RESUMO
BACKGROUND: The medical faculty of Heidelberg University implemented a new problem-based clinical curriculum (Heidelberg Curriculum Medicinale, or Heicumed) in 2001. The present study analyses the evaluation data of two student cohorts prior to the introduction of Heicumed. Its aim was to specify problems of the traditional training and to draw conclusions for implementation of a new curriculum. METHODS: The evaluation instrument was the Heidelberg Inventory for the Evaluation of Teaching (HILVE-I). The data were analysed calculating differences in the means between defined groups, with the 13 primary scales of the HILVE I-instrument as dependent variables. RESULTS: Teaching method and subject had no systematic influence on evaluation results. Thus, didactic lecture in orthopedic surgery achieved better results than small group tutorials, while the data on vascular and general surgery showed opposite results. Major factors for success were continuity and didactic training of lecturers and tutors. This is convincingly reflected by the results of the lecture course "Differential diagnosis in general surgery". The good evaluation data on small group tutorials resulted largely from the "participation" and "discussion" scales, which represent interactivity in learning. CONCLUSION: The results of the present study suggest the importance of two major pedagogic ideas: continuity and didactic training of lecturers and tutors. These principles were widely implemented in Heicumed and have contributed to the success of the new curriculum.
Assuntos
Educação de Graduação em Medicina , Cirurgia Geral/educação , Aprendizagem Baseada em Problemas , Atitude do Pessoal de Saúde , Estudos de Coortes , Currículo , Avaliação Educacional , Docentes de Medicina , Alemanha , Humanos , Avaliação de Programas e Projetos de Saúde , Faculdades de Medicina , Especialidades Cirúrgicas/educaçãoAssuntos
Oncologia , Neoplasias/cirurgia , Especialidades Cirúrgicas , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Cárdia/patologia , Colo/patologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Endoscopia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/patologia , Esôfago/patologia , Humanos , Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Neoplasias/diagnóstico , Neoplasias/etiologia , Neoplasias/patologia , Prognóstico , Reto/patologia , Fatores de Risco , Estômago/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaAssuntos
Desoxicitidina/análogos & derivados , Neoplasias Pancreáticas/cirurgia , Antimetabólitos Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Desoxicitidina/uso terapêutico , Diagnóstico Diferencial , Fluoruracila/uso terapêutico , Humanos , Leucovorina/uso terapêutico , Terapia Neoadjuvante , Cuidados Paliativos , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/radioterapia , Prognóstico , Fatores de Risco , GencitabinaAssuntos
Glicina/uso terapêutico , Transplante de Fígado/métodos , Fígado , Preservação de Órgãos/métodos , Traumatismo por Reperfusão/prevenção & controle , Adenosina , Adulto , Alanina Transaminase/sangue , Alopurinol , Aspartato Aminotransferases/sangue , Morte Encefálica , Glutationa , Glicina/administração & dosagem , Hepatectomia/métodos , Humanos , Infusões Intravenosas , Insulina , Testes de Função Hepática , Transplante de Fígado/fisiologia , Soluções para Preservação de Órgãos , Rafinose , Doadores de Tecidos , Coleta de Tecidos e Órgãos/métodosRESUMO
BACKGROUND: Emergency surgery for colorectal cancer has become more aggressive and radical over the past decade. This retrospective review analyses the impact on outcome. METHODS: The results of emergency surgery within 24 h of admission were compared between 1982 and 1987 (77 patients) and 1988 and 1993 (75 patients). Patient and tumour characteristics were similar in both groups. RESULTS: Right colonic obstruction or perforation was treated by primary resection and anastomosis in 11 of 12 patients before 1988 and in all 19 patients thereafter. Primary resection was also the treatment of choice for perforated cancer of the left colon and rectum before 18 of 20) and after (20 of 21) 1988. The rate of primary resection for obstructing cancer of the left colon and rectum increased from 17 of 45 to 30 of 35. One-stage resections for obstructing cancer were performed in ten of 45 and 22 of 35 patients before and after 1988 respectively. The overall mortality rate declined from 14 of 77 to three of 75 after 1988 (P< 0.01). The rate of radical lymphadenectomy rose from six of 46 patients to 42 of 69 after 1988. The 3-year survival rate increased from 50 to 74 per cent (P < 0.05). CONCLUSION: The data support further efforts towards improving the immediate and late outcome of emergency surgery in complicated colorectal cancer.
Assuntos
Neoplasias Colorretais/cirurgia , Obstrução Intestinal/cirurgia , Perfuração Intestinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Neoplasias do Colo/etiologia , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos Eletivos/métodos , Emergências , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Perfuração Intestinal/etiologia , Perfuração Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/etiologia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Among 947 patients operated on for gastric carcinoma between 1961 and 1976 there were 60 with early (superficial) gastric carcinoma. All but two patients consulted their doctor for diverse complaints. In one third of them treatment was delayed for a year or longer. In 26 of the 64 cancer foci it was limited to the mucosa. The correct diagnosis was made radiologically in 60%, gastroscopically in 70%. Selective endoscopic biopsy increased accuracy to 90%. The remaining false-negative findings occurred in the ulcerative form, which was the most frequent one. Improved radiological techniques (double-contrast) and obligatory gastroscopy with biopsy increased the relative proportion of early (superficial) carcinoma from under 4% in 1961 to 15%. The diagnosis of this type of carcinoma can be made only by careful histological study of the surgical specimens. Here as elsewhere in the surgery of carcinoma, multicentricity (in 5%) and possible lymph node metastases (10-20%) must be taken consideration in the surgical management.