1
|
Benneyworth MA, Hearing MC, Asp AJ, Madayag A, Ingebretson AE, Schmidt CE, Silvis KA, Larson EB, Ebner SR, Thomas MJ. Synaptic Depotentiation and mGluR5 Activity in the Nucleus Accumbens Drive Cocaine-Primed Reinstatement of Place Preference. J Neurosci 2019; 39:4785-4796. [PMID: 30948476 PMCID: PMC6561685 DOI: 10.1523/jneurosci.3020-17.2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/01/2019] [Accepted: 03/26/2019] [Indexed: 01/24/2023] Open
Abstract
Understanding the neurobiological processes that incite drug craving and drive relapse has the potential to help target efforts to treat addiction. The NAc serves as a critical substrate for reward and motivated behavior, in part due to alterations in excitatory synaptic strength within cortical-accumbens pathways. The present studies investigated a causal link between cocaine-induced reinstatement of conditioned place preference and rapid reductions of cocaine-dependent increases in NAc shell synaptic strength in male mice. Cocaine-conditioned place preference behavior and ex vivo whole-cell electrophysiology showed that cocaine-primed reinstatement and synaptic depotentiation were disrupted by inhibiting AMPAR internalization via intra-NAc shell infusion of a Tat-GluA23Y peptide. Furthermore, reinstatement was driven by an mGluR5-dependent reduction in AMPAR signaling. Intra-NAc shell infusion of the mGluR5 antagonist MTEP blocked cocaine-primed reinstatement and corresponding depotentiation, whereas infusion of the mGluR5 agonist CHPG itself promoted reinstatement and depotentiated synaptic strength in the NAc shell. Optogenetic examination of circuit-specific plasticity showed that inhibition of infralimbic cortical input to the NAc shell blocked cocaine-primed reinstatement, whereas low-frequency stimulation (10 Hz) of this pathway in the absence of cocaine triggered a reduction in synaptic strength akin to that observed with cocaine, and was sufficient to promote reinstatement in the absence of a cocaine challenge. These data support a model in which mGluR5-mediated reduction in GluA2-containing AMPARs at NAc shell synapses receiving input from the infralimbic cortex is a critical factor in triggering reinstatement of cocaine-primed conditioned approach behavior.SIGNIFICANCE STATEMENT These studies identified a sequence of neural events whereby reexposure to cocaine activates a signaling cascade that alters synaptic strength in the NAc shell and triggers a behavioral response driven by a drug-associated memory.
Collapse
|
2
|
Schmidt CE, Schuldt T, Kaiser A, Letzgus P, Liebeneiner J, Schmidt K, Öner A, Mlynski R. [Otorhinolaryngology in the field of demography, growing outpatient care and regionalization]. HNO 2016; 65:41-52. [PMID: 27430631 DOI: 10.1007/s00106-016-0196-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Otorhinolaryngology (ENT) departments are strongly affected by current changes in the reimbursement schemes for inpatients. The study was designed to investigate these effects on the ENT Department in Rostock and selected comparison clinics, as well as to outline solutions. METHODS We analyzed diagnosis-related group (DRG) reports of the ENT Clinic at Rostock University Medical Center from 2013 to 2015, according to the size of the outpatient potential. Comparisons were made with other surgical departments such as maxillofacial surgery and ophthalmology in terms of average length of stay and the resulting deductibles. We also compared billing as day surgery and complete outpatient surgery for the main small surgical procedures such as tonsillectomy and septum surgery. Finally, we compared the discounts with 22 ENT departments in other maximum care hospitals. RESULTS The average case mix index of an ENT department in Germany is 0.75, case load average of 2,500 patients and common length of stay 4.1 days. In a typical academic ENT department as in Rostock, health plans usually discount around 500 T€ (thousand euro), which is considerably higher than comparable departments, e.g., oral and maxillofacial surgery or ophthalmology departments. However, discounts on a DRG for inpatient surgery is still approximately 1,000 € more revenue than surgery in an outpatient setting. The benchmark analysis shows that health plans in rural areas are more likely to accept inpatient surgery with discounts for small procedures than strict billing according to outpatient reimbursement schemes. CONCLUSION These effects can result in an insufficient cost effectiveness of ENT departments in Germany. As a consequence, substantial restructuring of the in- and outpatient treatment seems necessary, also for academic ENT departments, e.g., in the form of day surgery or ambulatory surgical centers, outpatient clinics with special contracts and specialized inpatient surgery. However, this results in greater demands on the training of young physicians and management of patient flows within the department.
Collapse
|
3
|
Schmidt CE, Manbeck KE, Shelley D, Harris AC. Blockade of cholinergic transmission elicits somatic signs in nicotine-naïve adolescent rats. Front Pharmacol 2015; 6:239. [PMID: 26539119 PMCID: PMC4611158 DOI: 10.3389/fphar.2015.00239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/05/2015] [Indexed: 01/24/2023] Open
Abstract
High doses of the nicotinic acetylcholine receptor (nAChR) antagonist mecamylamine can elicit somatic signs resembling those associated with nicotine withdrawal in nicotine-naïve adult rats. Understanding this phenomenon, and its possible modulation by acute nicotine and age, could inform the use of mecamylamine as both an experimental tool and potential pharmacotherapy for tobacco dependence and other disorders. This study evaluated the ability of high-dose mecamylamine to elicit somatic signs in adolescent rats, and the potential for acute nicotine pretreatment to potentiate this effect as previously reported in adults. Single or repeated injections of mecamylamine (1.5 or 3.0 mg/kg, s.c.) elicited somatic signs in nicotine-naïve adolescents, but this effect was not influenced by 2 h pretreatment with acute nicotine (0.5 mg/kg, s.c.). In an initial evaluation of the effects of age in this model, mecamylamine (2.25 mg/kg, s.c.) elicited somatic signs in nicotine-naïve adolescents and adults. This effect was modestly enhanced following acute nicotine injections in adults but not in adolescents, even when a higher nicotine dose (1.0 rather than 0.5 mg/kg, s.c.) was used in adolescents to account for age differences in nicotine pharmacokinetics. These studies are the first to show that mecamylamine elicits somatic signs in nicotine-naïve adolescent rats, an effect that should be considered when designing and interpreting studies examining effects of high doses of mecamylamine in adolescents. Our findings also provide preliminary evidence that these signs may be differentially modulated by acute nicotine pretreatment in adolescents versus adults.
Collapse
|
4
|
Harris AC, Tally L, Muelken P, Banal A, Schmidt CE, Cao Q, LeSage MG. Effects of nicotine and minor tobacco alkaloids on intracranial-self-stimulation in rats. Drug Alcohol Depend 2015; 153:330-4. [PMID: 26094184 PMCID: PMC4509975 DOI: 10.1016/j.drugalcdep.2015.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND While nicotine is the primary addictive compound in tobacco, other tobacco constituents including minor alkaloids (e.g., nornicotine, anabasine) may also contribute to tobacco addiction by mimicking or enhancing the effects of nicotine. Further evaluating the behavioral effects of minor alkaloids is essential for understanding their impact on tobacco addiction and informing development of tobacco product standards by the FDA. METHODS This study compared the addiction-related effects of nicotine and the minor alkaloids nornicotine, anabasine, myosmine, anatabine, and cotinine on intracranial self-stimulation (ICSS) thresholds in rats. RESULTS Acute injection of nicotine produced reinforcement-enhancing (ICSS threshold-decreasing) effects at low to moderate doses, and reinforcement-attenuating/aversive (ICSS threshold-increasing) effects at high doses. Nornicotine and anabasine produced similar biphasic effects on ICSS thresholds, although with lower potency compared to nicotine. Myosmine only elevated ICSS thresholds at relatively high doses, while anatabine and cotinine did not influence ICSS thresholds at any dose. None of the alkaloids significantly influenced ICSS response latencies, indicating a lack of nonspecific motoric effects. CONCLUSIONS These findings indicate that some minor tobacco alkaloids can either fully (nornicotine, anabasine) or partially (myosmine) mimic nicotine's addiction-related effects on ICSS, albeit at reduced potency. These findings emphasize the need for further study of the abuse potential of minor alkaloids, including evaluation of their effects when combined with nicotine and other tobacco constituents to better simulate tobacco exposure in humans. Such work is essential for informing FDA regulation of tobacco products and could also lead to the development of novel pharmacotherapies for tobacco addiction.
Collapse
|
5
|
Lee JY, Khaing ZZ, Siegel JJ, Schmidt CE. Surface modification of neural electrodes with pyrrole-hyaluronic acid conjugate to attenuate reactive astrogliosis in vivo. RSC Adv 2015; 5:39228-39231. [PMID: 35528963 PMCID: PMC9075707 DOI: 10.1039/c5ra03294f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Surface of neural probes were electrochemically modified with a non-cell adhesive and biocompatible conjugate, pyrrole-hyaluronic acid (PyHA), to reduce reactive astrogliosis. Poly(PyHA)-modified wire electrodes were implanted into rat motor cortices for three weeks and were found to markedly reduce the expression of glial fibrillary acidic protein compared to uncoated electrodes.
Collapse
|
6
|
Harris AC, Tally L, Schmidt CE, Muelken P, Stepanov I, Saha S, Vogel RI, LeSage MG. Animal models to assess the abuse liability of tobacco products: effects of smokeless tobacco extracts on intracranial self-stimulation. Drug Alcohol Depend 2015; 147:60-7. [PMID: 25561387 PMCID: PMC4337227 DOI: 10.1016/j.drugalcdep.2014.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/12/2014] [Accepted: 12/11/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preclinical models are needed to inform regulation of tobacco products by the Food and Drug Administration (FDA). Typically, animal models of tobacco addiction involve exposure to nicotine alone or nicotine combined with isolated tobacco constituents (e.g. minor alkaloids). The goal of this study was to develop a model using extracts derived from tobacco products that contain a range of tobacco constituents to more closely model product exposure in humans. METHODS This study compared the addiction-related effects of nicotine alone and nicotine dose-equivalent concentrations of aqueous smokeless tobacco extracts on intracranial self-stimulation (ICSS) in rats. Extracts were prepared from Kodiak Wintergreen, a conventional product, or Camel Snus, a potential "modified risk tobacco product". Binding affinities of nicotine alone and extracts at various nicotinic acetylcholine receptor (nAChR) subtypes were also compared. RESULTS Kodiak and Camel Snus extracts contained levels of minor alkaloids within the range of those shown to enhance nicotine's behavioral effects when studied in isolation. Nonetheless, acute injection of both extracts produced reinforcement-enhancing (ICSS threshold-decreasing) effects similar to those of nicotine alone at low to moderate nicotine doses, as well as similar reinforcement-attenuating/aversive (ICSS threshold-increasing) effects at high nicotine doses. Extracts and nicotine alone also had similar binding affinity at all nAChRs studied. CONCLUSIONS Relative nicotine content is the primary pharmacological determinant of the abuse liability of Kodiak and Camel Snus as measured using ICSS. These models may be useful to compare the relative abuse liability of other tobacco products and to model FDA-mandated changes in product performance standards.
Collapse
|
7
|
Schiechtl B, Hunger MS, Schwappach DL, Schmidt CE, Padosch SA. [Second victim : Critical incident stress management in clinical medicine]. Anaesthesist 2014; 62:734-41. [PMID: 23982196 DOI: 10.1007/s00101-013-2215-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. METHODS A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. RESULTS In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. CONCLUSIONS The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.
Collapse
|
8
|
Schmidt CE, Möller J, Schmidt K, Gerbershagen MU, Wappler F, Limmroth V, Padosch SA, Bauer M. [Generation 55+: leadership and motivation of generations in hospitals]. Anaesthesist 2014; 61:630-4, 636-9. [PMID: 22740193 DOI: 10.1007/s00101-012-2055-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Demographic changes in Germany are leading towards a decrease of the population from the current 82 million to 74 million in the year 2050. As a consequence the shortage of qualified staff will be aggravated and intensifying recruiting efforts will increase competition among employers. An alternative is to utilize the potential of jobholders older than 55 years, the so-called generation 55 +. However, little is known about the hospital workforce generation 55 +. METHODS An internet search was conducted using google.de, yahoo.de and altavista.de for "generation 55 + and medicine" and "demographics, personnel and hospital" In Medline/pubmed a search was conducted for the key words "aging workforce" (949 sources) and in combination with AND "doctors" (134 sources), "demographic changes", "staff" (794 sources) as well as for "generation 55 + AND doctors" (312 sources). Finally, sources from reputable public institutions and academic medical societies were analyzed. The data were sorted by main categories and relevance for hospitals. Statistical analysis was done mainly using descriptive measures. RESULTS From initially more than 530,000 sources, a total of 289 studies and reports on the topic were plotted. There was no evidence for a negative correlation between age and work ability or fitness. Jobholders senior to 55 years can be divided into the "economic miracle generation" and into the so-called baby-boomers. Both groups have differences in values, communication needs and leadership requirements. They jointly prefer direct communication and seek appreciation for their experience on the job. CONCLUSIONS Generation 55 + is not asking for an upscaled position in hospitals. They expect respect and appreciation for their sound experience of work and life. Generation 55 + wants to be integrated and sought after. Keeping these employees fit, motivated and qualified is a sound approach to fight the foreseeable shortage of qualified staff in hospitals.
Collapse
|
9
|
Waeschle RM, Michels P, Jipp M, Riech S, Schulze T, Schmidt CE, Bauer M. [Quality assurance at the interface between anesthesia and transfusion medicine]. Anaesthesist 2014; 63:154-62. [PMID: 24469248 DOI: 10.1007/s00101-013-2284-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current situation in hospitals is characterized by financial limitations and simultaneously by increasing demands on quality and safety. The operative interface between anesthesia and transfusion medicine affects both factors. AIM A detailed analysis was performed to evaluate the process quality at this operative interface at the University Hospital of Göttingen. The aim of the project was to revise und develop the structures and responsibilities at this interface, to dispose of weak points and to realize the optimization potential in the supply of blood products. MATERIAL AND METHODS A databank-based electronic data processing solution was established with the clear definition of responsibilities for the various workflow procedures and the written documentation of these definitions in standard operating protocols. In order to guarantee the necessary transparency a routine reporting system to the department of surgery was established. In addition, a continuous further development of the blood supply standard based on electronic report data was implemented. RESULTS By implementing the above named measures the rate of supplied to transfused blood products could be increased from 43.1 % to 55.7 %. The compliance with the blood supply standard improved continually over the first 18 months from 60.3 % to 92.3 %. The rate of supplied blood product deliveries without subsequent operation could be reduced from 9.0 % to 4.6 %. As a result of this optimization the supply costs in the internal cost allocation were reduced from 9,406 <euro> to 3,544 <euro>. CONCLUSION The measures described are appropriate to cost-effectively improve quality and patient safety. The optimization measures presented in this article can be implemented in other hospitals to increase quality and safety after individual adjustment to the local circumstances.
Collapse
|
10
|
Schmidt K, Meyer J, Liebeneiner J, Schmidt CE, Hüttenbrink KB. [Generation Y in ENT: leading a young generation of doctors]. HNO 2013; 60:993-1002. [PMID: 23052220 DOI: 10.1007/s00106-012-2572-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The shortage of qualified doctors and nurses has led to a competition between hospitals. Analyzing the circumstances of the competition, nurses and doctors of so-called generation Y are important. These employees are mainly female and have different requirements compared to previous generations. Therefore, knowledge of these requirements will become a critical success factor for hospitals in the future. METHOD We interviewed medical students in Kiel and Hannover from 2005 to 2011 about the clinical department chosen, the criteria for choosing a specific clinic, and the importance of MD and PhD programs. In addition, we conducted an internet and Medline search for scientific studies on labor shortage, generation Y, and demographics. The data were sorted by main categories and relevance for hospitals. Statistical analyses were performed using descriptive measures. RESULTS We received 1,097 answers which represents approx. 75% of all students. Sixty-seven percent of the students were female, 33% male. Preferences for departments revealed internal medicine, pediatrics, and anesthesiology as the top three. ENT followed at rank 10. The main criteria for choosing a clinic were working climate, structure and broadness of education, family friendliness, and respect. MD programs were rated 2.6, while PhD programs were rated 3.6. Staff members of Generation Y "live while working" and disagree with hierarchies. Internet and computers are part of their daily routine. CONCLUSION Employees of Generation Y challenge leadership in hospitals by increasing demands. However, Generation Y can increase professionalization and competitiveness for hospitals significantly.
Collapse
|
11
|
Harris AC, Manbeck KE, Schmidt CE, Shelley D. Mecamylamine elicits withdrawal-like signs in rats following a single dose of nicotine. Psychopharmacology (Berl) 2013; 225:291-302. [PMID: 22868410 DOI: 10.1007/s00213-012-2814-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 07/16/2012] [Indexed: 10/28/2022]
Abstract
RATIONALE The ability of nicotine to induce dependence (result in a withdrawal syndrome) is typically thought to require long-term, daily smoking. Emerging evidence suggests that symptoms of nicotine withdrawal may occur following only a few cigarettes. Whether acute exposure to nicotine can induce dependence in animals has not been well established. OBJECTIVE The objective of this paper is to examine whether the nicotinic acetylcholine receptor antagonist mecamylamine elicits withdrawal-like signs in rats following acute nicotine exposure. METHODS AND RESULTS Mecamylamine (3.0 mg/kg, s.c.) administered ≈2 h after a single dose of nicotine (0.5 mg/kg, s.c.) elicited increases in intracranial self-stimulation (ICSS) thresholds and somatic signs, two well-established effects of withdrawal from long-term (chronic) nicotine exposure. The magnitude of these effects remained constant across five daily test sessions. A lower dose of mecamylamine (1.5 mg/kg, s.c.) had little or no effect on ICSS thresholds or somatic signs following acute nicotine exposure, but precipitated robust increases in these measures during a chronic nicotine infusion. Finally, rats exhibited a small increase in ICSS thresholds over time following a single nicotine injection (0.5 mg/kg, s.c.), possibly reflecting a modest spontaneous withdrawal-like effect. CONCLUSIONS Mecamylamine elicited withdrawal-like signs in rats following a single dose of nicotine. The different effects of mecamylamine 1.5 mg/kg following acute versus chronic nicotine exposure supports the notion that these models simulate the early and more advanced stages of nicotine dependence, respectively. While further optimization and validation of these models is necessary, they may provide a novel approach for studying the earliest stages of nicotine dependence.
Collapse
|
12
|
Schmidt K, Schmidt CE, Meyer JE, Liebeneiner J. Generation Y – Rekrutierung, Entwicklung und Bindung einer neuen Generation von Ärzten. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
13
|
Schmidt K, Schmidt CE, Liebeneiner J, Meyer JE. Fachkräftemangel in Deutschland – Erwartungen von Chefärzten an die Arbeitsauffassung junger Mitarbeiter. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
14
|
Schmidt CE, Liebeneiner J, Schmidt K, Meyer JE. Generation 55+ – Führung und Motivation von Generationen im Krankenhaus. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Schmidt K, Meyer JE, Liebeneiner J, Schmidt CE, Hüttenbrink KB. [The shortage of qualified staff in Germany: a survey on head physicians' expectations of young doctors]. HNO 2012; 60:102-8. [PMID: 22331084 DOI: 10.1007/s00106-011-2406-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The shortage of medical specialists in Germany has led to increased competition between hospitals, particularly in the recruitment of young skilled doctors. The quality of training appears to be the critical factor in a clinic's recruiting process. At the same time, the suitability of candidates is decreasing. There is currently no data on the suitability of candidates for otorhinolaryngology, nor are there any forecasts about the labor shortage in this speciality. METHODS We compiled a questionnaire according to accepted guidelines, which was then sent to 160 ENT departments by email. We asked about the size and location of the department and the number of applicants that were suitable or unsuitable. Finally, we asked about the current availability of staff as well as the requirements set by the head physician. RESULTS The response rate was 34% (54 questionnaires). Departments received an average of 20 applications per year, of which 36% were unsuitable. Departments received more applications in the new German states than in the old; however, no difference in the quality of candidates was seen. University hospitals receive almost three times more applications than other hospitals. The size of the department correlates with the number of applications and quality of the candidates. Almost 60% of chief physicians expected the lack of qualified staff to worsen in the future. However, 40% of chief physicians of large departments (> 50 beds) expected the situation to improve or remain unchanged. Chief physicians' main expectations of candidates included commitment, independent learning and team spirit. CONCLUSIONS A broad and structured residency program for new employees is the most important factor in the recruitment of new physicians. Large departments and university hospitals have advantages here. The expectations of head physicians differ from those of young staff in terms of commitment and autonomous learning.
Collapse
|
16
|
Slany E, Reuter W, Thüsing C, Schmidt CE. [From guilt and shame to professional handling of mistakes--risk management in surgical medicine]. VERSICHERUNGSMEDIZIN 2011; 63:180-185. [PMID: 22486049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Medical advances in diagnosis and therapy, especially in medical technology, lead to differenciated and more complex strategies in therapy with higher risks. Patients show higher expectations concerning the results of a therapy and claim more often that a mistake in treatment has been made. This makes patients turn to arbitration boards more often. They may also want to bring civil action against physicians and hospitals, claiming for compensation and damages. Personal liability insurances have to pay more for damages. Medical insurances have more recourse demands due to mistake in treatment. Hospital and especially operative medicine do have high chances of risks and mistakes. The implementation of a modern risk management system in the hospitals is becoming more and more important, for patients as well as for the surgical departments. A structured reporting system of critical incidents can produce indicators of potential sources of mistakes, which appears to be a successful approach to reduce or avoid typical risks and mistakes in medical treatment. Risk management in medical treatment must be more than just a trendy word, because its roots are in the medical principles of "primum nihil nocere". It is a challenge to today's and tomorrow's medicine. This article is a general overview of current strategies for avoiding mistakes: It is meant to be the basis of a new culture of mistake avoidance as a part of a future quality competition.
Collapse
|
17
|
Schmidt CE, Gerbershagen MU, Salehin J, Weib M, Schmidt K, Wolff F, Wappler F. [From personnel administration to human resource management : demographic risk management in hospitals]. Anaesthesist 2011; 60:507-16. [PMID: 21461756 DOI: 10.1007/s00101-011-1885-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The healthcare market is facing a serious shortage of qualified personnel in 2020. Aging of staff members is one important driver of this human resource deficit but current planning periods of 1-2 years cannot compensate the demographic effects on staff portfolio early enough. Therefore, prospective human resource planning is important to avoid loss of competence. METHODS The long range development (10 years) of human resources in the hospitals of the City of Cologne was analyzed. The basis for the analysis was a simulation model that included fluctuation of staff, retirement, maternity leave, status of employee illness, partial retirement and fresh engagements per department and profession. The model was matched with the staff requirements for each department. The results showed a capacity analysis which was used to convey strategic measures for staff recruitment and retention. RESULTS The greatest risk for shortage of qualified staff was found in the fluctuation of doctors and in the aging work force. Without strategic human resource management the hospitals would face a 50% reduction of the work force within 10 years and after 2 years there would be a 25% deficit of anesthesiologists with impact on the function of operation rooms (OR) and intensive care units. Qualification and continuous training of staff members as well as process optimization are the most important spheres of activity for human resource management in order to recruit and retain qualified staff members. CONCLUSION Prospective human resource planning for the OR and intensive care units can help to detect shortage of staff and loss of competence early enough to apply effective personnel development measures. A growing number of companies have started to plan ahead of the current demand of human resources. Hospitals should follow this example because the competition for qualified staff members is increasing rapidly.
Collapse
|
18
|
Abstract
Most neurotrophic factors are members of one of three families: the neurotrophins, the glial cell-line derived neurotrophic factor family ligands (GFLs) and the neuropoietic cytokines. Each family activates distinct but overlapping cellular pathways. Several studies have shown additive or synergistic interactions between neurotrophic factors from different families, though generally only a single combination has been studied. Because of possible interactions between the neurotrophic factors, the optimum concentration of a factor in a mixture may differ from the optimum when applied individually. Additionally, the effect of combinations of neurotrophic factors from each of the three families on neurite extension is unclear. This study examines the effects of several combinations of the neurotrophin nerve growth factor (NGF), the GFL glial cell-line derived neurotrophic factor (GDNF) and the neuropoietic cytokine ciliary neurotrophic factor (CNTF) on neurite outgrowth from young rat dorsal root ganglion (DRG) explants. The combination of 50 ng ml(-1) NGF and 10 ng ml(-1) of each GDNF and CNTF induced the highest level of neurite outgrowth at a 752 +/- 53% increase over untreated DRGs and increased the longest neurite length to 2031 +/- 97 microm compared to 916 +/- 64 microm for untreated DRGs. The optimum concentrations of the three factors applied in combination corresponded to the optimum concentration of each factor when applied individually. These results indicate that the efficacy of future therapies for nerve repair would be enhanced by the controlled release of a combination of neurotrophins, GFLs and neuropoietic cytokines at higher concentrations than used in previous conduit designs.
Collapse
|
19
|
Gfrörer R, Schüpfer G, Schmidt CE, Bauer M. [Teamwork in the operating theatre. Effect on quality of decision-making]. Anaesthesist 2006; 54:1229-34. [PMID: 16244850 DOI: 10.1007/s00101-005-0932-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
Collapse
|
20
|
Schmidt CE, Bestmann B, Küchler T, Kremer B. Factors influencing sexual function in patients with rectal cancer. Int J Impot Res 2005; 17:231-8. [PMID: 15716980 DOI: 10.1038/sj.ijir.3901276] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Only few studies have investigated the impact of surgery for rectal cancer on sexual function. Little of that research included quality of life (QoL) aspects and hardly any study analyzed the impact of age, gender and type of surgery on sexual function. The aim of the presented study was to address these issues. Over a 5 y period, EORTC-QLQ-C-30 and a tumor-specific module were prospectively administered to patients before surgery, at discharge, 3, 6, 12 and 24 months postoperatively. Comparisons were made between patients receiving abdominoperineal resection (APR), anterior resection (AR) with or without Pouch and Sigmoid resection. Furthermore, effects of surgery on female and male patients, and age groups were analyzed. A total of 819 patients participated in the study: 412 were males and 407 were females. The groups were comparable in terms of adjuvant treatment, tumor stage and histology. Patients after APR and AR with Pouch had worst sexual function. Men reported significantly more difficulties with sexual enjoyment; furthermore, over time, sexual problems created high levels of strain in men that were worse than baseline levels in the early postoperative period. These problems tended to remain. Patients aged 69 y and younger scored higher for problems with loss of sexual function and sexuality-related strain than patients aged 70 y and older. The findings in this study confirm that QoL changes postsurgery and that factors like type of surgery, gender and age have tremendous impact on sexual function and sexual enjoyment. APR and AR with Pouch affect sexual function more than AR and resection of the lower sigmoid. Through impaired sexual enjoyment, men are put more under strain than women. Patients aged 69 y and younger experience more stress through deteriorated sexual function.
Collapse
|
21
|
Schmidt CE, Möller J, Hesslau U, Bauer M, Gabbert T, Kremer B. Universitätskliniken im Spannungsfeld des Krankenhausmarktes. Anaesthesist 2005; 54:694-702. [PMID: 15942750 DOI: 10.1007/s00101-005-0860-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In recent years Germany has faced a growing economization and competition among hospitals. To protect their interests hospitals have to operate similarly to other commercial businesses. Academic hospitals face difficult circumstances in this competition. They have to facilitate research and education activities which require additional financial and personnel resources but also provide maximum acute care treatment at all times. This causes additional disadvantages in terms of financial resources, compared to private hospital chains. Such examples of financial shortcomings have led to the privatization of academic research centres in Germany. An alternative strategy to privatization of academic acute care hospitals is the change of their legal status into a capital company or into a foundation, according to US experiences. Public private partnerships (PPPs) may also represent a potential alternative, as they have already produced a growing number of successful examples in the public sector in Germany. Academic acute care hospitals can also choose a strategic reorganization of their targets, similar to their privately held competitors in the market. Potential economies in scale may be achieved in areas such as medical treatment, research and personnel planning.However, it is vital that academic acute care hospitals start to act productively and also individually. This article provides a number of managerial pathways and options to maintain and strengthen operational competitiveness.
Collapse
|
22
|
Fischbeck JA, Baier JM, Akella R, Hern-Anderson D, Schmidt CE. Genetic modification of alphaGal expression in xenogeneic endothelial cells yields a complex immunological response. TISSUE ENGINEERING 2001; 7:743-56. [PMID: 11749731 DOI: 10.1089/107632701753337690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The source of cells for tissue engineering applications remains a hurdle, predominantly for procedures in which there is insufficient time to harvest a patient's own cells. Animal cells are readily available, but undergo immune rejection. Rejection of animal (i.e., xenogeneic) tissue involves practically every component of the immune system. The initial phase, hyperacute rejection (HAR), involves natural xenoreactive antibodies and the complement system, and leads to endothelial cell lysis and rapid tissue destruction. The cell-surface epitope, galactose-alpha(1,3)-galactose (alphaGal), is presumed to play a key role in HAR. The later stage of immune response (delayed xenograft rejection or DXR), is mediated by immune cells such as monocytes. Carbohydrates are likely also involved in DXR, but their role in this phase of the immune response is less clear. A better understanding of all stages of xenogeneic immune rejection may make it feasible to create cell lines that are immune tolerant. In these studies, we have genetically modified bovine endothelial cells to study the roles of carbohydrates in immune rejection. Our studies suggest that one or more epitopes other than alphaGal may influence complement-mediated lysis. Furthermore, antibodies, as instigators in the complement response, and monocytes appear to recognize different cell surface epitopes.
Collapse
|
23
|
Furnish EJ, Zhou W, Cunningham CC, Kas JA, Schmidt CE. Gelsolin overexpression enhances neurite outgrowth in PC12 cells. FEBS Lett 2001; 508:282-6. [PMID: 11718731 DOI: 10.1016/s0014-5793(01)03078-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The rational design of therapies for treating nerve injuries requires an understanding of the mechanisms underlying neurite extension. Neurite motility is driven by actin polymerization; however, the mechanisms are not clearly understood. One actin accessory protein, gelsolin, is involved with remodeling the cytoskeleton, although its role in cell motility is unclear. We report a two-fold upregulation of gelsolin upon differentiation with nerve growth factor. Cells that were genetically modified to overexpress gelsolin have longer neurites and a greater neurite motility rate compared to controls. These data suggest that gelsolin plays an important role in neurite outgrowth.
Collapse
|
24
|
Dixit P, Hern-Anderson D, Ranieri J, Schmidt CE. Vascular graft endothelialization: comparative analysis of canine and human endothelial cell migration on natural biomaterials. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2001; 56:545-55. [PMID: 11400132 DOI: 10.1002/1097-4636(20010915)56:4<545::aid-jbm1126>3.0.co;2-v] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Canines are typically used as the standard preclinical model to gauge the success of vascular graft materials. However, canines spontaneously re-endothelialize vascular grafts, whereas humans do not, even after years. This raises questions of why there are differences in vascular healing between humans and other species and whether the canine is the appropriate preclinical model. In the present study we evaluated human and canine endothelial cell (EC) migration on the novel cross-linked collagen biomaterial PhotoFix(TM) pericardium. We compared in vitro migration of these cells on PhotoFix alone and on PhotoFix adsorbed with various growth factors (aFGF and bFGF) and adhesion proteins (fibronectin, collagen IV, vitronectin, and laminin). We also compared human and canine ECs in terms of their morphologies and prostacyclin production. We found that human umbilical vein ECs (HUVECs) and canine ECs (CECs) migrated well on PhotoFix, suggesting that this biomaterial may be a good vascular graft candidate. Both cell types responded similarly to different growth factors and adhesive proteins, but HUVEC migration was consistently higher than that for CECs. This suggested that human in vivo graft re-endothelialization is likely not hindered by poor endothelial migration but is hindered by other cellular or graft properties.
Collapse
|
25
|
Kotwal A, Schmidt CE. Electrical stimulation alters protein adsorption and nerve cell interactions with electrically conducting biomaterials. Biomaterials 2001; 22:1055-64. [PMID: 11352099 DOI: 10.1016/s0142-9612(00)00344-6] [Citation(s) in RCA: 337] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Electrical charges have been shown to enhance nerve regeneration; however, the mechanisms for this effect are unclear. One hypothesis is that an electrical stimulus alters the local electrical fields of extracellular matrix molecules, changing protein adsorption. We have investigated this hypothesis--that electrical stimulation increases the adsorption of serum proteins, specifically fibronectin (FN), to the electrically conducting polymer polypyrrole (PP), thereby, increasing neurite extension. PP was used because electrical stimulation of PP has been shown to significantly enhance neurite outgrowth, and more importantly, PP can be formed into conduits to guide nerve regeneration in vivo. Here, we looked at the effects of electrical stimulation on protein adsorption when an electrical current was applied to PP (1) during protein adsorption (immediate stimulation) and (2) several hours after protein adsorption (delayed stimulation). We found that immediate stimulation of PP increases FN adsorption from purified FN and serum-containing solutions. Correspondingly, PC-12 cells grown on PP films that had been previously adsorbed with FN during immediate stimulation expressed longer neurites. However, for delayed stimulation, no significant differences in adsorption or neurite outgrowth were observed. These studies suggest that increased FN adsorption with immediate electrical stimulation may explain enhanced neurite extension on electrically stimulated PP.
Collapse
|