610 Medizin und Gesundheit
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"A manager in the minds of doctors" : a comparison of new modes of control in European hospitals
(2013)
Background: Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals.
Methods: The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources.
Results: The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management.
Conclusions: Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective.
Auf dem Weg zur multikulturellen Gesellschaft besteht Bedarf, die psychologischen Komponenten verschiedener Migrantengruppen zu erfassen. In Deutschland sind 83.598 Mitmenschen mit chinesischer Staatsbürgerschaft verzeichnet (StatBA, 2009). Werden die Eingebürgerten Übersee-Chinesen mit einbezogen, beläuft sich die Zahl an gesamtchinesischen Mitmenschen auf 135.000 (OCAC, 2009). Als einzige Anhaltspunkte über im Ausland lebende Chinesen dienen Studien aus dem angloamerikanischen Sprachraum. Menschen chinesischen Ursprungs mit westlichem Intellekt erhalten dort die Bezeichnung „Banane“, welche eine gelbe Hülle mit einem weißen Inneren illustriert. Die vorliegende Studie beschäftigt sich erstmalig mit den psychologischen Komponenten der in Deutschland lebenden chinesischen Mitbürger. Welchen Einfluss nimmt die Anpassung an das europäische Umfeld gekoppelt mit der chinesischen Internalisierung auf erinnertes elterliches Erziehungsverhalten, Persönlichkeitsstruktur, Erleben von Emotionen und Körpererleben? 154 chinesisch-stämmige Studierende aus ganz Deutschland wurden für verschiedene standardisierte psychometrische Testverfahren rekrutiert. Ein eigens konzipierter Fragebogen diente zur Messung der asiatischen und europäischen Identität. Wie vorherige Studien (Chao & Aque, 2009) aussagten, zeigten sich in der vorliegenden Stichprobe Züge des autoritativen Erziehungsstils. Im FEE (Fragebogen zum erinnertenelterlichen Erziehungsverhalten) (Schumacher, Eisemann, & Brähler, 1999) erhielten die Übersee-chinesischen Probanden neben einer höheren mütterlichen Strenge auch höhere Werte in der elterlichen Kontrolle und Überbehütung als die deutsche Normstichprobe. Je mehr mütterliche „Ablehnung und Strafe“ und elterliche „Kontrolle und Überbehütung“ die Probanden perzipierten, desto chinesischer sieht der heutige Lebensstil aus. Kongruent mit den Ergebnissen von McCrae et al. (1998) schnitten Übersee-Chinesen im NEO-FFI (Borkenau & Ostendorf, 1993) mit niedrigeren Werten in der Offenheit und höheren Werten in der Verträglichkeit ab. Anders als bei Eap et al. (2008) zeigten Chinesen in Deutschland höhere Werte in der Gewissenhaftigkeit und Extraversion. Diese hingegen korrelierten positiv mit der europäischen Identität. In der MSWS (Multidimensionale Selbstwertskala) (Schütz & Sellin, 2006) erzielten die Übersee-Chinesen einen niedrigeren allgemeinen Selbstwert als die deutsche Normgruppe. Außerdem empfanden die Übersee-Chinesen weniger eigene Selbstwertschätzung im sozialen Kontakt zu anderen, im Umgang mit Kritik und im leistungsbezogenen Bereich. Überraschenderweise erhielten die Probanden einen höheren Selbstwert in der Sportlichkeit. Die SEE (Skalen zu Erleben von Emotionen) (Behr & Becker, 2004) zeigten, dass die körperliche Symbolisierung von Gefühlen bei der chinesischen Stichprobe niedriger war als bei der deutschen Norm. Dies hing mit der Ausprägung der europäischen Identität zusammen. Negativ korrelierte die europäische Identität auch mit der Regulation von Emotionen. Im FBeK (Fragebogen zur Beurteilung des eigenen Körpers) (Strauß & Richter-Appelt,1995) ging das Körpererleben der Übersee-Chinesen mit weniger Selbstbewusstsein für die eigene Attraktivität einher. Je mehr die Lebensart zum Asiatischen tendierte, desto weniger äußerte sich die Akzentuierung des äußeren Erscheinungsbildes und desto höher erschien die Unsicherheit. Zusammenfassend weisen die Ergebnisse darauf hin, dass die Auslebung einer bikulturellen Identität Folgen für die psychologische Entwicklung eines Individuums mit sich bringen, welche beispielsweise für die Arbeit bei Patienten im psychotherapeutischen Prozess mit berücksichtigt werden sollten.
"Ciaglia Blue Rhino Punktionstracheotomie" : perioperative Komplikationen und Langzeitergebnisse
(2009)
Im klinischen Alltag der Intensivstationen haben sich in den letzten Jahren verschiedene Verfahren der perkutanen Tracheotomie aufgrund ihrer einfachen Durchführbarkeit und dem geringen Komplikationsrisiko gegenüber dem chirurgischen Verfahren durchgesetzt. Die Blue Rhino Technik nach Ciaglia ist eine Methode, bei der zur Anlage des Tracheostomas nur ein einzelner Dilatationsschritt mittels eines, mit einer speziellen hydrophilen Beschichtung versehenen, gebogenen Dilatators notwendig ist. Die vorliegende Arbeit zeigt die Auswertung der Daten von 50 Patienten, die nach dieser Methode tracheotomiert wurden. Die Evaluation beinhaltet neben der Auswertung der peri- und postoperativen Komplikationen, die Ergebnisse einer telefonischen Befragung von 19 Patienten anhand eines standardisierten Fragebogens, hinsichtlich ihrer subjektiven Einschätzung bezüglich Veränderungen der Stimme, Luftnot, Schluckbeschwerden sowie dem kosmetischen Ergebnis des verschlossenen Tracheostomas. Die Ergebnisse wurden mit den in der Literatur vorhandenen Daten der verschiedenen perkutanen Verfahren verglichen, um potentielle Vorund Nachteile der Blue Rhino Technik zu eruieren. Es konnte gezeigt, dass bei der Blue Rhino Methode im Vergleich zu anderen Verfahren keine signifikant höhere perioperative Komplikationsrate auftrat. Die in verschiedenen Arbeitenbeschriebene Häufung an Trachealspangenfrakuren konnten auch wir in unserem Patientengut finden. Einen Beweis für die klinische Relevanz dieser Beobachtung wurde aber bisher in keiner Studie erbracht. Im Gegensatz dazu kann es als gesichert angesehen werden, dass ein höherer BMI ein Risikofaktor ist, der mit einer Erhöhung der perioperativen Komplikationsrate einhergeht. Auch in unserer Untersuchung traten die beiden einzigen schwerwiegenden Komplikationen bei Patienten mit einem BMI deutlich über 30 kg/m2 auf. Postoperative Komplikationen wie Blutungen oder Infektionen des Stomas konnten wir in unserem Patientenkollektiv nicht beobachten. Nach allgemeiner Studienlage treten diese Komplikationen bei den perkutanen Verfahren auch nur in Einzelfällen auf. Die bei der Befragung ein Jahr nach der Tracheotomie gefundenen Veränderungen der Stimme, Heiserkeit und das Vorliegen von Luftnot in verschiedenen Ausprägungen lassen sich bei den meisten Patienten auf ihre Vorerkrankungen zurückführen oder sind Ausdruck einer Schädigung der Stimmbänder durch die vorangegangene orotracheale Intubation. Nur bei 2 Patienten konnten wir eine Trachealstenose nicht sicher ausschließen. Einen schlüssigen Nachweis, dass eine Stenose bei Patienten nach Tracheotomie ursächlich auf die Tracheotomie alleine zurückzuführen ist, konnten wir bei Durchsicht der Literatur nicht finden. Das kosmetische Ergebnis beurteilten die meisten unserer Patienten (79%) als sehr gut bis gut. Unter Beachtung der absoluten Kontraindikationen, die für alle perkutanen Verfahren gültig sind, erfüllt die Blue Rhino Methode nach Ciaglia hinsichtlich der leichten Durchführbarkeit und der niedrigen peri- und postoperativen Komplikationsraten alle Anforderungen, die an ein perkutanes Verfahren gestellt werden.
Ihr Auftritt beim Science Slam Berlin (2012) ist mit über 130.000 Klicks ein Renner auf Youtube. Nun hat sie ein Buch zum Thema veröffentlicht, das bereits auf der Buchmesse Leipzig für Aufsehen gesorgt hat. Giulia Enders forscht für ihre Doktorarbeit am Institut für Mikrobiologie an der Goethe-Universität.
Vasointestinal peptide metabolism plays a key physiological role in multimodular levels of vasodilatory, smooth muscle cell proliferative, parenchymal, and inflammatory lung reactions. In animal studies, vasointestinal peptide relaxes isolated pulmonary arterial segments from several mammalian species in vitro and neutralizes the pulmonary vasoconstrictor effect of endothelin. In some animal models, it reduces pulmonary vascular resistance in vivo and in monocrotaline-induced pulmonary hypertension. A 58-year-old woman presented with dyspnea and mild edema of the lower extremities. A bronchoscopy was performed without any suspicious findings suggesting a central tumor or other infiltrative disease. Endobronchial ultrasound revealed enlarged pulmonary arteries containing thrombi, a few enlarged lymph nodes, and enlarged mediastinal tissue anatomy with suspicion for mediastinal infiltration of a malignant process. We estimated that less than 10% of the peripheral vascular bed of the lung was involved in direct consolidated fibrosis as demonstrated in the left upper lobe apex. Further, direct involvement of fibrosis around the main stems of the pulmonary arteries was assumed to be low from positron emission tomography and magnetic resonance imaging scans. Assuming a positive influence of low-dose radiation, it was not expected that this could have reduced pulmonary vascular resistance by over two thirds of the initial result. However; it was noted that this patient had idiopathic pulmonary arterial hypertension mixed with "acute" (mediastinal) fibrosis which could have contributed to the unexpected success of reduction of pulmonary vascular resistance. To the best of our knowledge, this is the first report of successful treatment of idiopathic pulmonary arterial hypertension, probably as a result of low-dose radiation to the pulmonary arterial main stems. The patient continues to have no specific complaints concerning her idiopathic pulmonary arterial hypertension.
"Eigentlich ist es nichts Besonderes – und genau das ist gut so!" : Nordic Walking in der Onkologie
(2011)