Biomedical subjects

J Barwing

Publications and source records attributed to J Barwing.

5 recordsLinked to original sources

PubMed2007

[Teaching and simulation. Methods, demands, evaluation and visions].

Since 1st October 2003 the new German "Approbationsordnung für Arzte" (Medical Licensing Regulations) requires an increasing amount of small group teaching sessions and encourages a multidisciplinary and more practical approach to the related topics. In 2004 the German Society of Anaesthesiology and Intensive Care Medicine has provided almost all anaesthesia faculties of German Universities with equipment for full-scale simulation. This article describes methods for a simulation-based medical education training program. Basic requirements for a successful training program using full scale simulators are the provision of an adequate logistical and material infrastructure, teacher attendance of train-the-trainer courses, implementation in the medical curriculum and an instructor-student ratio of 1:3, equivalent to that for bedside teaching. If these requirements were fulfilled, medical students scored the simulation scenarios "induction of anaesthesia", "acute pulmonary embolism", "acute management of a multiple trauma patient" and "postoperative hypotension" as 1.5, 1.6, 1.5 and 1.5, respectively, on a scale of 1-6. These scores were better than those given for other segments of the curriculum.

Anesthesia↗

PubMed2005

[Simulation and airway management].

Despite the development of new devices and strategies to manage and secure the difficult airway, morbidity and mortality in anaesthesia due to airway problems such as difficult intubation or unrecognised failed intubation remain high. The problem seems to lie in the transfer of skills and strategies to daily clinical practice. Common methods for airway management training include theoretical instructions and hands-on sessions with manikins, animal models and cadavers. Simulation provides the opportunity to train skills and resolve specific situations embedded in a realistic scenario, facilitate the transfer of cognitive, psychomotor and affective abilities into daily clinical practice and help to improve behaviour in critical situations. This article outlines new training concepts in airway management with the help of simulation and simulators. We describe technical prerequisites and provide information on the implementation of difficult airway scenarios.

Anesthesiology↗

PubMed2005

[New pathways in undergraduate medical education - first experiences with the cross section speciality emergency and intensive care medicine].

OBJECTIVE: On October 1 (st) 2003 Emergency Medicine was recognised for the first time as an independent cross section speciality in the new German "Approbationsordnung fuer Aerzte" (Medical Licensing Regulations). These amendments were made not only to increase the amount of small group teaching sessions but also to encourage a multidisciplinary and rather practical approach to the related topics. This article portrays the realisation of these objectives in form of a multidisciplinary module, as it has been established at University of Göttingen Medical School since the summer semester of 2004. We present the new curriculum, calculate the associated personnel resources and demonstrate the results of the structured evaluation given by the participating students. METHODS: We linked the fields of emergency and intensive care medicine by splitting them up into submodules which the students had to run through according to a set rota. 162 students were allocated to 27 small groups. Every student received a total of 38.5 hours of teaching, with the workshops coming to 46.8 %. The workshops comprised of nine sessions, three in Emergency Medicine, four in Intensive Care Medicine and two at human patient simulators. In addition we scheduled a seminar and an accompanying lecture. The final examination was performed as an Objective Structured Clinical Evaluation (OSCE). RESULTS: The realisation of the new module required a total of 1290 working hours for medical staff and 130 for our student aids. Compared to all other modules of Goettingen University Medical School the module here presented obtained the highest overall evaluation score by the medical students. Lessons with a high amount of practical involvement (i. e. Emergency Medicine and simulator-based workshops) were significantly better evaluated than rather formal teaching techniques, such as the lectures and the seminar. According to the students' self-assessment the simulator-based workshops were seen particularly valuable for the facilitation of knowledge transfer into clinical practice. CONCLUSION: The determined realisation of the new German Medical Licensing Regulations requires considerable time resources. However, its evaluation by the medical students is strikingly positive.

Anesthesiology↗

PubMed2004

[Lactic acidosis and acute abdomen from biguanide intoxication].

Metformin, an anti-hyperglycaemic drug, reduces mortality in obese patients with a non-insulin-dependent diabetes mellitus type II (United Kingdom Prospective Diabetes Study) and is therefore recommended as the first line therapy. A metformin-associated lactic acidosis due to accumulation or intoxication is a rare but severe complication with a mortality rate of up to 50%. The main clinical symptoms are unspecific and the patient may present with acute abdominal pain and reduced consciousness. This can easily be misinterpreted and may lead to a wrong diagnosis. Only a thorough clinical examination and exact analysis of laboratory values in combination with the medical history and chronic medication will allow a correct diagnosis. We report a case of a 79-year-old female patient whose clinical symptoms were initially interpreted as an acute intestinal ischemia. A progressively deteriorating haemodynamic state led to an exploratory laparotomy. Postoperatively, the correct diagnosis of a metformin-associated lactic acidosis due to acute renal failure was made. In the course of the ICU stay the condition improved after bicarbonate haemodialysis and the patient was discharged 11 days after admission.

Abdomen, Acute↗

PubMed1999

[Blood gas analysis in interhospital transfer--a useful extension of respiratory monitoring?].

OBJECTIVE: Investigation of blood gas analysis during hospital-to-hospital transport of ventilated ICU-patients to detect critical events, changes of gas exchange and reliability of non-invasive monitoring. METHODS: 47 ventilated patients (age 9-76 years, mean 50 years, diagnosis: ARDS = 16, intracranial bleeding = 14, severe trauma = 4, acute hemodynamic failure = 3, others = 10), transported by a special physician staffed intensive care ambulance using invasive hemodynamic monitoring. Blood gas analysis was performed before and during transport every 30 minutes and respirator mode, vital signs and events were documented. RESULTS: In 19 (40.4%) patients there were critical events during transport (paO2 < 70 mmHg, paCO2 < 25 mmHg, paCO2 > 55 mmHg, pH < 7.30, pH > 7.55). In 4 patients with PaO2 < 70 mmHg there was SpO2 > or = 97% (by pulsoximetry), correlation between SaO2 (invasive) and SpO2 (by pulsoximetry) was r = 0.81 (P < 0.001) with a maximum difference of 8 percent. In several patients critical changes of condition could be recognized in an early stage by blood gas analysis. CONCLUSIONS: Blood gas analysis during hospital-to-hospital transport of ICU-patients can be performed easily and allows to optimize artificial ventilation and to recognize earlier and safer severe problems of gas exchange.

Adolescent↗