Reinhard Strametz

Change in knowledge and skills of Year 3 undergraduates in evidence-based medicine seminars

Purpose  To evaluate the effect of a compulsory evidence‐based medicine (EBM) seminar in critical appraisal skills and the overall acceptance of compulsory EBM seminars for Year 3 medical undergraduate students.

Is the surgical repair of unruptured atherosclerotic aneurysms at a higher risk of intraoperative ischemia

BACKGROUND The incidence of ischemia might be increased in the surgical repair of atherosclerotic unruptured aneurysms compared to non-atherosclerotic aneurysms. The atherosclerotic wall might increase the occurrence of thrombembolic events or its rigidity might endanger the occlusion of perforators within the aneurysm vicinity. METHODS 87 patients (53 patients without and 34 patients with atherosclerotic unruptured aneurysms, 50.5 ± 9.7 years) were analyzed for severity of atherosclerosis within the aneurysm and the aneurysm bearing vessel, surgical maneuvers, intraoperative alterations in evoked potentials and clinical and neuroradiological results. RESULTS Temporary vessel occlusion (25% vs. 50%, p = 0.021), repositioning of a permanent clip (21% vs. 56%, p = 0.001) and aneurysm remnants (2% vs. 18%, p = 0.012) occurred more often in patients with atherosclerotic aneurysms. At 6 months, 3/34 patients with atherosclerosis (8.8%) had an unfavorable outcome, all patients without atherosclerosis had a favorable outcome (p = 0.056). CONCLUSION The surgical repair of unruptured aneurysms is safe but patients with atherosclerotic altered vessels and aneurysms accounted to a minor increase in unfavorable outcome and an increased risk of morbidity at 6 months postoperatively. This factor should be taken into consideration when performing surgery of atherosclerotic, unruptured aneurysms.

Survey zu Aus-, Weiter- und Fortbildungsangeboten in Evidenzbasierter Medizin – eine zielgruppenspezifische Analyse

INTRODUCTION A survey conducted in 2011/12 on evidence-based medicine teaching activities in Germany, Austria and Switzerland shows an apparent increase of undergraduate and postgraduate teaching activities addressing different target groups. The potential target-group specific or generalised nature of teaching activities in EbM were explored by comparing the contents and structures of educational offers in order to detect differences and commonalities. METHODS First, several large institutions of the healthcare system were contacted. In addition, the participants of the EbM Academy were consulted as key informants, and the members of the German-speaking colleges of general practitioners and the German Network for EBM were asked to identify potential providers of EbM teaching activities. In the second step pretested detailed questionnaires were sent out that allowed a target-group specific analysis of contents, structures and didactic methods. RESULTS Altogether, 185 teaching activities in EbM are described; 117 (6.8%) of these address students, 70 (37.8%) physicians and 55 (29.7%) caregivers and members of other healthcare professions. Further target groups include people interested in the healthcare system with a total of 38 (i.e., 20.5%) and patients with 18 (9.7%) teaching activities (multiple responses allowed). Students are mainly taught in obligatory seminars, courses or lectures with a high number of participants, whereas teaching activities addressing other target groups are mostly offered to small groups of participants in the form of optional seminars, courses or workshops lasting a similar length of time. As regards the content, attendees from all target groups with only little previous knowledge are taught the first three steps of EbM according to Sackett. Specialised contents are not distributed evenly and reveal some adaptation to the respective target groups. DISCUSSION Structural differences between the target groups are most likely attributed to distinct framework conditions in education and career. Parallels in content demonstrate high rates of conformity concerning the teaching of basic knowledge, though, while individually selecting particular focus areas of special expertise.

Intravenous versus inhalational anesthesia for pediatric inpatient surgery – A systematic review and meta-analysis

STUDY OBJECTIVE General anesthesia is commonly used in pediatric inpatient surgery. It can be induced and maintained by either intravenous or volatile anesthetic agents. We aimed to elucidate whether intravenous or volatile anesthetic agents are superior with regards to preventing anesthesia-related complications. DESIGN Using a predefined standardized study protocol we conducted a systematic review of randomized controlled trials (RCTs) with meta-analysis where appropriate searching the following data bases: CENTRAL, MEDLINE, EMBASE, metaRegister of Controlled Trials (until June 2016). SETTING AND PATIENTS We included any RCT comparing the adverse effects of intravenous or volatile anesthetic agents in pediatric inpatients. More specifically, primary endpoints were the appearance of cardiopulmonary complications or postoperative nausea and vomiting (PONV) or any cognitive dysfunction within 24 h following general anesthesia. Secondary endpoints were any other complication besides the aforementioned primary endpoints. MEASUREMENTS AND MAIN RESULTS In total, nine RCTs (762 children) were analyzed. Regarding primary endpoints, the use of propofol during strabismus surgery significantly increased the relative risk (RR) of oculocardiac reflex (RR 4.96, 95% confidence interval [CI]: 3.13-7.87, p < 0.00001; two studies, 257 children). PONV was significantly less frequent after general anesthesia with intravenous than with volatile anesthetic agents (RR 0.68, 95% CI: 0.48-0.98, p = 0.04; five studies, 563 children). We did not find identify any further difference with regards to the predefined primary or secondary endpoints due to clinical or statistical heterogeneity. CONCLUSIONS Taken together, propofol increased the risk of oculocardiac reflex whereas PONV was less frequent following intravenous anesthetics compared to volatile anesthetics. The study results may help tailoring the use of either intravenous of volatile anesthetics onto the needs of pediatric inpatients. Given the clinical or statistical heterogeneity among the studies, we call for a scientific effort to increase the body of evidence on anesthetic agents in pediatric general anesthesia.

Strategische Prozessoptimierung mit dem ServiceBlueprint™: Die Umstrukturierung der kombinierten Anästhesieambulanz der Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie am Universitätsklinikum Frankfurt

Die Klinik fur Anasthesiologie, Intensivmedizin und Schmerztherapie (KAIS) versorgt alle Abteilungen des Universitatsklinikums Frankfurt am Main mit Anasthesieleistungen. Sie erbringt mit ihren uber 100 arztlichen Mitarbeiterinnen und Mitarbeitern jahrlich uber 20.000 Narkoseleistungen, leitet die mit 34 Betten groste Intensivstation des Klinikums und betreut uber die Schmerzambulanz sowohl ambulante als auch stationare Patienten bei akuten und chronischen Schmerzen.