I. Background II. Guidelines 1. Applicability 2. Fundamental ethical principles 3. Criteria for ICU triage (admission and continued occupancy) under resource scarcity 4. Triage decisions 4.1. Phases 4.2. Admission criteria 4.3. Initial triage: criteria for ICU admission 4.4. Triage during ICU stay 5. Decision-making processes III. Appendix 1. Clinical Frailty Scale (CFS) 2. References 3. Information on the preparation of these guidelines

OBJECTIVE:To assess the feasibility, validity, and reliability of a postoperative Handover Assessment Tool (PoHAT) and to evaluate the current practices of the postoperative handover at 2 large European hospitals. BACKGROUND:Postoperative handover is one of the most critical phases in the care of a patient undergoing surgery. However, handovers are largely informal and variable. A thorough understanding of the problem is necessary before safety solutions can be considered. METHODS:Postoperative Handover Assessment Tool (PoHAT) was developed through task analysis, semistructured interviews, literature review, and learned society guidelines. Subsequent validation was done by the Delphi technique. Feasibility and reliability were then evaluated by direct observation of handovers at 2 large European hospitals. Outcomes measures included information omissions, task errors, teamwork evaluation, duration of handover, and number of distractions. RESULTS:The tool was feasible to use and inter-rater reliability was excellent (r = 0.96, P < 0.001). Evaluation of handover at the 2 study sites revealed a median of 8 information omissions per handover at both the centers (IQR 7-10). There were a median of 3 task errors per handover (IQR 2-4). Thirty-five percent of handovers had distractions, which included competing demands for nurse attention, bleeps, and case-irrelevant communication. CONCLUSION:This study has established the feasibility, validity, and reliability of a tool for evaluating postoperative handover. In addition to serving as an objective measure of postoperative handover, the tool can also be used to evaluate the efficacy of any intervention developed to improve this process. The study has also shown that postoperative handover is characterized by incomplete transfer of information and failures in the performance of key tasks.

Every two years the Otto Naegeli Prize is awarded to a scientist working in Switzerland who has made outstanding contributions to biomedical and/or clinical research and is likely to continue doing so. At its November 2007 meeting, the Otto Naegeli Award Committee of the BonizziTheler Foundation decided to award this year’s Prize to Pierre-Alain Clavien, Professor of Surgery at the University of Zurich. This is the first time that the Otto Naegeli Prize, worth CHF 200,000 and among the most important scientific distinctions in our country, is awarded to a clinician in surgery or any other perioperative discipline. This year’s award winner is one of the very few surgeons in the world who is not only an outstanding clinician and expert on liver surgery and liver transplantation, but also an internationally recognised researcher who has made substantial contributions to our understanding of liver ischaemia, reperfusion and regeneration. Pierre-Alain Clavien was born in Geneva in 1957, where he went to school and later studied medicine. On completing medical school in 1982 he decided to specialise in surgery. After two missions for the Red Cross in Peru and El Salvador, he began his surgical training in Morges. Although German has never been his language of predilection, he wished to broaden his training in as many surgical subdisciplines as possible and so decided to take up a two-year residency at the Department of Surgery in Basel. Shortly after his return to Prof. Rohner’s surgical clinic in Geneva he became a staff surgeon. Even as a young resident he was keenly interested in research, and published an impressive range of papers in prestigious journals (American and British Journals of Surgery and The Lancet, among others) during his training. In Basel he was the principal investigator in a clinical trial on the treatment of mesenteric infarction. Having had the privilege of working with him at that time, I will never forget how he always managed to be present when a new patient was included in the study, despite his customarily long working hours and regardless of whether he was on or off duty. Certified as a surgeon in Switzerland, he decided to obtain formal training in research and enrolled in a PhD programme at the Institute of Medical Science and the Department of Immunology of Toronto University. In 1992 he completed his doctoral thesis “Mechanisms of Preservation and Reperfusion Injury in Liver Allograft.” Since taking up his fellowship in clinical hepatobiliary and liver transplantation at the Department of Surgery, Toronto General Hospital and Hospital for Sick Children in 1991, his clinical activities and research have focused on liver surgery and more specifically on liver transplantation. In 1994 he became an Assistant Professor of Surgery and Director of the Liver Transplant Programme at Duke University in Durham, North Carolina. Only three years later he was promoted to Associate Professor and Director of the entire Division of Transplantation. He left Durham in 2000 as full professor to take over the chair of the Visceral and Transplant Surgery Department, University Hospital of Zurich. Figure 1

Aufgrund einer australischen Untersuchung (77 Patienten) und der multizentrischen Studie aus Europa (275 Patienten) hat das International Liaison Committee on Resuscitation beschlossen, die milde Hypothermie als Empfehlung in die Guidelines zur Behandlung nach prähospitalem Kreislaufstillstand aufzunehmen. Trotz der viel versprechenden Resultate in diesen 2 Studien ist es erstaunlich, wie rasch diese Ergebnisse zu Veränderungen in weltweit gültigen Guidelines geführt haben. Normalerweise würden Bestätigungen durch Studien mit noch größeren und weniger selektionierten Patientenkollektiven abgewartet. Das rasche Reagieren auf kleine mögliche therapeutische Erfolge spiegelt aber auch unsere Frustrationen im bisher Erreichten bei der prähospitalen kardiopulmonalen Reanimation. Die grundlegenden Arbeiten von Safar und seinen Kollegen vor 50 Jahren haben in uns die Hoffnung geweckt, dass wir unter der Voraussetzung, möglichst früh vor Ort zu sein und die nötigen Hilfsmittel zu haben, Tote wiederbeleben können. Die letzten 20 Jahre haben uns aber gezeigt, dass der Erfolg trotz Aufbau eines Notarztsystems und aller neuer technischen Hilfsmittel sehr beschränkt bleibt. Durch den riesigen Aufwand mit der Reanimationsausbildung von Laien haben wir viel Positives erreicht. Wir haben aber auch große Hoffnungen geschürt, denen wir bisher nicht gerecht werden konnten. Die Aufmerksamkeit für dieses Thema ist in der Bevölkerung riesig; fast in jeder KrankenhausFernsehserie wird eine Szene einer kardiopulmonalen Reanimation gezeigt, in einer Häufigkeit, wie sie glücklicherweise im normalen Alltag nicht vorkommt. Unsere Notärzte werden zur Wiederbelebung in Altersund Pflegeheimen aufgeboten, weil der mögliche Tod verdrängt wird, z. T. auch wegen den großen Hoffnungen, die wir dank Fortschritten in der Medizin immer wieder machen. Im Leitthema „Therapeutische milde Hypothermie nach Kreislaufstillstand“ dieser Ausgabe zeigen Popp et al. nicht nur die Vorteile dieser Methode auf, sondern beschreiben auch die historischen Irrwege, die wir auf dem Gebiet der Hypothermie gegangen sind. Um diese milde Hypothermie erzeugen zu können, braucht es neue technische Hilfsmittel. Bisher wurde darauf geachtet, dass die kardiopulmonale Reanimation mit möglichst wenig technischem Aufwand überall durchführbar ist. Die Industrie hat natürlich ein sehr großes Interesse daran etwas herzustellen, das aufgrund von Richtlinien bei jeder Reanimation eingesetzt werden muss. Es ist zu hoffen, dass die Forschung auf dem vorliegenden Gebiet dadurch nicht zu stark beeinflusst wird. Wenigstens wurde jetzt das vom European Resuscitation Council schon länger geforderte länderübergreifende Register über Herzstillstände eingeführt. Epidemiologische Untersuchungen sind auf diesem Gebiet überfällig und hätten eigentlich, falls die milde Hypothermie so erfolgreich ist, zeigen müssen, dass ein neurologisch intaktes Überleben nach Herzstillstand, z. B. beim Schneeräumen, oder nach prähospitalem Kreislaufstillstand, in nördlichen Ländern im Freien häufiger ist.