Transfer of an interprofessional emergency caesarean section training program: using questionnaire combined with outcome data of newborn.

PUPROSE: An emergency caesarean section is a potentially life-threatening situation both for the mother and the newborn. Non-technical skills can be improved by simulation training and are necessary to manage this urgent situation successfully. The objective of this study was to investigate, if training of emergency caesarean section can be transferred into daily work to improve the outcome parameters pH an APGAR of the newborn. METHODS: In this pre-post study, 141 professionals took part in a training for emergency caesarean section. Participants received a questionnaire, based on the tools "Training Evaluation Inventory" and "Transfer Climate Questionnaire" 1 year after training. Outcome data of the newborn were collected from the hospitals information system. RESULTS: Except the scale "extinction", Cronbach's alpha was higher than 0.62. All scales were rated lower than 2.02 on a 5-point Likert Scale (1 = fullest approval; 5 = complete rejection). "Negative reinforcement" was rated with 2.87 (SD 0.73). There were no significant differences in outcome data prior. The questionnaire fulfils criteria for application except the scale "extinction". CONCLUSION: The presented training course was perceived as useful by the professionals and attitudes toward training were positive; the content was positively reinforced in practice 1 year after training. Parameters of the newborn did not change. It is conceivable that other outcome parameters (e.g. posttraumatic stress disorder) are addressed by the training. The development of relevant outcome parameters for the quality of emergency sections needs further investigation.

[Part-time concepts in anaesthesia -example of a department of anaesthesiology at a university hospital in Germany]. / Teilzeitmodelle in der Anästhesie - Beispiel einer Anästhesieabteilung eines deutschen Universitätsklinikums.

Part-time work concepts are requested for different reasons from an increasing number of employees. Despite this fact there are no systematic part-time work concepts published in the German literature, especially for physicians working in hospitals. This article describes background and circumstances of a part-time work concept which was established two years ago in a department of anaesthesiology at a university hospital in Germany. This concept considers needs of young families as well as older employees. We are convinced that a transparent part-time work concept is a good argument for job-seeking physicians when deciding for an employer. The benefit for the already employed colleagues has at least the same value.

[Anaesthesia in patients after transplantation]. / Management von Organspendern und Organempfängern - Narkoseführung bei transplantierten Patienten.

More than 17000 patients currently live in Germany who have had organ transplants. The implications of this for the anaesthetists are that they are very likely to be confronted by such a patient at some point during their active career. Besides the preoperative assessment which includes that of the function of the transplanted organ, appropriate immunosuppression poses a particular challenge. Close collaboration with both patients and their transplant specialists is essential to preempt the perioperative consequences and plan continuation of immunosuppression. Strictly aseptic measures are mandatory as well as detailed evaluation of the risk-benefit balance of all invasive procedures.There are no significant differences between the anaesthetic approaches and agents in transplant and non-transplant patients. However, in the latter group, homeostasis of all organ systems should be more focused on.

A bioartificial liver support system using primary hepatocytes: a preclinical study in a new porcine hepatectomy model.

BACKGROUND: Bioartificial liver support systems providing a bridge to transplantation or even a definitive treatment of acute hepatic failure are a current focus of research. Different devices are used, although an impact on patient survival is doubtful for the time being. After developing a new flat membrane bioreactor, further preclinical studies have become necessary. Existing animal models of fulminant hepatic failure show common difficulties in defining a reproducible loss of functional liver tissue while considering systemic side effects. We now present a reproducible model with total hepatectomy in pigs, suitable to test the safety and efficacy of liver support systems. METHODS: Twelve pigs underwent total hepatectomy by using silicone tubes and a Y-adapter as vascular prosthesis; intracranial pressure was measured via a subdural probe. Anhepatic pigs were monitored under general anesthesia until death occurred. All were treated with a new flat membrane bioreactor (FMB) that contained porcine hepatocytes in 6 of the 12 cases. RESULTS: Our hepatectomy technique proved to be successful without requiring venovenous bypass circulation. Mean vascular clamping time was 9 minutes. The mean survival time was longer in animals treated with hepatocyte-equipped bioreactors than in untreated animals (24.8 +/- 4.3 vs 16.4 +/- 4.7 hours), which already showed increased intracranial pressure after 10 to 12 hours. Serum albumin levels indicated stable cell-specific functions of the FMB. CONCLUSIONS: The described technique of total hepatectomy is a well-reproducible animal model. The presented FMB maintained stable cell-specific functions and is a safe and efficient device.