Self-assessment of competencies in dental education in Germany - a multicentred survey.

INTRODUCTION: The aim was to assess the competencies of undergraduate dental students in Germany in the domains team competence, communicative competence, learning competence and scholarship. MATERIALS AND METHODS: The survey was conducted at 11 dental schools that are equally distributed all over Germany. Competencies were assessed with the Freiburg Questionnaire to Assess Competencies in Medicine (FCM). A short version of the FCM was used in this study. This short form included the four domains: team competence (three items), communicative competence (eight items), learning competence (five items) and scholarship (four items). Students had to rate each item twice: first with regard to the respondent's current level of competence and second with regard to the level of competence that respondents think is required by their job. All items were rated on a five-point Likert scale (1 'very much' and 5 'not at all'). Responsible lecturers from all selected dental schools received another questionnaire to answer the questions whether the FCM domain corresponding learning objectives were taught at the respective dental school. RESULTS: A total of 317 undergraduate students from 11 dental schools in their last clinical year participated. The response rate varied between 48% and 92%. Cronbach's α for the FCM scales addressing the current level of competencies ranged from 0.70 to 0.89 and for the scales measuring the presumed level of competencies demanded by their job ranged from 0.72 to 0.82. The mean values of the scales for the assessment of the presumed level of competencies demanded by the job were significantly lower compared to the mean values of the scales for the current level of competencies (P < 0.001 in all analyses). We found large differences between the two levels - in terms of 'standardised response means' (SRM) - in the domains team competence (SRM 1.34), learning competence (SRM 1.27) and communicative competence (SRM 1.18). Overall, the learning objectives that correspond to the assessed domains of competencies were taught to 19.6% completely, to 55.4% partially and to 25% not at all at the participating dental schools. CONCLUSION: The results of the present survey revealed that the participating students perceived deficiencies in all domains of competencies. These results indicate that the assessed domains are still barely integrated into dental medicine curricula in Germany and that further research in this field is needed.

[Personality and comorbidity: are there "difficult patients" in hip arthroplasty?]. / Persönlichkeitsprofil und Komorbidität: Gibt es den "schwierigen Patienten" in der primären Hüftendoprothetik?

BACKGROUND: Concomitant disorders at the time of surgery in addition to psychological and socioeconomic patient characteristics may influence treatment outcomes in hip arthroplasty. OBJECTIVES: To describe the impact of these factors on perioperative complications and postoperative results in terms of function, quality of life, and patient satisfaction. MATERIALS AND METHODS: Review of relevant clinical studies, meta-analyses, and presentation of our own results. RESULTS: Comorbidities in general, especially in combination, increase the perioperative risk profile. Socioeconomic factors (education, professional qualifications, social deprivation) in addition to psychological variables (depression, distressed personality) can have a major impact on postoperative functional outcomes and patient satisfaction. CONCLUSIONS: It is of crucial importance to avoid inequalities in the provision of joint replacement for patients with hip osteoarthritis and co-existing risk factors. Preventive strategies should be implemented to reduce the negative impact of comorbidities on treatment outcome. Personalized communication and education may be helpful in avoiding unrealistic patient expectations before hip replacement.

Electrospray ionization ion mobility spectrometer with new tristate ion gating for improved sensitivity for compounds with lower ion mobility.

An electrospray is a dispersed nebula of charged droplets produced under the influence of a strong electric field. The charged droplets subsequently result in ions in the gas phase. Therefore, electrospray is a commonly used method for transferring liquids to the gas phase while ionizing its constituents at the same time. In this work, we investigate the performance of an electrospray ionization ion mobility spectrometer by varying the electric field strength in the desolvation region. In particular, we investigate a new tristate ion shutter with increased sensitivity for ions with higher molecular mass and lower ion mobility that are usually suppressed by classical Bradbury-Nielsen or Tyndall-Powell ion shutters when using short gating times as required for high resolving power. The electric field in the tristate ion shutter affects the optimal ratio of the electric field strengths in the drift and desolvation region. Furthermore, the solvent flow rate needs to be considered when setting the field strengths in the desolvation region. However, a higher electric field strength in the desolvation region affects the field at the emitter tip. For this reason, a smaller ratio of the drift field strength and the desolvation field strength is beneficial, especially since higher solvent flow rates require higher fields to initiate an electrospray. In this work, we use tetraoctylammonium bromide as an instrument standard and the fungicide metalaxyl, the herbicide isoproturon and the antibiotic cefuroxime as model compounds.

Angiotensin converting enzyme inhibitor induced angio-oedema: a review of the pathophysiology and risk factors.

Angio-oedema (AE) is a known adverse effect of angiotensin converting enzyme inhibitor (ACE-I) therapy. Over the past several decades, evidence of failure to diagnose this important and potentially fatal reaction is commonly found in the literature. Because this reaction is often seen first in the primary care setting, a review was undertaken to analyse and document the keys to both diagnostic criteria as well as to investigate potential risk factors for ACE-I AE occurrence. A general review of published literature was conducted through Medline, EMBASE, and the Cochrane Database, targeting ACE-I-related AE pathomechanism, diagnosis, epidemiology, risk factors, and clinical decision making and treatment. The incidence and severity of AE appears to be on the rise and there is evidence of considerable delay in diagnosis contributing to significant morbidity and mortality for patients. The mechanism of AE due to ACE-I drugs is not fully understood, but some genomic and metabolomic information has been correlated. Additional epidemiologic data and clinical treatment outcome predictors have been evaluated, creating a basis for future work on the development of clinical prediction tools to aid in risk identification and diagnostic differentiation. Accurate recognition of AE by the primary care provider is essential to limit the rising morbidity associated with ACE-I treatment-related AE. Research findings on the phenotypic indicators relevant to this group of patients as well as basic research into the pathomechanism of AE are available, and should be used in the construction of better risk analysis and clinical diagnostic tools for ACE-I AE.

Dynamics at the liquid-vapor interface of a supercooled organic glass former.

We investigated the dynamics near the liquid-vapor interface of the supercooled model organic glass former dibutyl phthalate by using surface-sensitive x-ray scattering techniques. Our results reveal significant enhancement of the relaxation rate over a wide length-scales range. The analysis of the dispersion relation of long-wavelength surface fluctuations yields a nonzero value of the share modulus near the free surface. At the molecular level, the dynamics in the near surface region (10-15 nm) is inhomogeneous. The mobility is decreasing with increasing distance from the free surface. Below the bulk glass transition, two distinct relaxation times were observed differing by 1 order of magnitude. The observed fast relaxation proves the existence of a high mobility liquidlike surface layer of 10 nm thickness on top of a frozen in bulk system.

DARPP-32 and regulation of the ethanol sensitivity of NMDA receptors in the nucleus accumbens.

The medium spiny neurons of the nucleus accumbens receive both an excitatory glutamatergic input from forebrain and a dopaminergic input from the ventral tegmental area. This integration point may constitute a locus whereby the N-methyl-D-aspartate (NMDA)-subtype of glutamate receptors promotes drug reinforcement. Here we investigate how dopaminergic inputs alter the ethanol sensitivity of NMDA receptors in rats and mice and report that previous dopamine receptor-1 (D1) activation, culminating in dopamine and cAMP-regulated phosphoprotein-32 kD (DARPP-32) and NMDA receptor subunit-1 (NR1)-NMDA receptor phosphorylation, strongly decreases ethanol inhibition of NMDA responses. The regulation of ethanol sensitivity of NMDA receptors by D1 receptors was absent in DARPP-32 knockout mice. We propose that DARPP-32 mediated blunting of the response to ethanol subsequent to activation of ventral tegmental area dopaminergic neurons initiates molecular alterations that influence synaptic plasticity in this circuit, thereby promoting the development of ethanol reinforcement.