ZUSAMMENFASSUNGMikrobielle Kontaminationen von Schallköpfen, kutan oder endokavitär angewandt, sind häufig, tatsächliche Infektionen nach Sonografien werden jedoch nur kasuistisch berichtet. In Deutschland existieren rechtliche Vorschriften zur Schallkopfhygiene. Ein Expertengremium der DEGUM hat vor dem Hintergrund der Vorschriften und der verfügbaren Literatur differenzierte Empfehlungen zur Hygiene in der Sonografie und der Endosonografie, einschließlich der ultraschallgestütz-ten Interventionen, formuliert.
Introduction: Previous studies have shown that prestenting in ureterorenoscopic stone removal (URS) is carried out more frequently in Germany than in other countries. Objective: This investigation evaluated the impact of high prestenting rates on outcomes as well as the influence of stone characteristics and treatment habits on prestenting. Methods: The dataset from the BUSTER observational study was used. Patient and stone characteristics, as well as treatment outcomes, were analyzed for 307 cases from 14 urological clinics in Germany. Results: The overall prestenting rate was 70.0%. Prestenting rates were significantly higher for renal stones than ureteric stones (84.6 vs. 60.6%, p < 0.0001). Compared to the unstented cases, prestenting for renal stones improved stone-free rates (73.2 vs. 11.1%, p < 0.0001) and increased the rate of completely lesion-free URS (45.4 vs. 16.7%, p = 0.034) while reducing the rate of poststenting (from 100 to 80.8%, p = 0.041). None of these effects could be demonstrated when prestenting for ureteric stones. Prestenting rates were less variable for renal stones (57-100%) than for ureteric stones (0-100%, p < 0.01). Conclusions: This study confirms the benefits of prestenting in URS for renal stones but not for ureteric stones. There were considerable differences in prestenting rates between the participating clinics.
On the basis of our data, URS proved to be a safe and effective stone treatment procedure regardless of the degree of guideline conformity. Although the stone-free rate was higher with URS as treatment of first choice, the results of URS as treatment of second choice were not significantly worse. The recommendations of the GS2k-GL offer a safe guide for ureterorenoscopic stone treatment. The tendency for higher stone-free rates in URS as a treatment of first choice should be examined in further studies.
To address the increasing shortage of qualified residents, which leads to further discontent and additional on-call rotations for the remaining physicians, an analysis of the current situation was performed. Stress in the daily working routine, not enough free time, too little pay, or too little compensatory time off for overtime as well as inadequate options for continuing education were reported to be the main elements of dissatisfaction. The economic pressure of day-to-day work continues to define the physician's role and places demands on the medical staff by burdening them with nonmedical and administrative tasks.The major causes mentioned were staff shortage and lack of support provided by supervisors and the administration. For this reason, human resource development should be considered a strategic and central goal. This requires a normative, cross-functional approach at all levels of management and inclusion of personnel departments in the strategic processes of the hospital. The most important aspects for resident satisfaction were the work environment, acceptable work-life balance and remuneration, compensation for overtime, and quality of available continuing education, which is often rated as being insufficient.Effective strategies to improve the motivation of residents comprise offering opportunities for structured continuing education, optimizing the everyday work processes, and involving employees in social networks. The establishment of feedback strategies, including recognition of residents' achievements, will help to ensure their loyalty and identification with their clinic. This can serve as a preventive measure to offset any potential willingness to change jobs.
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