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Background: Traditional fasting rules for children prior to elective operations ("6‑4‑2 rule") often lead to prolonged fasting times with possible adverse events (discomfort, hypoglycemia, metabolic disorders, agitation/delirium). A new liberal fasting policy allowing children to drink clear fluids until being called to the operating room ("6‑4‑0") was established in our university hospital. This article describes our experiences and retrospectively examines the effects. Objective: Evaluation of real fasting times before and up to 6 months after the intervention (success and durability of changing fasting policy). Evaluation of impact on outcome parameters, such as patients' resp. parents' satisfaction as well as perioperative agitation, arterial hypotension after induction and postoperative nausea and vomiting (PONV). Material and methods: Retrospective evaluation of methods and interventions from 1 month before to 6 months after changing the fasting policy (June–December 2020). Statistical analysis using descriptive statistics, odds ratio and χ2-test. Results: Of 216 analyzed patients 44 were in the pre-change group and 172 in the post-change group. We could significantly reduce clear fluids fasting times over the 6 months after the intervention (median fasting time: from 6.1 h to 4.5 h; p = 0.034) and achieve our aim (fasting time for clear fluids less than or equal to 2h) in 47% of the patients. Fasting times became longer again reaching pre-change intervals in the 4th and 5th month, so reminder measures turned out to be necessary. By reminding the staff we could reduce fasting times again in the 6th month and restore patients' resp. parents' satisfaction. Satisfaction was improved by shorter fasting times (median school grade from 2.8 to 2.2; p = 0.004; odds ratio for better satisfaction 5.24, 2.1–13.2), and preoperative agitation was reduced (agitation modified PAED scale 1–2 in only 34.5% instead of 50%, p = 0.032). In the liberal fasting group, we observed a nonsignificant smaller incidence of hypotension after induction (7% vs. 14%, p = 0.26) while PONV was too rare in both groups for statistical purposes. Conclusion: With multiple interventions we could significantly reduce fasting times for clear fluids and improve patients' resp. parents' satisfaction as well as preoperative agitation. These interventions included regular presence in all staff meetings, a handout for both parents and staff, as well as a remark on the anesthesia protocol. Children who were operated on later in the day, benefited most from the new liberal fasting policy as they were allowed to drink until being called to the operating room. Following our experience, we consider simple and safe fasting rules for the whole staff as most important for change management. Nevertheless, we could not reduce the fasting intervals in all cases and had to remind the staff after 5 months to preserve this success. For enduring success, we suggest regular staff updates during the change process instead of one single kick-off information event. [ABSTRACT FROM AUTHOR]

The inclusive education of children with and without special educational needs is increasingly established in each of the German federal states, including Saxony, due to the development of inclusion (Statistisches Landesamt Sachsen, 2019). This relates to the objective of enabling equal participation for all and aims to establish social coexistence without exclusion already starting in childhood (Beauftragte der Bundesregierung für die Belange behinderter Menschen, 2017). As a result, the question of the most promotional conditions for fulfilling these ideas in inclusive education is becoming more and more important. Based on that, this article provides an overview of previous work from different federal states on promotional implementation factors, including current recommendations for the implementation of inclusive education, and the results are going to be classified into the ecosystem level model (Bronfenbrenner et al., 1981). At the same time, and especially when it comes to addressing the need for support for (future) teachers, it is necessary to take a look into practice, also considering promotional or even inhibiting conditions. Since 2016, the multi-methodological research project called GemU has been implemented by the Chair of "Speech-Language-Communication Pathology, Therapy and Support in Education" at Leipzig University, whose results, also against the background of promotional implementation conditions, will be presented later in this article. The aim was to identify content- methodological, organizational as well as cooperative aspects of the current integrative practice in primary schools in Saxony in order to generate tailor-made offers for teacher training and further education. The mixed-methods design includes a teacher survey (N = 191) with special education and primary school teachers, a parent survey (N = 41) and interviews with both special education teachers (N = 8) and primary school teachers (N = 7). The results show a largely unified picture despite the diverging perspectives: the implementation of integration in primary schools largely takes place in the form of individual support beyond classes, which happens to be an external differentiation action, and mutually consulting by the teachers. The parties are mostly satisfied with this implementation of cooperation. Though, the interviewed teachers and parents expressed dissatisfaction and a desire for change in terms of human and material resources (increase the number of hours for special education, the amount of double staffing and co-teaching; reduction of class sizes and equipping the rooms with materials) as well as establishing joint training courses with content-methodological priorities e.g. on integrated speech-language support during classes. With regard to the recommendations for the implementation of the inclusive education and the experience of the other German Federal States, it can be estimated that the resources made available should be increased in Saxony, as these have a far-reaching influence on the associated development of cooperation (as a condition for success for inclusive education). Moreover, individual support beyond classes should take place occasionally (and in the form of specific linguistic individual support) rather than in principle. Therefore, it is important to strive for co-operation with speech language therapists. To ensure inclusive education both methods of internal differentiation and the adaptation of regular teaching should be implemented generally. Furthermore this should also be considered in teacher training courses to focus more on content-related rather than organizational interventions. Parental work should be continued intensively as an equally important cornerstone. [ABSTRACT FROM AUTHOR]