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Biomedical subjects

G Schüpfer

Publications and source records attributed to G Schüpfer.

At least 19 recordsLinked to original sources
PubMed2006

[The Gini coefficient. A numerical grading for the degree of standardization of surgical subspecialities].

BACKGROUND AND GOAL: General hospitals are under pressure especially under payment by DRGs (diagnosis related groups), therefore, a general trend for specialized surgical centers is obvious. For this reason knowledge of the level of standardization is important and allows strategical management of surgical subspecialties. MATERIALS AND METHODS: The Gini coefficient (GC, range: 0-1) is a measurement of the level of standardization when an economical ABC analysis is performed. Low GC values are typical for low levels of standardization. All surgical cases coded by ICD-9-CM in 1 of the 8 central operation rooms in a Swiss general teaching hospital over a period of 30 months were included. The database was analyzed by the ABC method. Due to the ABC analysis the GC for each speciality was specified. RESULTS AND DISCUSSIONS: In data period 1 a total of 11,573 and in data period 2 3,449 operations done by 7 specialities were evaluated. The GC for the Pareto distribution was 0.86. Neurosurgery had a value of only 0.34, which means that nearly every operation was unique. The highest level of standardization was reached by vascular surgery with a GC of 0.68. Compared with other industries the degree of standardization in our general hospital is low as measured by the GC. CONCLUSIONS: The GC is a valuable and objective measurement of the different procedures and standardization of surgery of given surgical subspecialties. It can be calculated from the operation room management (ORM) database and allows an objective analysis of the variety of surgical procedures per subspecialty. In this study the GC was implicated in an ORM setting for the first time.

Algorithms↗
PubMed2006

[Operation room management in quality control certification of a mainstream hospital].

We report the results of our study concerning the organisation of operating room (OR) capacity planned 1 year in advance. The use of OR is controlled using 2 global controlling numbers: a) the actual time difference between the expected optimal and previously calculated OR running time and b) the punctuality of starting the first operation in each OR. The focal point of the presented OR management concept is a consensus-oriented decision-making and steering process led by a coordinator who achieves a high degree of acceptance by means of comprehensive transparency. Based on the accepted running time, the optimal productivity of OR's (OP_A(%) can be calculated. In this way an increase of the overall capacity (actual running time) of ORs was from 40% to over 55% was achieved. Nevertheless, enthusiasm and teamwork from all persons involved in the system are vital for success as well as a completely independent operating theatre manager. Using this concept over 90% of the requirements for the new certification catalogue for hospitals in Germany was achieved.

Certification↗
PubMed2005

[Impact and risks of cost cutting programs on the quality of hospital care in Switzerland].

Cost-minimization programs in Switzerland either in the public or the private sector have impact on quality and accessibility of the health care system. Rationalization may induce in fact hidden rationing of care and increases the workload of the health care workers involved. The relation of hospital staffing to inpatient quality of care are important issues. The reduction of funds may place patients at risk, due to lower staffing levels. Patient to nurses ratio have a substantial effect on inpatient mortality and nurse burnout. Research in Switzerland is needed to define the measurement of the nursing case mix on the basis of discharge data and to elucidate the factors influencing the staffing levels of nurses and the mix of nursing personnel in hospitals. Due to reduced funding the ability of hospitals to handle emergency cases may be compromised. The impact on quality and risks of unreflected cost minimization programs in hospitals but also the whole health care system are important and worth of public notice. Possible solutions for a health care reform in Switzerland are outlined and discussed.

Cost Control↗
PubMed2005

[Controlling systems for operating room managers].

Management means developing, shaping and controlling of complex, productive and social systems. Therefore, operating room managers also need to develop basic skills in financial and managerial accounting as a basis for operative and strategic controlling which is an essential part of their work. A good measurement system should include financial and strategic concepts for market position, innovation performance, productivity, attractiveness, liquidity/cash flow and profitability. Since hospitals need to implement a strategy to reach their business objectives, the performance measurement system has to be individually adapted to the strategy of the hospital. In this respect the navigation system developed by Gälweiler is compared to the "balanced score card" system of Kaplan and Norton.

Cost Control↗
PubMed2005

[Teamwork in the operating theatre. Effect on quality of decision-making].

German hospitals face growing economic pressure. Due to the reimbursement system with diagnosis-related groups (DRGs), revenues from capitation fees have to be earned by each clinic. This leads to minimization of resources for every single case. Cost effectiveness is also realised through shorter hospital stays, reduction of hospital beds and a steady rise in cases per year. As a consequence, all employees are confronted with an increasing workload. Compensation of these working conditions can be achieved by human engineering. Despite statements from politicians and hospital leadership in order to cope with this situation, reality is far away: overwork, shorter or missing recreation periods, pressure of time and low income of staff members have turned hospitals into a deterring workplace. If satisfaction of elementary needs such as adherence to break times, is not achieved shortly, politicians and hospital leadership will find out that without motivated and satisfied staff there will not be efficient performance. The present article addresses this issue and gives examples for increasing efficiency through motivation. Focus is on cooperation in the operation room, advantages and risks of teamwork and auxiliary measures for improvement. The aim is to underline how complex and fragile working in an operation room proceeds and how little is done to support this process. Finally, examples are described which improve teamwork, motivation, efficiency and efficacy.

Cost-Benefit Analysis↗
PubMed2004

Estimation of myocardial performance in CABG patients.

Myocardial performance index (MPI) permits a relative easy estimation of global left ventricular (LV) systolic and diastolic function. It was shown that MPI inversely correlated strongly with the maximum derivative of LV pressure with respect to time (+dP/dtmax). The current study evaluated the change of MPI during and immediately after coronary artery bypass surgery (CABG) surgery and analyzed the relationship between MPI and hydraulic energy (exemplified by preload adjusted maximal power-PAMP) during that same period. The study was conducted in 45 patients undergoing CABG. After induction of anaesthesia, 10 min after revascularization and 2 h postoperatively, haemodynamics were assessed. Preload was characterized by LV end-diastolic area indexed for BSA (LVEDAI); afterload was estimated by arterial elastance (Ea) and indexed systemic vascular resistance (SVRI). Global myocardial performance was indicated in terms of MPI and contractility was achieved by PAMP. Myocardial performance index increased postoperatively (0.44 +/- 0.13, 0.37 +/- 0.17 and 0.50 +/- 0.16, respectively; P < 0.001). Preload adjusted maximal power did not alter significantly (1.90 +/- 1.24, 2.02 +/- 1.34 and 2.12 +/- 1.00 W cm(-2)*10(4), respectively). Left ventricular enddiastolic area indexed did not change. Arterial elastance augmented to 0.76 +/- 0.39, 0.80 +/- 0.40 and 1.01 +/- 0.43 mmHg ml(-1), respectively; P < 0.001. Systemic vascular resistance did not change. A relationship was found between 1-MPI/LVEDAI2 and PAMP (R2 = 0.50). This study shows that in the setting of CABG surgery, MPI appears to be a good measure of global LV function.

Aged↗
PubMed2001

[Tracheal rupture: delayed diagnosis with endobronchial intubation].

Tracheobroncheal rupture is a rare complication of intubation techniques using a stylet. In this case report the patient was intubated by an emergency physician in a preclinical setting after a motor vehicle accident. Iatrogenic tracheal laceration was masked by inappropriate position of the endobronchial tube. By chance ventilation was maintained to both lungs by flow through the Murphy's eye of the tube and the lumen of the tube. In correcting the deep tube position after a chest x-ray laceration of the trachea was unmasked and ventilation problems occurred immediately. The tube was replaced under fiberoptical control and the patient was managed for surgical repair using a jet ventilation technique. In this case two complications of endobronchial intubation occurred, but the deep tube placement opposed the effects of the tracheal laceration. This was probably life saving for the patient during emergency transfer by helicopter after the accident. The anaesthesiological management during tracheal repair is discussed.

Accidents, Traffic↗
PubMed2001

[Postpartum neurologic complications following delivery with peridural analgesia. Case report with literature review].

Regional analgesia provides effective pain relief during delivery. Postpartal neurological deficits may be due to pressure of the fetal head on nerve structures at the pelvic rim or may be a complication of epidural analgesia. Nerve injuries due to spontaneous delivery and instrumental delivery are much more common than neurological deficits from epidural analgesia such as epidural hematoma or epidural abscess. The pattern of nerve damage is usually unilateral and non segmental. This case report describes the differential diagnosis of neurological deficit after spontaneous delivery under epidural analgesia and a discussion of the recent literature. Finally recommendations for the treatment of neurological deficits after delivery under epidural analgesia are presented.

Adult↗
PubMed2000

Age does not influence early and late tumor-related outcome for bronchogenic carcinoma.

BACKGROUND: The influence of age on early and late outcome after surgical resection of bronchogenic carcinoma is unknown. In an attempt to clarify this issue, we reviewed the outcome of 212 consecutive patients with primary lung cancer who had surgical treatment for bronchogenic carcinoma. METHODS: Ninety-two patients were younger than 50 years (group 1), and 120 patients were older than 70 years of age (group 2). Squamous cell carcinoma and adenocarcinoma were the most common histologic types in both groups. According to the new international staging classification, a similar proportion of stage I, II, and III were observed in both groups. RESULTS: Only the rate of pneumonectomy was significantly higher in younger patients (41% versus 22%, p = 0.002). The overall operative mortality rate in group 1 was 2.2% and 2.6% after pneumonectomy. In group 2 the overall mortality rate was 2.5% and 3.8% after pneumonectomy. Advanced age did not affect operative mortality. The adjusted (tumor-related) survival rate at 5 years was 56% in group 1 and 53% in group 2 (p = 0.93). The adjusted survival rate for patients with stage I was 61% in group 1 and 65% in group 2 (p = 0.21), and for stage IIIa 39% in group 1 and 48% in group 2 (p = 0.43). The adjusted 5-year survival rate was 56% in group 1 and 59% in group 2 for squamous cell carcinoma (p = 0.53) and 49% in group 1 and 42% in group 2 for adenocarcinoma (p = 0.76). CONCLUSIONS: Perioperative risk and midterm survival were similar in younger and older patients after surgical resection of bronchogenic carcinoma. We believe that this result is because surgical candidates constitute already a highly selected group of patients. From these data it is not possible to conclude that biologic behavior of lung cancer is more aggressive in younger patients.

Adult↗
PubMed1999

[Operating room management].

The changing health care climate has triggered important changes in the management of high cost components of acute care facilities. By integrating and improving management of various elements of the surgical process, health care institutions are able to rationally trim costs while maintaining high-quality services. If the results of surgery are viewed as a product, everything associated with surgery can be evaluated as one would a manufacturing process. All steps involved in producing the end result can and should be analyzed with the goal of producing an efficient, economical and quality product. The leadership that physicians can provide is crucial to the success of this undertaking. The role of the anesthesiologist in the management of the operating room setting (OR) has gained broad acceptance because: a) it contributes to the effort of a larger team process; b) the anesthesiologist ordinarily practices in the OR setting; and c) the anesthesiologist can view the priorities of the OR in an unbiased manner. Many of the successful concepts in managing an OR are just common sense. The single best opportunity for dramatic improvement in effective resource use in Surgical Services lies in the perioperative process. The management strategy must focus on process-measurement using information technology and feedback implementing modern quality management tools. The impact of new treatments, drugs, devices and process changes can be assessed rationally.

Appointments and Schedules↗
PubMed1998

[Insulin as an anabolic: hypoglycemia in the bodybuilding world].

Excessive body building may be dangerous. To promote athletic performance and to improve physical appearance many of the body builders abuse anabolic-androgenic steroids and other drugs. The abuse of insulin as an anabolic medication in this athletic community was followed by a case of severe hypoglycaemia in a body builder. A 30-year old male presented with cerebral symptoms of hypoglycaemia. Directly before an international competition he tried to stimulate muscle growth by using the hypoglycaemic stimulus to the growth hormone. To achieve this he injected 70 IE of a short-acting insulin subcutaneously, resulting in severe hypoglycaemia. After the initial administration of intravenous glucose by the paramedics, he lost consciousness and showed signs of convulsions. After orotracheal intubation by an emergency physician, despite of ongoing infusion of glucose the blood glucose concentration remained low as measured in the out-of-hospital setting. Finally administration of additional glucose and glucagon in the intensive care unit was able to stabilize the metabolic system. In any case of severe hypoglycaemia, repetitive measurements of blood glucose even in the prehospital setting should be performed to detect the hypoglycaemia especially if athletes are concerned.

Adult↗
PubMed1998

Learning manual skills in anesthesiology: Is there a recommended number of cases for anesthetic procedures?

UNLABELLED: The learning process is a multidimensional function with a wide intra- and interindividual scattering. To determine the learning process in anesthesia, we evaluated 11 first-year residents according to their rate of success or failure when applying manual anesthesiological skills, such as performance of spinal, epidural, or brachial plexus anesthesia and tracheal intubation or insertion of an arterial line. Epidural anesthesia was the most difficult procedure (P < 0.05). Significant differences were found between epidural anesthesia and tracheal intubation (P < 0.05), insertion of an arterial line (P < 0.05), and brachial plexus block (P < 0.05), as well as between spinal anesthesia and orotracheal intubation (P < 0.05). Learning curves are a valid tool for monitoring institutional and individual success. IMPLICATIONS: To investigate the learning process in anesthesia, typical anesthetic procedures were performed by inexperienced residents during their first year. Learning curves were generated for each procedure performed. Epidural anesthesia was the most difficult procedure to perform (P < 0.05).

Anesthesia, Epidural↗
PubMed1998

Comparing the enzyme allergosorbens and coated allergen particle tests for latex allergy: which in vitro test should be chosen by an anesthesiologist?

UNLABELLED: To determine sensitivity and specificity of the enzyme allergosorbens test (EAST) and the coated allergen particle Test (CAP) in detecting specific antibodies against latex, we compared these two methods in a previously investigated sample of an epidemiological study among our anesthesia staff. One hundred one blood samples were tested with EAST and CAP for specific antibodies against latex. Skin test results were used as references. CAP was more sensitive in detecting sensitized individuals than EAST (56% vs 18.8%). Two additional persons with previously negative skin tests were detected. These results suggest that the EAST system is not as sensitive as the CAP system. Therefore, the CAP system should be preferred for the in vitro diagnosis of latex allergy. IMPLICATIONS: Testing for latex allergy requires time-consuming and technically difficult tests. Easy to perform in vitro tests for latex allergy are desirable. Our results indicate that the coated allergen particle test is more sensitive and easy to use than the enzyme allergosorbens test.

Anesthesiology↗