[Best conditions to perform TAVI procedures]. / Les bonnes conditions pour réaliser des TAVI.

Well conditions to perform TAVI procedures are guided by ministry regulation and dedicated to centers with both on-site a cath-lab and cardiac surgery. Heart Team decision is mandatory to select patient for TAVI and local anesthesia is recommended. Conditions changes would be discuss according to increased procedures number related to indications evolution.

Medicolegal structure, consequences, and recommendations for daily practice: The example of surgical infection.

Surgical infections are the leading cause of complications and have major economic consequences and medico-legal fallout. In this article, the author revisits the foundations of medical law in France and reviews the mechanisms of medical liability, the place of recommendations in the definition of "secundum Artem", or the "state-of-the-art", and the necessity to provide high quality information. The author then proposes an approach to improve safety in daily practice.

A review of illicit psychoactive drug use in elective surgery patients: Detection, effects, and policy.

Limited information is present in literature regarding detection of illicit drug users visiting physicians when planning elective surgery; also, there is no update manuscript that is illustrating the effects of illicit drugs use that require reconstructive surgery interventions. Aims of this manuscript are: 1) to summarize existing knowledge, and give surgeons information how to detect patients who might possible use illicit drugs; 2) to review the effects of illicit drug use that specifically require reconstructive surgery interventions; 3) to assess on existing policies on asymptomatic illicit drug users when planning elective surgery. Studies were identified by searching systematically in the electronic databases PubMed, Medline, The Cochrane Library and SveMed+. Because of the nature of research questions to be investigated (drug policy and surgery), a "systematic review" was not possible. In spite of some existing policies to detect illicit drug use in specific situations such as workplaces or acute trauma patients, there is a lack of data and lack of information, and subsequently no policy has ever been made, for detection and management of illicit drug use asymptomatic patients requesting or referred for plastic surgery interventions. This manuscript poses questions for further ethical evaluations and future policy.

A Preoperative Medical History and Physical Should Not Be a Requirement for All Cataract Patients.

Cataract surgery poses minimal systemic medical risk, yet a preoperative general medical history and physical is required by the Centers for Medicare and Medicaid Services and other regulatory bodies within 1 month of cataract surgery. Based on prior research and practice guidelines, there is professional consensus that preoperative laboratory testing confers no benefit when routinely performed on cataract surgical patients. Such testing remains commonplace. Although not yet tested in a large-scale trial, there is also no evidence that the required history and physical yields a benefit for most cataract surgical patients above and beyond the screening performed by anesthesia staff on the day of surgery. We propose that the minority of patients who might benefit from a preoperative medical history and physical can be identified prospectively. Regulatory agencies should not constrain medical practice in a way that adds enormous cost and patient burden in the absence of value.

[Preoperative tests recommendations in adult patients for ambulatory surgery]. / Recomendaciones de pruebas preoperatorias en el paciente adulto para procedimientos en régimen de cirugía ambulatoria.

Anesthetic assessment traditionally included a series of laboratory tests intended to detect undiagnosed diseases, and to ensure that the patient undergoes surgery following safety criteria. These tests, without a specific clinical indication, are expensive, of questionable diagnostic value and often useless. In the context of outpatient surgery, recent evidence suggests that patients of any age without significant comorbidity, ASA physical status gradei and grade ii, do not need additional preoperative tests routinely. The aim of the present recommendations is to determine the general indications in which these tests should be performed in ASA gradei and grade ii patients undergoing ambulatory surgery.

[Surgical errors and risks--the head and neck cancer patient]. / Fehler und Gefahren: Onkochirurgie im Kopf-Hals-Bereich.

Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. This can lead into functional impairment and even have impact in future chances for disease related survival. There are many risks for head and neck surgeons which can cause errors and malpractice. To avoid surgical errors, thorough preoperative management of patients is demanded for. Such is ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of medical studies and data as well as qualifications in modern surgical techniques and the surgeons ability for critical self assessment are basic but important prerequisites for head and neck surgeons in order to prevent from mistakes. Moreover it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and be capable of dealing with complications, when they occur.Despite all preventive precaution and surgical care, mistakes cannot always be avoided. For that it is important to be able to deal with errors and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery.

[Preoperative risk evaluation from the perspective of anaesthesiology]. / Präoperative Risikoevaluation aus anästhesiologischer Sicht.

Medical and technical progress together with demographic changes has led to a more complex perioperative care for patients. Accordingly, an optimal preoperative assessment in particular an adequate risk evaluation is more important than ever. A recently published joint recommendation of the German Society of Anaesthesiology and Intensive Care Medicine, the German Society of Surgery and the German Society of Internal Medicine aims to reduce considerable uncertainties in the preoperative risk evaluation especially with regard to"technical tests" by providing transparent and comprehensive arrangements. Consequently, routine screening will be abandoned in favour of targeted patient and operation-oriented individual risk assessment. This approach will change the preoperative risk evaluation in a scientific, organisational and economic way. The following article on preoperative risk evaluation is based on the valuable and helpful recommendation and aims to provide additional important aspects from the perspective of anaesthesiologists.

[Multimedia preoperative patient information]. / Multimediale Patientenaufklärung in der Klinik.

Due to heavy workloads and shortage of staff, doctors often find it difficult to explain operations to their patients with the legally required detail and timing (in Germany, 24 h preop). This is however mandatory for obtaining informed consent. We developed a computer program that generates films explaining 24 common orthopedic operations and blood transfusion. They explain the operation, early postoperative phase, and benefits and risks to the patient. At our clinic, this program is used in daily routine and precedes the actual doctor-patient conversation for informed consent. We asked 300 patients about their satisfaction with the newly developed program. The multimedia presentation gives the patient more time, enough detail and clarity, and the chance to repeat parts of the film. For the doctor, it saves time. The time gap required in Germany between explanation and operation is thus easily adhered to. In case of legal problems, the film can be used for evidence. The use of this multimedia presentation to help in getting informed consent is improving workflow considerably.