[Success factors and obstacles in the implementation of competence-oriented teaching in surgery]. / Erfolgsfaktoren und Hindernisse bei der Implementierung kompetenzorientierter Lehre in der Chirurgie.

BACKGROUND AND OBJECTIVES: For successful competence-oriented teaching at the medical faculties it is important to identify the factors that influence its implementation in order to benefit from the strengths and balance out weaknesses. The present study examined the success factors and obstacles of the implementation of competence-oriented teaching in the surgical discipline from the point of view of students and lecturers. METHODS: After implementation of competence-oriented teaching based on the teaching goals of the NKLM, in clinical examination courses (bedside teaching and block internship, BP) at two hospitals, a qualitative content analysis and quantification of the answers were performed using focus group interviews and questionnaires with students (S) and lecturers (D). RESULTS: During the summer semester 2022 a total of 31 students and 14 lecturers were interviewed in focus groups and 143 questionnaires (123 S, 20 D) were analyzed. For the students the presence of concrete competences/teaching goals, guidelines for the lesson, transparent goals and ability to demand teaching goals as well as structured lessons and mentoring were the main success factors. Lecturers on the other hand reported the presence of concrete goals, assistance for the lesson preparation and the activity of the students as success factors. The results of the questionnaires showed that the majority (88% S, 75% D) were informed about the teaching goals and considered them to be followed (84%S, 95% D). Obstacles were the factors "time", "mentoring" and "information". Factors that were between negative and positive (indifferent factors) were "uncertainty about competence-orientation" and "uncertainty how to examine the teaching success". DISCUSSION: Transparent structure and teaching goals as well as a mentoring system are the success factors for the implementation of competence-oriented lessons and should be used as strengths. Indifferent factors represent weaknesses and need to be addressed by training and instruction. Restricted time and personnel resources are the immanent problems that hamper the implementation and require fulminant structural changes.

[Plain x-ray studies of bone material in the repair of fractures (author's transl)]. / Nativradiologische Studie zur Beurteilung osteosynthetisch mit kortikospongiösem Material versorgter Defektfrakturen.

Ten patients who had had osteosynthetic repairs of bone defects carried out by means of bone grafts were studied. It was shown that magnification radiography permitted better and more complete evaluation of the healing process. Trabecular bone structure can be recognised and changes in the configuration and position of the trabeculae during their incorporation into the bone can be evaluated.

[Does low intensity, pulsed ultrasound speed healing of scaphoid fractures?]. / Beschleunigt niedrig intensiver, gepulster Ultraschall die Heilung von Skaphoidfrakturen?

Since pulsed low-intensity ultrasound (frequency: 1.5 MHz, pulsed by 1 kHz, signal burst width: 200 microseconds, intensity: 30 mW/cm2) has been proven to stimulate fracture healing both clinically and experimentally, our question was whether this therapy also accelerates healing of fresh stable scaphoid fractures. Addressing this question, we did the following prospective randomized clinical trial. Regarding the results of former clinical fresh fracture studies by Heckman and Kristiansen, we postulated that low intensity ultrasound accelerates healing by about 30%. Based on this thesis, we calculated that 30 patients divided into two groups would be necessary to show significant differences between the standard treatment (treated by casting) and an adjunctive ultrasound treatment (treated by casting and additional daily 20 minutes ultrasound treatment) if present. Diagnosis and healing was assessed by CT scans every two weeks. CT's were analyzed by two independent radiologists and one hand surgeon. Furthermore, areas of cancellous bone bridging in correlation to the diameter of the scaphoid was measured in each CT scan. The results showed ultrasounded fractures healing in 43.2 +/- 10.9 days versus 62 +/- 19.2 days in the control group (p < 0.01). Trabecular bridging six weeks after injury showed 81.2% +/- 10.4% healed in the ultrasound-stimulated fractures versus 54.6% +/- 29% in the control (p < 0.05). Our study results confirm those of Heckman and Kristiansen and show a similar acceleration of bone healing. Low intensity ultrasound is successful in accelerating the healing of fresh scaphoid fractures.

[Nebacetin and taurolin as intraoperative disinfectant solutions in surgery of the locomotor system (author's transl)]. / Nebacetin und Taurolin als intraoperative Spüllösungen bei Eingriffen am Bewegungsapparat.

The anti-infective preventive action of intraoperative disinfection with physiological solution containing antibiotics, appears to be firmly established, judging from numerous publications. Since germs are showing a world-wide increasing resistance, the search for antibiotics which continue to be effective must be kept up, but alternative suggestions are equally necessary. Some publications have already been presented indicating that success similar to that previously obtained with antibiotics is possible by using disinfectants in the prophylaxis and treatment of infections. Hence, a comparative study was conducted using the non-absorbable broad-spectrum antibiotic Nebacetin and the disinfectant Taurolin in a 1% solution with a group of patients subjected to a total of 7699 major and minor surgical operations. Prospectively, early infections during the stay of the patient in the hospital, als well as disturbed wound healing, were included. No significant difference was found in the number of infections and the rate of disturbed wound healing. Indirectly, it is possible to conclude with the help of results from literature that the disinfectant Taurolin is suitable as an addition to intra-operative rinsing in the prophylaxis of infections.

[Installation and reconstruction of autologous spongiosa and compacta after substitution with ground bone]. / Der Ein- und Umbau von autologer Spongiosa und Compacta im ersatzschwachen Knochenlager.

Defined tissue defects were made in the tibiae of 24 sheep. In each animal three defects were set; one of these was completely filled with cancellous bone and the other one with ground compact bone, whereas the third one was not grafted and served as control. During the first 3 weeks no significant difference was seen in the formation of new bone at any of the defects. Most of the ground grafts were transformed into new bone between the 4th and the 6th week; in contrast most new bone was made both in the control defect and the cancellous graft between the 7th and 12th week. In the early phase of our experiment the graft made of ground compact bone was superior to the graft formed from cancellous bone with regard to the amount of new bone formed as well as to its structure. Under clinical conditions, ground compact bone could be useful for autologous bone grafting.

[Formation of autologous spongiosa in bone layers as a function of revascularization]. / Einbau autologer Spongiosa im Knochenlager in Abhängigkeit von der Revascularisation.

In 24 sheep standardized holes were drilled into the tibia. These defects were filled differently with autologous cancellous bone: a) The defect was filled only with cancellous bone or b) it was filled like in (a) but additionally covered by a Milliporefilter layer; c) the defect was filled like in (a) but the bottom of the defect was covered by a Milliporefilter layer or d) it was filled like in (a) but the cancellous bone was sandwiched by Milliporefilter layers. Bine remodelling was adversely influenced by the Milliporefilters, but the inhibition in (b) was two times bigger than in (c).

[Tumoral calcinosis--an independent disease?]. / Die tumoröse Kalzinose--eine eigenständige Erkrankung?

Tumoral calcinosis has up to date been considered as an independent disease. The survey of the literature shows that only its clinical and radiological appearance are generally accepted while its epidemiology and etiology are still under discussion. A genetical disorder, recurrent soft tissue microtrauma or terminal renal failure are blamed to cause tumoral calcinosis. All these causes may lead to localized or generalized disturbance of the calcium-phosphate-metabolism which in turn causes tumoral calcinosis. Therefore tumoral calcinosis should be regarded as a rare symptom of a metabolic disorder rather than an independent disease. Clinical appearance and treatment of two cases of tumoral calcinosis are reported followed by a review of the literature.