Der Anaesthesist
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Discussions with relatives are relevant and crucial aspects of the organ donation process and contribute to a consolidated and sustainable decision by the families of the deceased. Despite the great importance of family care, there is no systematic analysis of the quality of this communication, in contrast to the diagnosis of irreversible loss of brain function, organ retrieval and organ transplantation. For this reason, organ donation experts were interviewed about recurring characteristics of communication with relatives of the deceased. The aim of this qualitative study was to define criteria for the assessment of the structure and quality of the communication process with relatives for internal quality management in Germany. ⋯ Recurring communication and process characteristics as well as requirements for the members of the treatment team who conduct the conversation can be identified for the interviews with relatives, which show potential for improvement to various degrees. This justifies the structured derivation of a quality bundle for the structural and process quality family care related to organ donation, which should enable a low-threshold entry into an institution internal systematic quality assessment of communication with relatives in Germany. Due to the different legal, medical and social specifics in an international context, the study results cannot be directly transferred to other countries.
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In developed countries, peripartum hemorrhage, thromboembolic events and hypertensive pregnancy disorders are the most frequent complications in pregnancy. They pose a significant challenge for the interdisciplinary team of gynecology and anesthesiology. Untreated, these pregnancy-related complications result in a fulminant course. ⋯ The hypertensive diseases in pregnancy have a very high risk of complications. In addition to symptomatic treatment in the intensive care unit, the optimal time of delivery must be determined by an interdisciplinary consensus. This is the only causal treatment option possible.
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Focused treatment of epileptic emergencies, and in particular status epilepticus (SE), require a reliable differentiation of epileptic syndromes. In these cases, and especially in cases with predominant non-motor symptoms, clinical and electroencephalographic expertise is necessary. In 2020 the German guidelines for the management of SE were updated, which adhere to a strict stage-based treatment algorithm. ⋯ Therapeutic interventions especially for refractory forms of SE have been shown to be complex with relevant implications concerning intensive care aspects. Consequently, the modern treatment strategy of SE is characterized by an interdisciplinary approach. Future research is needed to define the optimal treatment of non-convulsive SE, in particular regarding the time point and degree of treatment escalation with associated ethical considerations.