[Urology onLINE-webinar for assistants : Implementation and evaluation of a voluntary, web-based e­learning training series for urology assistants in continuing education (Urology onLINE)]. / Urologie onLINE ­ Webinar für Assistenten : Implementierung und Evaluation einer freiwilligen, webbasierten E­Learning Fortbildungsreihe für urologische Assistenten in Weiterbildung (Urologie onLINE).

BACKGROUND AND OBJECTIVES: The rapid development of new knowledge resources is essential for continuous training and continuing education. Since the training period often coincides with the starting of a family, time resources are often scarce. For this reason, a new, voluntary, web-based e­learning training series was designed for urological assistants (urology onLINE). We investigated to what extent the offer of a web-based training series is used by urological training assistants and how it is evaluated by participants and speakers. MATERIALS AND METHODS: The training series includes a one-month training on a topic from the urological continuing education, which is presented online and whose contents are checked by means of interspersed CME questions. During the investigation period November 2016 to October 2017, participants in the Urology onLINE training series were evaluated. In addition, an evaluation of individual events and an evaluation of the work load of the speakers took place. RESULTS: On average, 60 participants participated in the individual events. These were rated very well with an average grade of 1.43 ± 0.21. Two thirds of the participants experienced an active and inquisitive experience during the event. The workload for the speakers was less than that of a comparable classroom event. CONCLUSIONS: Overall, the new Urology onLINE training series aims to contribute to the increase in spatial and temporal flexibility, and complements existing training formats, especially in times of scarce time resources.

Subspecialisation in Emergency Radiology: Proposal for a harmonised European curriculum.

Introduction: Radiology plays a crucial role in the emergency care setting by delivering early and precise diagnoses under pressure of time, right at the beginning of patient treatment. Although there is a need for postgraduate education in emergency radiology, most of the national bodies responsible do not offer it in a uniform fashion and a general proof of qualification is missing in Europe. Therefore, the European Society of Radiology (ESR) has founded the (Sub-)Society of Emergency Radiology (ESER), prompting them to develop a European curriculum. This trend, which is currently also encouraged in many other non-radiological specialties which demand the highest professional qualifications, often lacks expertise in medical education. Goals: The goal of this article is the general description of the curricular planning process for a European postgraduate subspecialisation programme, using the example of Emergency Radiology (European Diploma in Emergency Radiology, EDER), including the utilisation of TOOLS and recommendations derived from comparable projects. Project description: The project was divided into partial steps: the timeline displayed in a GANTT chart, and tasks and responsibilities assigned in a RASCI matrix. The curriculum was iteratively developed using the KERN approach and steps were prioritised using the PARETO principle. Furthermore, the following TOOLS were used: limitations and needs assessment, SWOT analysis, formulating learning objectives and categorising them after MILLER and SCLO, and using BLOOM's taxonomy for cognitive learning objectives and operationalising them according to MAGER. Psychomotoric and affective learning objectives were assigned to CANMEDS roles, grouped by topic using CLUSTERING, and then mapped by MATRIX analysis to appropriate learning and evaluation methods. Striving for continuous improvement, the curriculum was finally embedded in curricular quality management. Results: The standardisation of the EDER access, considering the different national conditions, the minimisation of European learners' attendance phases, restricting expenses by best possible use of existing structures, respecting the requirements and retaining the support of the European umbrella society ESR, finishing the project by a specific deadline and the demands of continuous improvement were particular challenges. A curriculum with the eligibility of five years' speciality training in general radiology has evolved on schedule. The subspeciality training lasts at least one year and is divided into webinars, workshops during congresses (e.g. the annual ESR and ESER congresses) and one year practical training at the individual learner's corresponding local hospitals, which adhere to a catalogue of requirements, comparable to national educational policies. The curriculum is completed by passing a written and oral exam (diploma) and re-accreditation every five years. Conclusions: Despite complex requirements, the TOOLS utilised allowed an almost seamless, resource-minimised, professional, location-independent distributed development of a European subspeciality curriculum within one year. The definitive implementation is still due. If any deviations from the draft presented should become necessary in the future, the embedment in the curricular quality management will lead to a redirection in the right way and, furthermore, secure a continuous improvement in the best way possible.

Assessment of practical tasks in the Phantom course of Conservative Dentistry by pre-defined criteria: a comparison between self-assessment by students and assessment by instructors.

INTRODUCTION: Assessment of practical skills in undergraduate dental education has difficulties, including a lack of transparency/objectivity in student evaluations. This prospective study investigated whether agreement between student- and faculty-based assessments increased when students were trained to use the assessment criteria. MATERIALS AND METHODS: Assessment criteria were available for 6 tasks in the Phantom course of Conservative Dentistry: Class II cavity preparation, composite restoration, gold and ceramic partial crown preparation, trepanation and access cavity preparation, and root canal filling. Forty-two students were allocated to three different assessment training groups. Students' self-assessments of practical tests were compared with instructors' assessments, depending on training intensity and task type (Pearson's rho, ANOVA, Tukey's post hoc test, Kruskal-Wallis test). Students/instructors were questioned regarding benefits/drawbacks of the criteria. RESULTS: Student self-assessments showed either consent (24.2%), overestimation (31%) or underestimation (44.8%). Gender differences were negligible. Regarding passing/failing grades, more intensive training yielded significantly increased agreement only for preparation of gold partial crowns (rho = +0.313, P = 0.044). Ratings exhibited significant differences amongst tasks (P = 0.002), for example, trepanation assessment had significantly lower differences than gold or ceramic preparation assessments. These discrepancies decreased with increased training. Students consistently reported benefitting most from learning the criteria for gold preparations, followed by composite and ceramic preparations. They also reported that learning the criteria was beneficial for knowledge transfer/feedback. Instructors rated the criteria as helpful for task evaluation and feedback efficiency. CONCLUSIONS: Pre-defined assessment criteria may increase consistency between student self-assessment and instructor assessment depending on the task, improving transparency and feedback in dental education.

Vaccination: Developing and implementing a competency-based-curriculum at the Medical Faculty of LMU Munich.

BACKGROUND: In Germany medical students should gain proficiency and specific skills in the vaccination field. Especially important is the efficient communication of scientific results about vaccinations to the community, in order to give professional counseling with a complete overview about therapeutic options. AIM OF THE PROJECT: The aim of this project is to set up a vaccination-related curriculum in the Medical Faculty at the Ludwig-Maximilians-University in Munich. The structure of the curriculum is based on the National catalogue for competency-based learning objectives in the field of vaccination (Nationaler Kompetenzbasierter Lernzielekatalog Medizin NKLM). Through this curriculum, the students will not only acquire the classical educational skills concerning vaccination in theory and practice, but they will also learn how to become independent in the decision-making process and counseling. Moreover, the students will become aware of consequences of action related to this specific topic. METHODS: According to defined guidelines, an analysis was performed on courses, which are currently offered by the university. A separate analysis of the NKLM was carried out. Both analyses identified the active courses related to the topic of vaccination as well as the NKLM learning objectives. The match between the topics taught in current courses and the NKLM learning objectives identified gaps concerning the teaching of specific content. Courses were modified in order to implement the missing NKLM learning objectives. RESULTS: These analyses identified 24 vaccination-related courses, which are currently taught at the University. Meanwhile, 35 learning objectives on vaccination were identified in the NKLM catalogue. Four of which were identified as not yet part of the teaching program. In summary, this interdisciplinary work enabled the development of a new vaccination-related curriculum, including 35 learning objectives, which are now implemented in regular teaching courses by the Medical Faculty. CONCLUSIONS: This project successfully describes a method to develop and implement a competency-based teaching program on the topic of vaccination. Importantly, the process presented here can serve as a guide to develop and implement similar teaching programs on other subjects and Universities.

Effectiveness of a novel endoscopy training concept.

BACKGROUND AND STUDY AIMS: Training standards in gastrointestinal endoscopy are poorly defined even though different simulators are increasingly used for skills training. In 2001 a new training concept called "GATE--gastroenterological education-training endoscopy" was established, which provides a combination of background theory, video demonstrations, and simulator training. We aimed to evaluate the acceptance and training effect of this training model. METHODS: In total, 98 physicians participating in four training courses were included. Data were collected on baseline characteristics, acceptance (5-point Likert scale), and pre- and post-course knowledge through a structured questionnaire (A-type and Pick-N multiple choice questions). A total of 13 trainees were randomly selected for additional simulator assessment of training effects on manual skills (5-point Likert scale). RESULTS: A total of 78 trainees (80%) provided complete data sets. The evaluation showed a positive acceptance of the training program (value 1 and 2, Likert scale); for example, 88% of participants suggested the inclusion of the GATE course as an obligatory part of endoscopic education. There was a significant improvement in theoretical knowledge in the post-test set compared with the pre-test set (mean 3.27 ±1.30 vs. 1.69 ±1.01 points; P<0.001). The training effect on practical skill showed a significant reduction in time needed for a procedure (445 ±189 s vs. 274 ±129 s; P<0.01). The mean assessment rating for practical skills improved from 3.05 ±0.65 at baseline to 2.52 ±0.59 on Likert scale ( P=0.085). CONCLUSIONS: The integrated GATE training improved theoretical knowledge and manual skill. The GATE courses have been accredited by the German Society of Gastroenterology, underlining the demand for implementing preclinical training courses in endoscopic training.

[The motivation to become a medical doctor - doctoral students in a formal academic study program compared with those pursuing their doctorate independently]. / Die Motivation zu promovieren. Ein Vergleich von medizinischen Doktoranden in einem Promotionsstudiengang mit individuell promovierenden Doktoranden.

BACKGROUND AND OBJECTIVE: Weight and quality of medical doctoral theses have been discussed in Germany for years. Doctoral study programs in various graduate schools offer opportunities to improve quality of medical doctoral theses. The purpose of this study was to demonstrate distinctions and differences concerning motivation, choice of subject and the dissertation process between doctoral candidates completing the doctoral seminar for doctoral students in the Ludwig-Maximilians-University (LMU) Munich and doctoral candidates doing their doctorate individually. METHODS: All 4000 medical students of the LMU obtained an online-questionnaire which was completed by 767 students (19 % response rate). The theoretical framework of this study was based upon the Self-Determination-Theory by Deci and Ryan. RESULTS: Doctoral candidates completing the doctoral study program were more intrinsically motivated than doctoral candidates doing their doctorate individually; no difference was found in their extrinsic motivation. In regard to choice of subject and dissertation process the doctoral students in the seminar were distinguished from the individual group by having chosen a more challenging project. They anticipated a demanding dissertation process including conference participation, publishing of papers, etc. Intrinsic motivation correlates positively with choosing a challenging project and a demanding dissertation process. CONCLUSION: High intrinsic motivation seems to be very important for autonomous scholarly practice. Our results suggest that doctoral study programs have a positive impact on intrinsic motivation and interest in research.

Is a PBL curriculum a better nutrient medium for student-generated learning issues than a PBL island?

Problem based learning (PBL) is often introduced in curricula in form of short segments. In the literature the value of these PBL-islands is doubted. In order to gain more insight in this curricular approach, we compared student generated learning issues, from a 7-week PBL-island introduced in a traditional curriculum (PBL-I), with the gold standard of a PBL-based model-curriculum (PBL-B) existing in parallel at the same University (Ruhr-University Bochum, Germany). Both tracks use five identical PBL-cases. Thousand seven hundred and three student-generated learning issues of 252 tutorial groups (193 PBL-I and 59 PBL-B groups with six to seven students per group) were analysed in seven different categories. Results showed that overall there were no substantial differences between both curricula. PBL-B students generated more problem-related and less basic science clinical learning issues than PBL-I students, but in both groups learning issues were related to the same number of different subjects. Furthermore, students in the PBL-curriculum tend to generate little less but slightly better phrased issues. Taken together, we found no substantial evidence with respect to student-generated learning issues that could prove that students cannot work with the PBL-method, even if it is introduced later in the curriculum and last only for a short period of time.

[Acceptance of case-based, interactive e-learning in veterinary medicine on the example of the CASUS system]. / Akzeptanz von fallbasiertem, interaktivem eLearning in der Tiermedizin am Beispiel des CASUS-Systems.

OBJECTIVE: New teaching methods such as e-learning, are increasingly used to support common methods such as lectures, seminars and practical training in universities providing education in veterinary medicine. In the current study, the acceptance of e-learning in the example of the CASUS system by veterinarians as well as students of veterinary medicine of all German-speaking universities was analyzed. Material und methods: For this purpose an online evaluation questionnaire was developed. Members of the target groups were informed by e-mail and references in professional journals, as well as through veterinarian exchange platforms on the internet. Additionally, 224 students' final anatomy marks were compared and correlated to the utilization of CASUS to gain an important insight for the development of new teaching practices in the teaching of veterinary medicine. RESULTS: In total 1581 questionnaires were evaluated. A good acceptance regarding new teaching practices was found, although the classical textbook is still the most important instrument for imparting knowledge. The degree of utilization of e-learning strongly depends on its integration into the teaching content. CASUS is regarded as an efficient teaching method, with over 90% of the respondents indicating a strong desire to expand the number of case studies. Due to the present low degree of integration into the teaching content, no significant correlation could be found between the utilization of anatomy case studies and the final anatomy mark. However, based on their subjective perception, the students reported a high level of success in their study results with the likely effect of supporting increasing self-assurance in the situation of examinations. CONCLUSION: With the help of e-learning, educational objectives can be achieved that are not attainable by traditional teaching methods, e.g. the review of individual improvements by using the integrated feedback-function of e-learning programs. However, e-learning is not able to completely replace current teaching practices and hence should be considered as an additional element in future teaching models.

Teaching and assessment in otolaryngology and neurology: Does the timing of clinical courses matter?

Little is known about the effectiveness of clinical courses as a learning environment. To accurately assess performance in these courses, equal conditions for all candidates are required. We investigated the influence of the proximity of the course to the students test taking, the students' learning styles, and their self-motivation for learning in relation to performance success. One hundred and eleven students were randomized into eight groups, each attending a 2 week course in otolaryngology with a high proportion of patient-related teaching, and a 2 week long course in neurology with a low level of patient-related teaching. All students took multiple-choice end-of-term exams to assess their knowledge in both subjects. There was a different time interval between the course participation and the test taking for each of the groups. Performance success was correlated with the different groups, as well as with the type of learning style (LIST questionnaire) and with motivation for learning (study interest questionnaire). Explorative rank variance analysis showed a significant correlation between students' performance on the written exam and the time interval between completion of the neurology course and test-taking, with the shortest interval corresponding to highest scores (P = 0.002). There was no such effect on the success rate in otolaryngology (P = 0.28). Study motivation was not the major component for performance success, but a strong correlation between the use of strategic and deep learning styles and success in the exam was observed (R = 0.62; P < 0.001). The duration of time between a clinical course with little practical teaching and the students' taking of the exam plays a significant role on performance success; this effect does not occur in a course with a high proportion of practical patient-related teaching. More studies on clinical courses are needed to establish how students can be given adequate opportunities to develop necessary skills for patient care and for objective success on assessment. With such further information, the effectiveness of clinical courses as a learning experience might be enhanced.

[Evaluation of a case-based computerized learning program (CASUS) for medical students during their clinical years]. / Evaluation eines fallbasierten computergestützten Lernsystems (CASUS) im klinischen Studienabschnitt.

BACKGROUND: Clinical undergraduate medical education at the Ludwig-Maximilians University in Munich (LMU) is supplemented by computerized case presentations. This educational strategy teaches problem-solving abilities and differential diagnostic reasoning, thus preparing the students for the management of actual clinical situations with real patients. This study describes the use of a case-based learning system and its acceptance in internal medicine from the students' perspective. Effects of age and gender were taken into account. The results are used for continually improving the system and the offered contents (cases). METHODS: By means of qualitative and quantitative methods data on the integrated concept of the students' perceived learning success, their motivation and acceptance were assessed during 1999 to 2002. Connections between the different factors were evaluated and the reasons for not using the learning program were given particular attention. Data were obtained from on-line and printed questionnaires as well as electronic protocols. Results were obtained from 380 fourth year medical students, aged between 20 and 34 years. 47% of all registered students during the academic year 2001/2 were female, but they were 58% of those completing the written questionnaire part of the study. RESULTS: The study showed a good acceptance rate and broad utilization of cases by the students. Case-based learning improved study motivation. Voluntary use of cases increased from 11% in 1999 to 31% in 2002. Male and older students were more motivated than female and younger students. In free comments the students pointed out the close link between this new learning method and real life and the chance of a useful learning experience. CONCLUSION: Case-based computerized learning programs adapted to concurrent lectures assists in the self-assisted learning. Thus the integration concept contributes to the learning process.

[57-year-old patient with diplopia and headache]. / 57-jähriger Patient mit Doppelbildern und Kopfschmerzen.

A 57-year old patient presented with an 8 week history of headache and diplopia. Left-sided incomplete oculomotor nerve paresis was found, whereas further clinically relevant visual impairment was not seen. Magnetic resonance imaging of the head showed an extensive intra-, para- and suprasellar tumor which in combination with a markedly elevated serum prolactin level was identified as a macroprolactinoma. The symptoms began 7 years ago with a loss of libido and virility. The application of a dopamine agonist lead to a reduction of serum prolactin level to 0.5% of the initial value and a considerable tumor regression within three months. The development of oculomotor nerve paresis is an unusual manifestation of prolactinoma. By contrast, long-term medical history with slowly developing signs and symptoms of hypogonadotropic hypogonadism are often to be found in men. The delayed diagnosis is responsible for the high percentage of macroprolactinomas in male subjects.

Comparing health care delivery systems--initiating a student exchange project between Europe and the United States.

BACKGROUND: Cross-cultural contact among different health care systems can provide a framework for identifying the strengths and weaknesses of one's own healthcare system. However, such contact has rarely had much impact upon medical education curricula. Despite intense debate on reforming the healthcare delivery systems (HCDS) in Europe and the United States, there is very little formal representation of this interdisciplinary field in our educational programs. DESCRIPTION: To address this problem, a medical student exchange program was conducted in which students developed case studies that produced comparative analyses of HCDS in Germany, Sweden, Denmark and the United States. Each case is intended to highlight critical differences among the systems. EVALUATION: Students and their faculty preceptors completed pre- and post-exchange questionnaires to assess perceived knowledge of the HCDS and the adequacy of time devoted to it in their curricula. Both perceived that too little attention was devoted to this content in their programs. Following the exchange, students described clear increases in perceived knowledge. DISCUSSION: Our common interest in curriculum reform was key to implementing the exchange. The written cases generated by the students are being developed as course material in some of the schools and a conference is planned to disseminate the cases and the implementation strategies for their inclusion in medical curricula.

Do computers teach better? A media comparison study for case-based teaching in radiology.

A prospective study was performed to better define the role of computers in teaching radiology to medical students. Two hundred twenty-five 3rd-year students were randomly assigned to one of four groups and exposed to 10 radiology cases as well as to a voluntary weekly radiology lecture. Group A used computer-based cases with interactive elements; group B used computer-based cases without interactive elements; group C used paper-based cases with interactive elements; and group D was not exposed to the cases and served as a control group. On a multiple-choice question test, groups A, B, and C showed significant improvement (+11.2%, +15.1%, and +13.0%, respectively), whereas group D did not (+0.6%). On an image interpretation test, group A showed the most improvement (+15.7% [P <.001]), followed by group B (+15.1% [P <.01]) and group C (+10.2% [P <.05]); group D showed no significant improvement (+8.5%). No significant differences in the learning outcome were found between the two interactive groups (computer based and paper based). Computer-based teaching with case studies (with or without interactivity) improves students' problem-solving ability in radiology.

[Computer-assisted instruction in medicine: a multicenter evaluation study in 7 German language media resource centers]. / Rechnerunterstützte Instruktion in der Medizin: Eine multizentrische Evaluationsstudie in sieben deutschsprachigen Mediotheken.

EVA, a multicentre study of seven computer resource centres (CRCs) in three German-speaking nations, was carried out over a period of six months to gather structural and process data regarding the use of computer-based instruction (CBI) applications in medicine, and to identify the factors contributing to a more successful integration of CBI into the medical curriculum. 618 machine-readable questionnaires from CRC users and seven questionnaires on structural data of the participating CRCs covering 51 computer stations were evaluated. For Macintosh workstations (n = 34), an additional digital log-protocol was analysed. In conclusion, it seems that so far less than 10% of medical students use CBI programs in German-speaking countries. The data show the presently still poor integration of CBI into the medical curriculum.

[Immunogenic hyperthyroidism with hyperdynamic heart failure and early cirrhotic transformation of the liver]. / Immunogene Hyperthyreose mit hyperdynamischem Herzversagen und beginnendem zirrhotischem Umbau der Leber.

HISTORY AND CLINICAL FINDINGS: A 58-year-old woman was admitted because of jaundice, ascites and marked oedema. For three years she had suffered from nervousness, decreasing fitness and weight loss, which had been assumed as due to chronic alcoholism. Liver biopsy revealed extensive fibrosis, in part with early cirrhotic transformation. This was followed by cardiac failure with atrial fibrillation (ventricular rate 140/min) and marked pleural effusions. The thyroid was diffusely enlarged and there were signs of exophthalmos. INVESTIGATIONS: Bilirubin concentration was 3 mg/dl, lactate dehydrogenase activity was 310 U/l, cholesterase 1.3 kU/l and the prothrombin test was 21%. The TSH level was 0.01 microU/ml while the free thyroxine level was 4.7 ng/dl and that of free triiodothyronine 13.5 pg/ml. Chest radiograph revealed cardiomegaly, bilateral peripheral pulmonary congestion and pleural effusions to midfield. Right heart catheterization excluded pulmonary hypertension; cardiac output was 10l/min. The thyroid was enlarged on ultrasound and diffusely echopoor, as in immune thyroid disease. TREATMENT AND COURSE: Cardiac failure regressed and thyroid function normalized within ten days on propranolol, 4 x 40 mg and thiamazole 3 x 40 mg daily intravenously. Subtotal thyroidectomy was performed three weeks later with subsequent thyroid hormone substitution. Liver functions were normal six months later and ultrasound showed no signs of cirrhotic change and the ascites had resolved. CONCLUSION: Hyperthyroidism is frequently associated with changes in liver functions. In extreme cases, high-output cardiac failure may occur, with liver congestion and clinical as well as histological changes like those in liver cirrhosis.

[CASUS model trial. A computer-assisted author system for problem-oriented learning in medicine]. / Modellversuch CASUS. Ein computergestütztes Autorensystem für die problemorientierte Lehre in der Medizin.

The CASUS-project, a three year publicly funded effort to improve the quality of continuing medical education in Germany, has one major goal: The development and evaluation of an easy-to-handle author-system for problem-oriented learning in medicine. On the theoretical basis of the cognitive apprenticeship-approach, the concept of a teaching and learning database as a hypermedia system was built. The student should learn to manage authentical problems in the form of authentical clinical cases. The step-by-step learning process is expert-guided by the clinical authors of each case. The creation of various differential diagnoses by the learner is strongly supported in the process. The structure of the program can also be used for case-based examinations. In parallel to the technical development, a case-selection process for medical students students in internal medicine was initiated. About 120 relevant diseases were identified to be represented in the CASUS-case library. Prevalence, transferability of knowledge, treatability, urgence of treatment and preventive aspects were used as selection criteria. The system will be evaluated during the implementation of test cases and will then be available to be used by authors and students on a routine basis in 1997.

Data quality in computerized patient records. Analysis of a haematology biopsy report database.

This paper addresses the problem of data quality in electronic patient records using a computerized haematology biopsy report system as an example. Physicians extracted five parameters from a traditional free text cytology report and encoded these parameters thus producing a computer processable report. The parameters were 1) the organ biopsied, 2) quality of specimen, 3) cytological diagnosis including 4) a modifier code for the main diagnosis code (i.e. status post chemotherapy, Y-code) and 5) an additional key describing the degree of remission obtained after chemotherapy of acute leukemias. From the various steps involved in generating the electronic record we selected two critical ones: encoding of free text terms by physician staff; entering of the coded terms into a computer by lab staff. We analyzed the rates of correct, incorrect and missing codes for each of the five parameters. Our findings indicate that in this model of an electronic patient record: 1) there is significant inaccuracy of physicians during the process of encoding the free text report with error rates between 3.2 and 28% and omission rates up to 64%. 2) lab staff entering these coded data into the computer introduce additional errors (0-7.8%) but rarely miss correctly encoded data (0-0.9%). 3) introducing a revised coding system data quality improved significantly (p < or = 0.001) with a fivefold increase of correct and a 75% reduction of missing codes. 4) the clinical relevance of the diagnoses encoded as perceived by clinicians is a significant factor affecting error and omission rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Building a cytology report database: a computer-assisted system for documentation, evaluation and hospital-wide recall of haematological biopsy reports.

Owing to an increasing number of biopsies from different organ systems in our institution and referring institutions there was need to develop a computer-based system to improve documentation, analysis and reports of pathological findings, as well as speed of transmission of information in a clinical haematology/oncology unit. As terminals connected to a central minicomputer are located on all wards of our hospital, we have now provided a faster way of moving information from the cytology reporting site to all hospital departments. Using the hospital's minicomputer we developed an easy-to-use system based on five different codes for each cytological specimen: organ biopsied, quality of specimen, cytological diagnosis including information as to status of patient (i.e. pretherapy), and an additional code describing the degree of remission obtained after chemotherapy of acute leukemias. After microscopic analysis of the specimen these five codes are read into a terminal; minutes after the diagnosis is made, a short version of the report can be accessed from all wards in the hospital.

13C magic angle spinning NMR study of the light-induced and temperature-dependent changes in Rhodobacter sphaeroides R26 reaction centers enriched in [4'-13C]tyrosine.

Solid-state 13C magic angle spinning (MAS) NMR has been used to investigate detergent-solubilized photosynthetic reaction centers of Rhodobacter sphaeroides R26, selectively enriched in [4-13C]-tyrosine. The reaction centers were frozen, in the dark and while subject to intense illumination, and studied at temperatures between approximately 215 and approximately 260 K. The signal consists of at least seven narrow lines superimposed on a broad doublet. The chemical shift anisotropy is similar to that for crystalline tyrosine. The two narrowest resonances, corresponding to signals from individual tyrosines, are 28 +/- 5 Hz wide, comparable to what is observed for quaternary carbons in linearly elastic organic solids. The line width as well as the chemical shift of these signals is essentially independent of temperature. This provides strong evidence for an unusually ordered, well-shielded, and structurally, electrostatically, and thermodynamically stable interior of the protein complex without structural heterogeneities. As the temperature is lowered, additional signal from the labels develops and the natural abundance resonances from the detergent broaden, providing evidence for considerable flexibility at the exterior of the protein complex and in the detergent belt at the higher temperatures. In addition, the NMR provides evidence for an electrostatically uniform and neutral complex, since the total dispersion in isotropic shifts for the labels is < 5 ppm and corresponds to electron density variations of less than 0.03 electronic equivalents with respect to tyrosine in the solid state or in solution. When the sample is frozen while subject to intense illumination, a substantial part of the protein is brought into the charge-separated state P.+QA.-. At least three sharp resonances, including the narrowest lines, are substantially reduced in intensity. It is argued that this effect is caused by the electronic spin density associated with the oxidized primary donor P.+. These results strongly suggest that the environment of the special pair is extremely rigid and question the role of protein conformational distortions during the primary photoprocess.