Did we learn the lesson after 60 years of Management by Objectives? A survey among former physician executives in German hospitals.

Background: Management by Objectives (MbO) has been shown to establish efficient team work in both industry and medicine. Its most important prerequisite for success is target agreements between managers and medical professionals on equal footing. In medicine, lump-sum financing urges the delivery of a health care service with minimal effort.

Prone positioning in the elderly extends perioperative process times: a retrospective analysis.

Cervical bone fractures describe a predominant trauma in the elderly. With demographic change, prone patient positions might create further stress on personnel resources. Therefore, the aim of this study was to conduct an age-related analysis of pre- and intraoperative process times in patients with cervical fractures.

Pre-anesthetic assessment with three core questions for the detection of obstructive sleep apnea in childhood: An observational study.

Background: Children with obstructive sleep apnea are at high risk for perioperative airway obstruction. Many "at risk" children may remain unrecognized. The aim of this study is to find a clinically practicable test to identify obstructive sleep apnea in childhood.

The impact of economic rationalization, prioritization and rationing on job satisfaction, motivation and team cohesion in hospitals: a survey among retired physician executives in Germany.

Background: The growing economization of the health care system and implication of market principles in the medical field have risen new and serious questions on the meaning of the medical profession, the doctor-patient relationship and the orientation of medicine itself. The impact of the dynamic clinical structures on the doctor-doctor and the doctor-patient interaction appear even unpredictable. Therefore, the impact of market-based methods, i.

Ethical challenges for medical professionals in middle manager positions: a debate article.

Background: Demographic changes increase the financing needs of all social services. This change also generates new and complex demands on the medical staff. Accordingly, medical professionals in middle management positions hold a characteristic sandwich position between top management and the operational core.

Case report of a medication error by look-alike packaging: a classic surrogate marker of an unsafe system.

Background: The acronym LASA (look-alike sound-alike) denotes the problem of confusing similar- looking and/or sounding drugs accidentally. The most common causes of medication error jeopardizing patient safety are LASA as well as high workload.

Case Presentation: A critical incident report of medication errors of opioids for postoperative analgesia by look-alike packaging highlights the LASA aspects in everyday scenarios.

Asymmetry in patient-related information disrupts pre-anesthetic patient briefing.

Background: If one party has more or better information than the other, an information asymmetry can be assumed. The aim of the study was to identify the origin of incomplete patient-related preoperative information, which led to disruptions and losses of time during pre-anaesthetic patient briefing. We hypothesized that lower employees' educational level increases the amount of disruptive factors.

Comparison of 3 methods to induce acute pulmonary hypertension in pigs.

Large animal models for acute pulmonary hypertension (PHT) show distinct differences between species and underlying mechanisms. Two embolic procedures and continuous infusion of a stable thromboxane A(2) analogue (U46619) were explored for their ability to induce PHT and their effects on right ventricular function and pulmonary and systemic circulation in 9 pigs. Injection of small (100 to 200 microm) or large (355 to 425 microm) polystyrene beads and incremental dosage (0.

Brain metabolism during a decrease in cerebral perfusion pressure caused by an elevated intracranial pressure in the porcine neocortex.

Background: Cranial hypertension coincides with a reduction in cerebral blood flow as well as in oxygen delivery and influences outcome. In this study, we monitored changes in energy-related metabolites in the porcine cortex during an increase of intracranial pressure (ICP) and to determine the level at which damage occurs.

Methods: Male domestic pigs (32-40 kg) were anesthetized, mechanically ventilated, and randomly assigned to either the experimental (n = 6) or control groups (n = 5).

Heating capabilities of the Hotline and Autoline at low flow rates.

Background: At low flow rates, fluid warmers using coaxial warming tubes are superior in preventing heat loss. This laboratory investigation was performed in order to compare the heating capabilities of two coaxial fluid warmers.

Methods: The Hotline and the Autoline were investigated by using normal saline at various flow rates (10-99 ml x h(-1)).

Short-term elevation of intracranial pressure does neither influence duodenal motility nor frequency of bolus transport events: a porcine model.

Background: Patients with traumatic brain injuries and raised intracranial pressure (ICP) display biphasic response with faster gastric emptying during the early stage followed by a prolonged gastric transit time later. While duodenal contractile activity plays a pivotal role in transpyloric transit we investigated the effects of raised intracranial pressure on duodenal motility during the early phase. In order to exclude significant deterioration of mucosal blood supply which might also influence duodenal motility, luminal microdialysis was used in conjunction.

A long-term porcine model for measurement of gastrointestinal motility.

Animal models have become an essential tool in the investigations of gut motility under experimental conditions. To determine the influence of various anaesthetic drugs on the motility pattern of the gastroduodenal tract, a new long-term model has had to be developed for allowing measurements in conscious and unrestrained as well as in sedated and analgosedated pigs. Since mechanical ventilation influences gut motility, it was necessary that this animal model enabled the investigation of the effect of drugs causing sedation and analgosedation during spontaneous breathing.