[Structured oral examination ("guided questions") as a method for objectifying the ENT specialist examination in Germany]. / Strukturierte mündliche Prüfung ("guided questions") als Methode zur Objektivierung der HNO-Facharztprüfung in Deutschland.

On behalf of the federal Ministries of Health, the various German medical associations organize and conduct the board certification examinations for becoming an ENT specialist at the end of residency. The oral examination comprises a collegial discussion that should last at least 30 min and which rarely exceeds 45 to 60 min in practice. The current article describes the quality criteria upon which examinations in general should be based, and lists the most common mistakes during conduction of oral examinations. Using "oral guided questions" (OGQ or GQ) can guarantee a high degree of standardization, objectivity, transparency, and justiciability. The principles of a GQ-guided examination are described and specified by a typical example. Experiences with this form of examination from the federal states of Brandenburg and Thuringia are presented.

[The situation of education in ENT-residency-training in Germany]. / Die Weiterbildungssituation in der HNO-Heilkunde in Deutschland.

BACKGROUND: As a starting point for developing concrete suggestions for optimizing specialty training in German ENT departments, the present study analysed the current status of residency training in order to identify weaknesses. METHODS: Residents at German ENT departments were invited to participate in an online survey. The questionnaire comprised 78 individual questions. RESULTS: The questionnaire was answered by 223 ENT residents. Educational deficits such as a lack of regular feedback from supervisors, only moderately rated mediation of specialist competencies, capriciousness of the trainers in charge regarding the organisation of training, and time and personnel shortages were identified. Some of the mandatory recommendations of the specialty training regulations, including determination of concrete training goals during regular meetings or the use of a logbook, have only been implemented in limited cases. Demands for development of more external training opportunities (job shadowing/rotation) and an external objective review of the residency training (e.g., by a representative of the German Society of Otorhinolaryngology, Head and Neck Surgery, DGHNOKHC) in the sense of quality assurance are discussed. CONCLUSION: Implementation of structured and standardized ENT residency training in Germany, for which DGHNOKHC reviewal is also possible, can generate a basis for more effective compulsory residency training.

[Tips for training assistants on preparing and conducting their board certification examination]. / Hinweise für Weiterbildungsassistenten zur Vorbereitung und Durchführung ihrer Facharztprüfung.

This article first discusses the general requirements for conducting board certification examinations as laid down in the specialty training regulations of the German State Chambers of Physicians. Concrete suggestions are made for training assistants concerning selection of the specialist literature to be processed and allocation of the time in which the material to be covered can be learned. Aspiring medical specialists are provided with suggestions regarding their surroundings and a favorable atmosphere in the final hours before the examination. Furthermore, desirable but also undesirable behaviors of the examinee during the examination are highlighted, and coping strategies for blackout situations and excessive anxiety are discussed.

[Georgia, a country of diverse aid from Germany in the ENT field]. / Georgien, ein Land vielfältiger Hilfen aus Deutschland auf dem HNO-Gebiet.

Following a long-term tradition, several teams of German ENT specialists are currently working in different Georgian clinics on a charitable basis. The current paper describes the structures of the medical and health insurance systems in this southern Caucasian country. The course of medical education for physicians in Georgia is portrayed and differences to the German situation which explain why young Georgian colleagues have difficulties when moving to Germany are highlighted. The paper describes the typical stay of a German ENT specialist in Georgia and also points out how these physicians are in turn supported in their charitable work by medical devices and equipment sent from Germany. Finally, the input that German colleagues can contribute to improving the situation in the Georgian health care system is discussed from the perspective of German ENT specialists and future goals of the cooperation between German and Georgian physicians are summarized.

[Global surgery from an otorhinolaryngological perspective]. / "Global surgery" aus otorhinolaryngologischer Sicht.

Since the middle of this century, the United Nations (UN) has paid increasing attention to the surgical care of the worldwide population, with the aim of global access to basic surgical procedures ("global surgery") in the future. The current article describes models for training and continuing education of "global surgeons," with a focus on activities in the field of otolaryngology. The diagnostic inventory in which the global surgeon should be educated is presented. Lists of indications and operative procedures the global surgeon should master are suggested, as are the limits of his/her actions. The surgical instruments required by the global surgeon are summarized in a table, whereby their description is oriented toward the different individual anatomic regions relevant to the otorhinolaryngologist. The paper concludes with an outlook devoted particularly to the idealized vision of availability of global surgery in the future.

An apparatus for pulsed ESR and DNP experiments using optically excited triplet states down to liquid helium temperatures.

In standard Dynamic Nuclear Polarization (DNP) electron spins are polarized at low temperatures in a strong magnetic field and this polarization is transferred to the nuclear spins by means of a microwave field. To obtain high nuclear polarizations cryogenic equipment reaching temperatures of 1 K or below and superconducting magnets delivering several Tesla are required. This equipment strongly limits applications in nuclear and particle physics where beams of particles interact with the polarized nuclei, as well as in neutron scattering science. The problem can be solved using short-lived optically excited triplet states delivering the electron spin. The spin is polarized in the optical excitation process and both the cryogenic equipment and magnet can be simplified significantly. A versatile apparatus is described that allows to perform pulsed dynamic nuclear polarization experiments at X-band using short-lived optically excited triplet sates. The efficient (4)He flow cryostat that cools the sample to temperatures between 4 K and 300 K has an optical access with a coupling stage for a fiber transporting the light from a dedicated laser system. It is further designed to be operated on a neutron beam. A combined pulse ESR/DNP spectrometer has been developed to observe and characterize the triplet states and to perform pulse DNP experiments. The ESR probe is based on a dielectric ring resonator of 7 mm inner diameter that can accommodate cubic samples of 5mm length needed for neutron experiments. NMR measurements can be performed during DNP with a coil integrated in the cavity. With the presented apparatus a proton polarization of 0.5 has been achieved at 0.3 T.

Trauma in conflict and postconflict settings: contributions to health systems strengthening.

Violent trauma does not only affect conflict and post conflict regions, but increasingly industrialized nations afflicted by violence from terror attacks. We conducted a comparative health systems analysis, assuming that that health systems with various backgrounds might learn from each other's health systems challenges caused by violent trauma. During the tragedy of Beslan in the Russian North Caucasus in September of 2004, more than 1000 children with their families were taken hostage in a school. Over three days, 334 people were killed and many more injured. While immediate trauma care was offered to all victims, many suffered from more complex injuries or from blast injuries to the ear caused by indoor bomb explosions, which were left untreated due to the lack of regional capacity for the required specialized microsurgery. Most if not all victims suffered from mental trauma as a consequence of violence, which also impacted surgical care-seeking. In April of 2013, two improvised explosive devices detonated at the Boston Marathon, killed three victims and injured 264, more than 20 of them critically. As a consequence of previous terror acts with mass casualties, local hospitals were prepared with drilling and coordination among health facilities, responders and government agencies. Some injury patterns similar to those in the North Caucasus emerged in the aftermath of the event and need to be addressed by the health system. Trauma from violent conflict and terrorism creates similar challenges to health systems. Preparedness for mass casualties requires revision and coordination of available services, and may prompt the strengthening of existing health systems. Health professionals should encourage victims' representatives and citizen groups to assist with assessing the prevalence and burden of injuries, including mental trauma, and to facilitate connecting affected patients to health care. Awareness for late trauma sequelae, including mental health trauma, is essential to appropriately address victims' needs.

[Vocational rehabilitation after total laryngectomy]. / Berufliche Rehabilitation nach Laryngektomie.

BACKGROUND: Aim of this study was to find out how many patients after a total laryngectomy (TLE) return to work successfully and what factors support vocational rehabilitation. PATIENTS AND METHODS: Laryngectomees (n=231) aged up to 60 years completed questionnaires and structured interviews before TLE (t1), before rehabilitation (t2), at the end of rehabilitation (t3), 1 year after TLE (t4), 2 years after TLE (t5), and 3 years after TLE (t6). RESULTS: Prior to TLE, 38% of all respondents were employed, 34% were unemployed, 23% received disability-related and 3% age-related pension retirement. One year after TLE, 13% were employed, 15% 2 years and 14% 3 years after TLE. Unemployed were 10% (t4), 5% (t5), and 7% (t6) of the patients. For 59% of all respondents it was very important to have a job. Predictors of successful vocational rehabilitation were employment prior to TLE, age <50 years, being self-employed or clerical employee, good physical functioning, good speech intelligibility, high motivation to go back to work, and support from colleagues. CONCLUSION: Only few laryngectomees return to work. However, even before TLE only a third of the patients was employed, another third was unemployed. Most of the patients receive pension retirement after TLE. As return to work is important for many patients, patient consultations should consider possibilities to support vocational rehabilitation before offering to apply for retirement.

Bioinformatic and experimental fishing for artemisinin-interacting proteins from human nasopharyngeal cancer cells.

Determining interacting cellular partners of drugs by chemical proteomic techniques is complex and tedious. Most approaches rely on activity-based probe profiling and compound-centric chemical proteomics. The anti-malarial artemisinin also exerts profound anti-cancer activity, but the mechanisms of action are incompletely understood. In the present investigation, we present a novel approach to identify artemisinin-interacting target proteins. Our approach overcomes usual problems in traditional fishing procedures, because the drug was attached to a surface without further chemical modification. The proteins identified effect among others, cell cycle arrest, apoptosis, inhibition of angiogenesis, disruption of cell migration, and modulation of nuclear receptor responsiveness. Furthermore, a bioinformatic approach confirmed experimentally identified proteins and suggested a large number of other interacting proteins. Theoretically predicted interaction partners may serve as a starting point to complete the whole set of proteins binding artemisinin.