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ABSTRACT: In der vorliegenden Studie wurden 188 Medizinstudenten des ersten und 120 des sechsten Studienjahres der Universität Zürich
hinsichtlich ihrer Einstellungen zum Alter, ihrem Wissen zu alterspezifischen Vorgängen, ihren Erfahrungen mit alten Menschen
und ihren eigenen Erwartungen an das Alter befragt. Eingesetzt wurden voll strukturierte, standardisierte Fragebögen. Die
Auswertung erfolgte mittels uni- und multivariater statistischer Methoden. Die Ergebnisse zeigen, weitgehend unabhängig von
Geschlecht und Studienjahr, ein positives Altersbild der Studierenden. Ihre positiven Erfahrungen mit alten Menschen und ihre
positiven Erwartungen an das eigene Alter betreffen vor allem die eigene psychische Gesundheit. Für die Vermittlung von gerontologischem
und geriatrischem Wissen in der Ausbildung von Medizinstudenten sollte diesen überwiegend positiven Einstellungen gegenüber
älteren Menschen Rechnung getragen werden und sowohl auf Risiko- als auch auf protektive Faktoren für die Entstehung und Behandlung
alterstypischer gesundheitlicher Störungen hingewiesen werden.
In the present study, 188 first year and 120 sixth year students of the University of Zurich were questioned about their attitudes
towards older people, their knowledge concerning aging specific developments, their experiences with older people and their
own expectations concerning old age. Structured and standardized questionnaires were used. The data were analyzed using univariate
and multivariate statistical methods. The results show a positive image of old age independent of gender and point in time
of education. Their positive experiences with older people and their positive expectations concern their own aging refer,
above all, to their own mental health. For the transfer of gerontological and geriatric knowledge in the education of medical
students, these mainly positive attitudes towards older people should be taken into account. Risk factors as well as protective
factors concerning the development and treatment of diseases which are characteristic for old age should be pointed out.
SchlüsselwörterMedizinstudenten-Altersbilder-Wissen zum Alter-Altern
KeywordsMedical students-Attitudes towards older people-Geriatric knowledge-Aging
Zeitschrift für Gerontologie + Geriatrie 04/2012; 42(5):365-371. · 0.61 Impact Factor
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ABSTRACT: A transplant represents a decisive event for patients and their caregivers. This article deals with the attitudes patients and their spouses have towards the transplantation.
In a cross-sectional study, 121 patients and their spouses were surveyed by questionnaire after a heart, lung, liver or kidney transplant. Attitudes were assessed by means of semantic differentials. Based on the results, an 'Attitudes towards Transplantation' Scale was developed. Sense of coherence (SOC-13), quality of life (Sf-36), quality of the relationship (RAS), burnout (BM) and the patient's emotional response to the transplant (TxEQ-D) were additional psychosocial variables measured in order to assess the association between the attitudes and psychosocial characteristics of transplant patients and their spouses.
The majority of patients and their spouses reported positive attitudes towards the transplant, including the attitudes towards medication, their perceived self and fate of being a transplant patient or spouse. Patients and spouses, however, had a negative attitude towards the transplantation in terms of stress and anxiety. Patients reported greater emotional stress from the transplant and rated their post-transplant perceived fate more negatively than their spouses. Attitudes towards the transplant were significantly associated with the sense of coherence and the quality of relationship.
The attitudes of patients and spouses to different aspects of the transplant itself and to being a transplant patient or spouse should be deliberately reconsidered and facilitated in the psychosocial counselling with regard to the comprehensibility, manageability and meaningfulness of the transplant experience as well as to potential conflicts in the partnership.
Schweizerische medizinische Wochenschrift 01/2012; 142:w13595. · 1.68 Impact Factor
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ABSTRACT: Sexual dysfunctions can adversely affect men's and women's satisfaction with life over a prolonged period. Besides sexual medicine services in primary medical care, in Switzerland there exist specialized consultation services at University Hospitals. The assessment of the case histories of three years (1980, 1990, and 2004) of the Sexual Medicine Consultation Service at Zurich University Hospital provided the following results: the most common disorders are lack/loss of libido in women and erectile dysfunction in men. Treatment options for sexual disorders have become more differentiated in recent years. The collaboration between the doctors making the referral and the sexual medicine specialists improved markedly between 1980 and 2004. After a diagnostic assessment and a primary treatment in the specialized consultation service, many patients are referred back to the referring doctors for further treatment. Basic and further training in sexual medicine ought to be intensified and improved.
Praxis 04/2010; 99(8):481-6.
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ABSTRACT: In recent years, distress and alexithymia have been recognised as psychosocial factors related to both somatic and psychosomatic diseases. In this study distress and alexithymia and their associations with physical parameters were investigated in lung recipients.
The study, which included 76 patients after a lung transplant, measured psychological distress (Symptom Checklist, SCL-K-9) and alexithymia (Toronto Alexithymia Scale, TAS-20). Physical health was assessed by means of lung function (FEV1), exhaled nitric oxide (eNO), and comorbidity (CCI) at the time of the questionnaire survey. A bronchiolitis obliterans syndrome (BOS) was assessed at the time of the questionnaire survey and one year later.
Mean values of distress were found to be significantly higher in lung recipients than in a normal community sample, and mean values of alexithymia were significantly higher in lung patients than in healthy persons. There is a significant positive correlation between distress and BOS at the time of the questionnaire survey (p = .008). Distress is a predictor for new-onset BOS one year after the questionnaire survey (p = .026). No significant correlations were found between alexithymia and physical parameters.
Lung transplants go hand-in-hand with increased alexithymia and psychological distress. In addition, psychological distress may contribute to the development of BOS. This association underlines the importance of psychosocial support after lung transplantation.
Schweizerische medizinische Wochenschrift 02/2010; 140(25-26):382-7. · 1.68 Impact Factor
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ABSTRACT: To date, there are hardly any studies on the choice of career path in medical school graduates. The present study aimed to investigate what career paths can be identified in the course of postgraduate training of physicians; what factors have an influence on the choice of a career path; and in what way the career paths are correlated with career-related factors as well as with work-life balance aspirations.
The data reported originates from five questionnaire surveys of the prospective SwissMedCareer Study, beginning in 2001 (T1, last year of medical school). The study sample consisted of 358 physicians (197 females, 55%; 161 males, 45%) participating at each assessment from T2 (2003, first year of residency) to T5 (2009, seventh year of residency), answering the question: What career do you aspire to have? Furthermore, personal characteristics, chosen specialty, career motivation, mentoring experience, work-life balance as well as workload, career success and career satisfaction were assessed. Career paths were analysed with cluster analysis, and differences between clusters analysed with multivariate methods.
The cluster analysis revealed four career clusters which discriminated distinctly between each other: (1) career in practice, (2) hospital career, (3) academic career, and (4) changing career goal. From T3 (third year of residency) to T5, respondents in Cluster 1-3 were rather stable in terms of their career path aspirations, while those assigned to Cluster 4 showed a high fluctuation in their career plans. Physicians in Cluster 1 showed high values in extraprofessional concerns and often consider part-time work. Cluster 2 and 3 were characterised by high instrumentality, intrinsic and extrinsic career motivation, career orientation and high career success. No cluster differences were seen in career satisfaction. In Cluster 1 and 4, females were overrepresented.
Trainees should be supported to stay on the career path that best suits his/her personal and professional profile. Attention should be paid to the subgroup of physicians in Cluster 4 switching from one to another career goal in the course of their postgraduate training.
Schweizerische medizinische Wochenschrift 01/2010; 140:w13056. · 1.68 Impact Factor
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ABSTRACT: Within the framework of organisational development, an assessment of the workplace experience of radiographers (RGs) was conducted. The aims of this study were to develop structural and interpersonal interventions and to prove their effectiveness and feasibility.
A questionnaire consisting of work-related factors, e.g. time management and communication, and two validated instruments (Workplace Analysis Questionnaire, Effort-Reward Imbalance Scale) was distributed to all RGs (n = 33) at baseline (T1). Interventions were implemented and a follow-up survey (T2) was performed 18 months after the initial assessment.
At T1, areas with highest dissatisfaction were communication and time management for ambulant patients (bad/very bad, 57% each). The interventions addressed adaptation of work plans, coaching in developing interpersonal and team leadership skills, and regular team meetings. The follow-up survey (T2) showed significantly improved communication and cooperation within the team and improved qualification opportunities, whereas no significant changes could be identified in time management and in the workplace-related scales 'effort' expended at work and 'reward' received in return for the effort.
Motivating workplace experience is important for high-level service quality and for attracting well-qualified radiographers to work at a place and to stay in the team for a longer period.
European Radiology 09/2009; 20(2):377-84. · 3.22 Impact Factor
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ABSTRACT: In the present study, 188 first year and 120 sixth year students of the University of Zurich were questioned about their attitudes towards older people, their knowledge concerning aging specific developments, their experiences with older people and their own expectations concerning old age. Structured and standardized questionnaires were used. The data were analyzed using univariate and multivariate statistical methods. The results show a positive image of old age independent of gender and point in time of education. Their positive experiences with older people and their positive expectations concern their own aging refer, above all, to their own mental health. For the transfer of gerontological and geriatric knowledge in the education of medical students, these mainly positive attitudes towards older people should be taken into account. Risk factors as well as protective factors concerning the development and treatment of diseases which are characteristic for old age should be pointed out.
Zeitschrift für Gerontologie + Geriatrie 08/2009; 42(5):365-71. · 0.61 Impact Factor
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ABSTRACT: Based on the Effort-Reward-Imbalance Model by Siegrist a study was undertaken to find out (a) in what way young doctors assess effort and reward during their specialist training; (b) whether there are certain job stress patterns over time; and (c) what the correlations are, if any, between perceived job stress, health and satisfaction with life.
Within the framework of a prospective study (2001 - 2007) 370 doctors who had just qualified and were residents in the German-speaking part of Switzerland were assessed four times by means of anonymized questionnaires. Job stress, measured by the Effort-Reward-Imbalance scale, as well as health and satisfaction with life were assessed in these doctors' 2nd (T2), 4th (T3), and 6th (T4) year of specialist training ("residents"). Stress patterns of the participants were evaluated, based on the effort and reward scale values at T2, T3, and T4, by two-step cluster analysis. Gender differences between the clusters were calculated by the 2 test and differences in the continuous variables by analysis of variance with repeated measurements.
During residency the percentage of doctors who experienced an Effort-Reward-Imbalance (ratio between effort and reward ERI > 1) increased from 18% at T2 to 20 % at T3 to 25 % at T4. The cluster analysis revealed two clusters: Type 1 (67%) with effort values below average and reward values above average (ER balance) across the three measurement points, and type 2 (33 %) with effort values above average and reward values below average (ER imbalance). Subjects in cluster 2 showed unfavorable values, when compared with those in cluster 1, in overcommitment, in workload and in the health variables (anxiety, depression, physical and psychological well-being), as well as in their assessed satisfaction with life at all three measurement points.
One third of the doctors experienced stress at work, caused by an effort-reward imbalance. This had a negative impact on their health and satisfaction with life. Regular supervision and goal-oriented career counselling provided by senior physicians could contribute to young doctors not feeling so much stressed at work, feeling well and being more content with their work.
DMW - Deutsche Medizinische Wochenschrift 12/2008; 133(47):2441-7. · 0.53 Impact Factor
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ABSTRACT: The objectives of this study are to investigate young physicians' career plans at the end of their residency, and to assess what factors contribute in their view to improve the image of family medicine/general practice and make it an attractive career goal.
As part of a prospective study on career determinants in young physicians, begun in 2001, 534 residents were asked in 2007 about their aspired to professional career, their planned model of private practice, arguments against or for family medicine/general practice, respectively, and factors to improve the attractiveness of the latter.
Of the study sample, 84 participants (42% men, 58% women) decided on family medicine (60% specialise in primary care, 40% in general internal medicine), 450 specialise in other medical specialties. Of the 534 study participants, 208 plan to work in a private practice, mostly in a group practice (88%). Of the future family physicians, 49% want to open their practice in an urban area, of the future specialists the respective number is 77%. Main reasons not to decide on family medicine are the uncertain development in health policy and the low income. The diversity of work, the broad spectrum of patients and the continuity in the doctor-patient relationship are named as factors in favour of family medicine. The possibility to run interdisciplinary group practices and better financial conditions are crucial factors to make family medicine an attractive career goal for young physicians.
Family medicine is still assessed as an interesting field, however, the conditions of work as a family physician/general practitioner have a deterrent effect on young physicians.
Das Gesundheitswesen 04/2008; 70(3):123-8. · 0.94 Impact Factor
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ABSTRACT: Sexual disorders are common in community samples. Even so these problems are not often addressed by primary care physicians. In 1980, 1990, and 2004 three cohorts of primary care physicians in the German speaking part of Switzerland were asked to answer a questionnaire on the prevalence of sexual problems and disorders in their patients and their knowledge in sexual medicine. The prevalence of sexual disorders in primary care is underestimated by primary care physicians. Female doctors and female patients address sexual problems more often than male doctors and patients. Lack of sexual interest and erectile dysfunction are the most frequent sexual disorders in primary care. In 2004 the participating doctors assess their knowledge in sexual medicine at a higher level compared to 1980. The training of primary care physicians in primary care should further be improved.
Praxis 06/2007; 96(18):721-5.
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ABSTRACT: Non-compliance is one of the crucial problems impairing outcome after transplantation. Fourteen lung transplant recipients were interviewed about their thoughts regarding transplant-related topics. Compliance was assessed by doctors. The psychological processing was investigated by content analysis. Highly compliant patients perceived more advantages by transplantation. In contrast, low-compliant patients reported either an emotional distance to the lung or a closer relationship to the donor. Furthermore, they showed a contradictory relationship to the medical staff. There are some indications that perception of advantages by transplantation is crucial to compliance. This experience takes place in the context of a good staff-patient relationship. Emotional distance to the lung or nearness to the donor are further contributing factors of non-compliance.
Psychology Health and Medicine 02/2007; 12(1):94-106. · 1.18 Impact Factor
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ABSTRACT: The number of patients in need of a liver transplant vastly exceeds the number of available organs; the demand worldwide for organs leads to increased waiting times and mortality of patients on the waiting list. The aim of our study was to assess the psychosocial well-being of transplant candidates and their need for psychosocial counselling.
Sixty-nine liver transplant candidates were asked about their psychosocial well-being, quality of life, spirituality, and need for counselling assessed by interview and questionnaire (HADS-D, FLZ, LOT, SOC, SF-36, SBI-15R) during the initial evaluation procedure for organ transplantation as well as 3 and 6 months after listing.
Candidates for a liver transplant exhibited a significant limitation in the levels of their quality of life and psychological well-being, compared with the community normal samples. They showed significantly higher levels of anxiety, but lower levels of spirituality. Almost half of the candidates (47%) expressed a need for counselling during the evaluation procedure. Patients with advanced diseases reported a lower need. Age and the personality-related "Sense of Coherence" correlated negatively with need for counselling. On the waiting list, psychosocial parameters and functions remained largely stable; the need for counselling decreased significantly.
There is a relevant need for psychosocial counselling during the process of liver transplant evaluation. Need for counselling is associated with personality and age, as well as with somatic parameters.
Transplantation Proceedings 12/2006; 38(9):2931-6. · 1.00 Impact Factor
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ABSTRACT: In order to improve perioperative subjective quality of care it seems desirable to shorten preoperative fasting times as much as possible within acceptable safety limits. These efforts should result in a measurable reduction of preoperative thirst and hunger as well as in improvements of patient well-being. It is unknown to what extent preoperative patient comfort is limited by thirst and hunger from a patient point of view. The purpose of this study was to determine the impact of a traditional fasting regimen on preoperative patient discomfort.
We conducted a survey on preoperative thirst and hunger in 412 adult American Society of Anesthesiologists ASA I and II patients scheduled for minor elective surgery.
Of the patients 33% complained of moderate to strong thirst, whereas 19% had moderate to strong hunger, 47% of the participants would have liked to have been able to drink and 72% would have appreciated a light breakfast before surgery. Mean preoperative fasting times were 12.8+/-3.4 h for fluids and 15.5+/-4.4 h for solids. "Thirst" was named by 3.3% and "hunger" by 0.8% of patients as the most important factor for preoperative discomfort but "long wait" (8.5%), "tenseness" (6.5%) and "anxiety" (4.8%) were the most frequently named factors. Answers were independent of the duration of preoperative fasting.
Patient comfort is compromised by traditional fasting rules and liberalization of these policies is desired by patients. However, efforts to reduce preoperative anxiety and tenseness might have an additional, important potential to improve perioperative quality of care from a patient's perspective.
Der Anaesthesist 07/2006; 55(6):643-9. · 0.99 Impact Factor
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ABSTRACT: HintergrundMit dem Ziel der subjektiven perioperativen Qualittsverbesserung scheint es wnschenswert, die properativen Nchternzeiten im Rahmen der als sicher geltenden Grenzen so kurz als mglich zu halten. Diese Manahmen sollten mit einer messbaren Verminderung von properativem Hunger und Durst einhergehen und v.a. in einer Verbesserung der properativen Befindlichkeit resultieren. Welchen Einfluss Durst und Hunger aus Patientensicht auf den properativen Komfort haben, ist jedoch weit gehend unbekannt. Ziel dieser Studie war es, das Ausma der Beeintrchtigung der Patienten durch eine traditionelle Nchternheitsregelung abzuschtzen.Patienten und MethodenEin Kollektiv von 412Patienten der American-Society-of-Anesthesiologists- (ASA-)RisikoklassenI und II, das sich einem kleineren chirurgischen Eingriff unterzog, wurde mithilfe eines Fragebogens zum Ausma und Stellenwert von properativem Durst und Hunger befragt.ErgebnisseEs hatten 33% der Patienten migen oder starken Durst, 19% migen bis starken Hunger. Von den Befragten mchten 47% vor der Operation noch trinken, 72% htten gern noch ein leichtes Frhstck eingenommen. Die mittlere Nchternzeit war 12,83,4h fr Flssigkeiten und 15,54,4h fr Essen. Durst wurde von 3,3% und Hunger von 0,8% der Patienten als Hauptgrund fr die Beeintrchtigung des properativen Wohlbefindens genannt. Das lange Warten (8,5%), Nervositt (6,5%) und Angst (4,8%) wurden am hufigsten genannt. Die Antworten waren unabhngig von der Zeitdauer der properativen Nchternheit.SchlussfolgerungDer Patientenkomfort ist durch eine traditionelle Nchternheitsregelung beeintrchtigt, und Minimierung der properativen Nchternzeiten wird von den Patienten gewnscht. Anstrengungen mit dem Ziel der Reduktion von properativer Angst und Nervositt bergen jedoch zustzliches groes Potenzial fr eine Steigerung der perioperativen Behandlungsqualitt aus Sicht der Patienten.BackgroundIn order to improve perioperative subjective quality of care it seems desirable to shorten preoperative fasting times as much as possible within acceptable safety limits. These efforts should result in a measurable reduction of preoperative thirst and hunger as well as in improvements of patient well-being. It is unknown to what extent preoperative patient comfort is limited by thirst and hunger from a patient point of view. The purpose of this study was to determine the impact of a traditional fasting regimen on preoperative patient discomfort.Patients and methodsWe conducted a survey on preoperative thirst and hunger in 412 adult American-Society-of-Anesthesiologists ASA I and II patients scheduled for minor elective surgery.ResultsOf the patients 33% complained of moderate to strong thirst, whereas 19% had moderate to strong hunger, 47% of the participants would have liked to have been able to drink and 72% would have appreciated a light breakfast before surgery. Mean preoperative fasting times were 12.83.4h for fluids and 15.54.4h for solids. Thirst was named by 3.3% and hunger by 0.8% of patients as the most important factor for preoperative discomfort but long wait (8.5%), tenseness (6.5%) and anxiety (4.8%) were the most frequently named factors. Answers were independent of the duration of preoperative fasting.ConclusionPatient comfort is compromised by traditional fasting rules and liberalization of these policies is desired by patients. However, efforts to reduce preoperative anxiety and tenseness might have an additional, important potential to improve perioperative quality of care from a patients perspective.
Der Anaesthesist 05/2006; 55(6):643-649. · 0.99 Impact Factor
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ABSTRACT: The new Volumetric Ejection Fraction monitoring system (VoLEF), when combined with the Pulse Contour Cardiac Output monitoring system (PiCCO) system, allows measurement of left and right heart end-diastolic volumes by thermodilution. The aim of this study was to evaluate whether the left heart end-diastolic volume index determined by the VoLEF system (LHEDI) better reflects left ventricular end-diastolic area index (LVEDAI) measured by transoesophageal echocardiography than does global end-diastolic volume index (GEDI) measured by the PiCCO system alone. Following induction of anaesthesia, PiCCO, VoLEF and transoesophageal echocardiography measurements were performed before and after a fluid challenge in 20 patients scheduled for elective cardiac surgery. Both left ventricular end-diastolic area index and global end-diastolic volume index, but not left heart end-diastolic volume index, significantly increased after fluid administration. Mean bias +/- 2 SD for DeltaLHEDI-DeltaLVEDAI was -2.2 +/- 32.0% and for DeltaGEDI-DeltaLVEDAI -0.6 +/- 16.8%. In contrast to global end-diastolic volume index, the use of left heart end-diastolic volume index determined by the VoLEF system cannot be recommended as an estimate of left ventricular preload.
Anaesthesia 05/2006; 61(4):316-21. · 2.96 Impact Factor
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ABSTRACT: During cardiopulmonary bypass (CPB), measurement of kaolin-based activated clotting time (kACT) is a standard practice in monitoring heparin-induced anticoagulation. Despite the fact that the kACT test from the Sonoclot Analyzer (SkACT) has been commercially available for several years, no published data on the performance of SkACT are available. Thus, the aim of this in vitro study was to compare SkACT with an established kACT from Hemochron (HkACT).
Blood was withdrawn from 25 patients before elective cardiac surgery. SkACT and HkACT were measured in duplicate after in vitro administration of heparin (0, 1, 2 and 3 U/ml), calcium-free lactated Ringer's solution (25% and 50% haemodilution) and aprotinin (200 kIU/ml).
A total of 600 duplicate kACT measurements were obtained from 25 cardiac surgery patients. Overall, mean bias +/- SD between SkACT and HkACT was 7 +/- 70 s (1.3% +/- 14.1%). Administration of heparin, haemodilution and aprotinin induced a comparable effect on both activated clotting time (ACT) tests. Mean bias ranged from -4 +/- 39 s (-1.7% +/- 12.9%) to 4 +/- 78 s (3.2% +/- 15.6%) for heparinzed blood samples after haemodilution or aprotinin application and increased after combined aprotinin administration and haemodilution. After haemodilution and administration of aprotinin, both ACT tests were less reliable for values >480 s in heparinized blood samples.
Accuracy and performance of SkACT and HkACT were comparable after in vitro administration of heparin, aprotinin and haemodilution. Both ACT tests were considerably affected by aprotinin and haemodilution.
Acta Anaesthesiologica Scandinavica 04/2006; 50(4):461-8. · 2.19 Impact Factor
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ABSTRACT: Sexual dysfunctions are common among the general population. An essential part of the assignments to specialized sexual medicine care units are from primary care physicians.
In 2002 to 2004 for a period of 18 months questionnaires were given to all patients, who attended the special sexual medicine care unit at the University Hospital of Zurich for the first time. At the beginning of their treatment, the patients were questioned about different psychosocial characteristics and aspects of their sexuality.
We studied 43 women (48.3%) and 46 men (51.7%). Women were with an average age of 33.8 years 10 years younger than men, 43.5 years. The most common sexual dysfunction in women was lack or loss of sexual desire (51.2%), followed by nonorganic vaginism (20.9%) and orgasm disorders (11.6%), in men erectile dysfunction (50.0%), followed by premature ejaculation (26.1%) and lack or loss of sexual desire (15.2%). The studied subjects showed distinctively lower values in their sense of coherence than men and women in the general population. The patients were much more anxious than people in the average population. The questioned men were also much more depressive than men in the general population and than the examined women. The examined men reported sexual wishes, needs and sexual activities significant more frequently than the examined women.
As men and women with sexual dysfunctions are much more anxious than people from the general population, physicians should address sexual themes in the conversations with their patients carefully but actively.
Praxis 03/2006; 95(7):226-31.
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ABSTRACT: End-diastolic volume indices determined by transpulmonary thermodilution and pulmonary artery thermodilution may give a better estimate of left ventricular preload than pulmonary capillary wedge pressure monitoring. The aim of this study was to compare volume preload monitoring using the two different thermodilution techniques with left ventricular preload assessment by transoesophageal echocardiography (TOE).
Twenty patients undergoing elective cardiac surgery with preserved left-right ventricular function were studied after induction of anaesthesia. Conventional haemodynamic variables, global end-diastolic volume index using the pulse contour cardiac output (PiCCO) system (GEDVI(PiCCO)), continuous end-diastolic volume index (CEDVI(PAC)) measured by a modified pulmonary artery catheter (PAC), left ventricular end-diastolic area index (LVEDAI) using TOE and stroke volume indices (SVI) were recorded before and 20 and 40 min after fluid replacement therapy. Analysis of variance (Bonferroni-Dunn), Bland-Altman analysis and linear regression were performed.
GEDVI(PiCCO), CEDVI(PAC), LVEDAI and SVI(PiCCO/PAC) increased significantly after fluid load (P<0.05). An increase >10% for GEDVI(PiCCO) and LVEDAI was observed in 85% and 90% of the patients compared with 45% for CEDVI(PAC). Mean bias (2 SD) between percentage changes (delta) in GEDVI(PiCCO) and deltaLVEDAI was -3.2 (17.6)% and between deltaCEDVI(PAC) and deltaLVEDAI -8.7 (30.0)%. The correlation coefficient (r2) for deltaGEDVI(PiCCO) vs deltaLVEDAI was 0.658 and for deltaCEDVI(PAC) vs deltaLVEDAI 0.161. The relationship between deltaGEDVI(PiCCO) and deltaSVI(PiCCO) was stronger (r2=0.576) than that between deltaCEDVI(PAC) and deltaSVI(PAC) (r2=0.267).
GEDVI assessed by the PiCCO system gives a better reflection of echocardiographic changes in left ventricular preload, in response to fluid replacement therapy, than CEDVI measured by a modified PAC.
BJA British Journal of Anaesthesia 06/2005; 94(6):748-55. · 4.24 Impact Factor
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ABSTRACT: The aim of this prospective randomized trial was to evaluate the efficacy of 3 intraoperative warming systems (Warm-Touch, Thermamed SmartCare OP system, and Allon 2001) on maintenance of normothermia and to investigate their effects on perioperative bleeding and transfusion requirements in patients undergoing off-pump coronary artery bypass grafting.
With institutional approval/patient informed consent, 90 patients presenting for elective multiple off-pump coronary artery bypass grafting were randomly assigned to 1 of the 3 warming systems. Active warming was started after the induction of anesthesia. Perioperative transfusion was based on international guidelines. Body core temperature was recorded every 30 minutes during operation. Perioperative blood loss, autotransfusion, and allogenic transfusions were recorded. Analysis of variance was performed with post hoc Scheffé tests and chi 2 tests.
Normothermia could be sufficiently maintained during operation by the Allon 2001 only. Final body core temperature was 34.7 degrees C +/- 0.9 degrees C (Warm-Touch), 35.6 degrees C +/- 0.8 degrees C (Thermamed SmartCare OP), and 36.5 degrees C +/- 0.4 degrees C (Allon 2001; P < .001, Warm-Touch vs Thermamed SmartCare OP, Warm-Touch vs Allon 2001, and Thermamed SmartCare OP vs Allon 2001). Perioperative blood loss was 2683 +/- 1049 mL (Warm-Touch), 2300 +/- 788 mL (Thermamed SmartCare OP), and 1497 +/- 497 mL (Allon 2001; P = .195, Warm-Touch vs Thermamed SmartCare OP; P < .001, Warm-Touch vs Allon 2001; P = .001, Thermamed SmartCare OP vs Allon 2001). Transfusion requirements were 1097 +/- 874 mL (Warm-Touch), 986 +/- 744 mL (Thermamed SmartCare OP), and 431 +/- 387 mL (Allon 2001; P = .838, Warm-Touch vs Thermamed SmartCare OP; P = .003, Warm-Touch vs Allon 2001; P = .013, Thermamed SmartCare OP vs Allon 2001). Free of allogenic transfusion were 15 (51.7%; Warm-Touch), 18 (60%; Thermamed SmartCare OP), and 24 (82.8%; Allon 2001) patients ( P = .037).
The goal of normothermia during off-pump coronary artery bypass grafting was best achieved by the Allon system. With this concept, overall blood loss and transfusion requirements were reduced, hence indicating improved quality of perioperative care.
Journal of Thoracic and Cardiovascular Surgery 04/2005; 129(4):838-43. · 3.41 Impact Factor
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ABSTRACT: This prospective survey aimed at elucidating the patients' expectations and needs regarding the pre-anaesthetic visit and the forthcoming anaesthesia. The same questionnaire was answered by both patients and anaesthesiologists.
A total of 200 ASA I-III patients were interviewed prior to the preoperative anaesthetic visit. The questionnaire consisted of the topics preoperative affective situation, information and self-estimation of anaesthesia knowledge, expectations regarding the pre-anaesthetic visit/anaesthesia and extent of information concerning the perioperative course including risk and possible complications. The same questionnaire was presented to 35 certified anaesthesiologists with the request to estimate the patients' answers. Answers were rated using a Likert-scale, a comparison of patients' and anaesthesiologists' replies was performed.
For all 5 topics considerable differences between patients' answers and anaesthesiologists' rating were found (e.g. for the assessment of the affective situation, the relevance of family physicians as information source, the desired anaesthetic technique or the extent of anaesthesia-related risk information). No differences were observed for the importance of an anaesthesiologist as information source and fear reduction by the pre-anaesthetic visit.
Anaesthesiologists tend to misinterpret many patients' expectations and attitudes. The results demonstrate the potential for quality improvement of the pre-anaesthetic visit.
Der Anaesthesist 12/2004; 53(11):1061-8. · 0.99 Impact Factor
