästhesietechnische Assistenten/-innen ­ ein neuer Beruf im Gesundheitswesen.

For many colleagues, the job of anesthesia technical assistant (ATA) is a new - previously unknown - job description in the healthcare sector. The anesthesia departments currently employ qualified nurses (3 years of training) or specialist nurses (5 years of training). However, there has been a known shortage of skilled workers in the care industry for many years. Vacancies are often difficult or impossible to fill. The result is a higher service burden for existing employees. It can also happen that operating theaters have to be closed because no staff is available - this has not only economic effects on the respective provider, but also in particular on patient care.The independent basic training of the technical assistant for anesthesia was not only created to counteract the shortage of skilled workers. At the same time, this new field of work was supposed to be attractive and to train specialists - directly. In the future, the anesthesia departments will be supported by anesthesia technical assistants. This article explains the training structure and areas of responsibility.

Risk Factors for Negative Global Treatment Outcomes in Lumbar Spinal Stenosis Surgery: A Mixed Effects Model Analysis of Data from an International Spine Registry.

OBJECTIVE: To determine risk factors for negative global treatment outcomes as self-assessed by patients undergoing surgical treatment for lumbar spinal stenosis (LSS). METHODS: Patients from the Spine Tango registry undergoing first-time surgery for LSS were analyzed. The primary outcome was global treatment outcomes measured at the last available follow-up ≥3 months postoperatively using a single question rating how much the operation had helped the patient's back problem (negative = no change/operation made things worse). A 2-level logistic mixed effects model with the treating department as the random effect was used to assess factors associated with a negative outcome. RESULTS: A total of 4504 patients from 39 departments in 10 countries were included. Overall, 14.4% of patients reported a negative global treatment outcome after an average follow-up of 1.3 years. In patients with dominant leg pain, negative outcome was associated with higher baseline back pain; in those with dominant back pain, it was associated with higher baseline back pain, ASA (American Society of Anesthesiologists) ≥3, lower age, not having rigid stabilization, not having disc herniation, and the vertebral level of the most severely affected segment (L5/S1 vs. L3/4). Four departments had significantly higher odds of a negative outcome, whereas 1 department had significantly lower odds. Three out of the 4 negative effects were related to 2 departments from 1 country. CONCLUSIONS: LSS surgery fails to help at least 1 in 10 patients. High baseline back pain is the most important factor associated with a negative treatment outcome. Department-level and potentially country-level factors of unknown origin explained a nonnegligible variation in the treatment results.

[Acute headache and neck pain caused by crowned dens syndrome]. / Acute hoofd- en nekpijn door 'crowned'-denssyndroom.

BACKGROUND: Crowned dens syndrome (CDS) is a rare cause of acute headache and neck pain, which is accompanied by fever and a stiff neck. It is caused by calcium deposits (pseudogout) around the dens axis (C2). CASE DESCRIPTION: A 61-year-old woman, with a history of migraine and of breast cancer 8 years previously, was referred to the accident and emergency department of our hospital with acute headache and neck pain. She was treated in the department with prednisone, on suspicion of giant-cell arteritis. However, an 18F-FDG-PET-CT showed inflammation and calcification around the dens, consistent with CDS. The patient's condition improved rapidly after treatment with prednisone. CONCLUSION: CDS should be considered in the differential diagnosis of acute headache and neck pain. Familiarity with the disease course can prevent unnecessary diagnostic tests and treatment. The syndrome can be easily diagnosed with a CT scan, but an 18F-FDG-PET-CT can also be used to reveal inflammatory activity around the dens.

[Absent liver dullness due to left-sided liver]. / 'Opgeheven leverdemping' door links gelegen lever.

BACKGROUND: Abnormal organ sites may impede the interpretation of physical findings. CASE DESCRIPTION: A 75-year-old man with hypertension had constipation and variable abdominal pain symptoms for a long time. He had no fever or abdominal pain at that time. Physical examination of the abdomen revealed high-pitched bowel sounds and hypertympanic percussion with absent liver dullness. An abdominal CT scan revealed coincidentally a left-sided liver, gallbladder and portal system. This was an explanation for the absent liver dullness. CONCLUSION: Rare abnormalities in the anatomical position of organs (such as situs inversus or situs ambiguus) may confuse clinicians in the interpretation of the physical examination. It may lead to an atypical presentation of typical disease pictures, as well as to unfounded alarm symptoms. As far as we know an isolated left-sided liver has not been described before.