Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewAdjunct medications for peripheral and neuraxial anesthesia.
Regional and neuraxial anesthesia can provide a safer perioperative experience, greater satisfaction, reduced opioid consumption, and reduction of pain, while minimizing side effects. Ultrasound technology has aided clinicians in depositing local anesthetic medication in precise proximity to targeted peripheral nerves. ⋯ This manuscript describes the current state of the use of adjuncts, e.g., dexmedetomidine, dexamethasone, clonidine, epinephrine, etc., in regional anesthesia. Additionally, evidence behind dosing and block prolongation is summarized along with patient outcomes, adverse effects, and future directions.
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewWhat is new in the battle against postoperative nausea and vomiting?
The issue of postoperative nausea and vomiting (PONV) still poses a significant burden on our patients. Although rarely associated with a life-threatening condition, it is consistently considered as one of the most undesirable side effects of surgery and anesthesia. ⋯ Because pharmacologic interventions for PONV are not without risks, practitioners must assess patient's risk status from low to high and consider the benefits of treatment. This review summarizes the current state of knowledge related to PONV and provides a practical approach toward risk assessment, prevention, and numerous treatment strategies.
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Best Pract Res Clin Anaesthesiol · Mar 2018
ReviewMoving towards a competence centre for geriatric medicine and care: Quality management and human resource management as major support factors.
Changed employment models, an ageing workforce and demands of new generations are challenging healthcare facilities to go down new paths. Never before have well-qualified staff been as highly sought after within the medical and nursing care sector as they are today. For many years, the Geriatric Health Care Centres of the city of Graz (GGZ)-a large regional health care provider with more than 650 staff across five locations-has focused a lot on the topic of competence management, facilitation of specialist and management careers in nursing and medicine as well as the optimal mix of skills and grades in staffing. ⋯ EFQM). The strategic corporate objective of GGZ is to increase the health literacy of the population-and by doing so, also increases the health literacy of patients and residents. This kind of patient empowerment can be substantially supported by specially qualified, empathic staff with good social skills and a genuine interest in the elderly; this reinforces the high significance of professional human resource management.
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Best Pract Res Clin Anaesthesiol · Mar 2018
ReviewIntegrating cross-border emergency medicine systems: Securing future preclinical medical workforce for remote medical services.
The European Union intends to enable its citizens to interact across borders in relevant areas of society and culture to further integrate neighboring regions. Medicine has not been at the core of recent EU-funded efforts in central Europe, partially due to significant differences in health care administration, delivery, reimbursement, and culture. However, impeding changes in social structure and centralization of specialized care warrant changes in preclinical administration of medical care, which are already transforming practices across developed countries in central Europe. ⋯ Finally, the pre-existing and developing acceptance and sustainability aspects of personnel involved in the aforementioned actions and stakeholders on both sides of the border will be evaluated. In essence, the project focuses on a multimodal improvement of professional cooperation of key providers of emergency medicine services in the Euroregion Pomerania. Thereby, it aims to improve infrastructure; interpersonal and professional skills of involved personnel, administrative, and cultural relations; and eventually identification of specialized personnel with their workplace and region to secure and retain important medical workforce in an otherwise remote area on both sides of a formerly secluded border.