ABSTRACT
BACKGROUND: Due to an increasing competence orientation of medical studies, surgical curricula are being adapted in many places. In addition to surgical knowledge and practical skills, these should also teach competencies in differential diagnostics and treatment. The teaching of surgical knowledge through lectures and seminars and the demonstration of practical skills, e.g., through the use of logbooks in the Bock Practical Surgery (BP), only allows limited active engagement with surgical competencies on differential diagnostics and treatment. A reflection-based portfolio allows, through the independent written elaboration of surgical topics, an active engagement with the competencies and promises a higher learning effect. In the context of the implementation of such a portfolio as part of the proof of activity in BP, the effects on the acquisition of competencies and on the way of learning were investigated. MATERIAL AND METHODS: Using a mixed methods approach, we compared competence acquisition using a reflection-based portfolio with learning using a logbook. Students conducted a self-assessment of competencies using questionnaire surveys before and after the BP. Through focus group interviews with discussions among students using a guideline, we explored the different ways of acquiring competencies. In addition, the examination and evaluation results of both cohorts were compared. RESULTS AND DISCUSSION: Students' self-assessed competency acquisition and examination and evaluation results showed no differences when comparing the two cohorts. During the focus group interviews, we were able to show that in the perception of the students, surgical competencies can be made more visible and thus more explicit with the help of a reflection-based portfolio. In addition, self-regulated learning was promoted without neglecting practical skills. Students demanded greater supervision and guidance by mentors in both groups.
Subject(s)
Education, Medical, Undergraduate , Humans , Education, Medical, Undergraduate/methods , Students , Clinical Competence , Educational Measurement/methods , Focus GroupsABSTRACT
Optical correction is an independent factor in expert opinions. It is outlined how this should be considered in different legal areas.
Subject(s)
Expert Testimony/legislation & jurisprudence , Eyeglasses/standards , National Health Programs/legislation & jurisprudence , Germany , Humans , Lenses, Intraocular/standards , Quality Assurance, Health Care/legislation & jurisprudence , Social Security/legislation & jurisprudence , Vision, Binocular , Visual Acuity , Visual FieldsABSTRACT
Detailed evidence for psychogenic effects after an accident: evidence from 3 expert reports.
Subject(s)
Diagnostic Techniques, Ophthalmological/psychology , Eye Diseases/psychology , Medical Errors/psychology , Ophthalmologic Surgical Procedures/psychology , Psychophysiologic Disorders/psychology , Vision Disorders/psychology , Accidents, Occupational/psychology , Adult , Diagnosis, Differential , Disability Evaluation , Expert Testimony , Eye Diseases/diagnosis , Eye Diseases/therapy , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/psychology , Eye Foreign Bodies/therapy , Eye Injuries/diagnosis , Eye Injuries/psychology , Eye Injuries/therapy , Female , Humans , Male , Malingering , Middle Aged , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/therapy , Vision Disorders/diagnosis , Vision Disorders/therapy , Visual AcuityABSTRACT
OBJECTIVE: Early menopause (EM), menopause before 45 years, affects up to 10% of women. The internet was perceived by women with EM to be the best source of information regarding EM; however, the reality is unknown. The aim of this study was to assess the quality and content of easily accessible websites relating to EM. METHODS: The keyword 'early menopause' was used for a web search using Google. The first two pages of results, plus an additional five websites, were analyzed for website quality and content by two independent reviewers according to published methodology. RESULTS: After excluding duplicates, 26 websites were analyzed. Geographical origin of Google domain conferred 32-53% search congruity. Commercial websites (10/26) and inclusion of advertisements (50%) were common. Few websites listed authorship (39%) or provided references (54%), and only 35% were quality certified. Most (54%) had a readability level above recommended. Median score for website content was 9/20. Medical society websites did not rank higher than other website categories for content but more frequently provided references/supporting data (p = 0.017). CONCLUSION: Easily accessible websites regarding EM have significant deficiencies in quality and content. This study indicates the need for higher-quality internet resources for women seeking EM information.
Subject(s)
Internet/standards , Menopause, Premature , Adult , Female , Humans , Patient Education as Topic , Quality Assurance, Health Care , Women's HealthABSTRACT
Background: In the last decades, a reduction in mortality in severely injured patients with an ISS ≥ 16 could be observed. Some authors report a death rate of about 22â%. Moreover, there were some new insights in the last years such as the reduction in mortality by use of whole-body CT and the introduction of the S3 guideline of the German Society of Trauma Surgery "Treatment of Patients with Severe and Multiple Injuries" have supported the evidence-based treatment of severely injured patients. Methods: A retrospective analysis of 2304 patients was performed between 2002 and 2011. The data of the authors' clinic for the trauma registry of the DGU® were used. After applying the inclusion criteria, ISS ≥ 16 and primary transfer from the accident site, 968 patients remained. Results: In the study population, a mean ISS of 29.81 and a mean GCS of 9.42 were found. The average age was 46.04 years. The mortality rate was 28.7â%. A significant difference between decedents and survivors was found at the ISS, GCS, RTS, new ISS, TRISS, RISC, AIS head, AIS skin, RR pre-clinical, pre-clinical heart rate and age. To test whether the lethality was reduced by the increased use of whole-body CT, a division into a group prior to and from 2009 was performed. Results revealed a significant increase in the whole-body CT rate from 56.96 to 71.7â%. The mortality rate declined from 32.3 to 24.5â%. In the same way it was verified whether the S3 guideline had an impact on mortality. Therefore, a division into groups before and from 2011 was conducted. Here, the mortality rate decreased from 30.4 to 18.4â%. In addition, a comparison between 2010 and 2011 was performed. Overall, there were statistically significant differences in the trauma room time, the surgical time, the volume infused, the rate of multiple organ failure and the rate of whole-body CTs performed. Conclusion: In the period from 2002 to 2011 a mortality rate of 28.7â% was found. The higher rate in comparison to published data is most likely explained by the high rate of serious and severe head injuries. The increased use of whole-body CT and the introduction of the S3 guideline led to a significant decrease in mortality in the authors' patient population. This is due particularly to the accelerating of the treatment of severely injured patients, the reduction of the infused volume, shortened surgical phase within the first 24 hours and the increased use of whole-body CT.
Subject(s)
Guideline Adherence/statistics & numerical data , Information Services/statistics & numerical data , Multiple Trauma/mortality , Multiple Trauma/therapy , Registries/statistics & numerical data , Trauma Centers/statistics & numerical data , Adult , Aged , Craniocerebral Trauma/mortality , Craniocerebral Trauma/therapy , Female , Germany , Hospital Mortality , Humans , Injury Severity Score , Male , Middle Aged , Multiple Trauma/diagnostic imaging , Retrospective Studies , Survival Analysis , Tomography, X-Ray Computed/statistics & numerical data , Utilization Review/statistics & numerical data , Whole Body Imaging/statistics & numerical dataABSTRACT
For private accident insurance, the article describes double vision zones and how they are used in various disorders of ocular motility with double vision.
Subject(s)
Diplopia/diagnosis , Disability Evaluation , Expert Testimony/standards , Insurance, Accident/standards , Ocular Motility Disorders/diagnosis , Vision Tests/standards , Expert Testimony/methods , Female , Germany , Humans , Male , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
A simple new scheme to evaluate defects in field of vision in private accident insurance.
Subject(s)
Blindness/diagnosis , Disability Evaluation , Eligibility Determination/standards , Eye Injuries/diagnosis , Insurance, Accident/standards , Private Sector/standards , Visual Field Tests/standards , Blindness/classification , Blindness/etiology , Expert Testimony , Eye Injuries/classification , Eye Injuries/complications , Germany , HumansABSTRACT
A variety of different factors may participate in causing an accident or in influencing its course. These have different legal consequences in different areas of insurance. These differences are outlined for the assessment areas, together with the different states of evidence. In particular, it is discussed whether and under which conditions a trauma can indirectly (as a participating factor) either cause, trigger or exacerbate detachment of the retina.
Subject(s)
Accidents/legislation & jurisprudence , Disability Evaluation , Eye Injuries/diagnosis , Insurance, Accident/legislation & jurisprudence , Liability, Legal , Retinal Detachment/diagnosis , Expert Testimony/legislation & jurisprudence , Eye Injuries/classification , Eye Injuries/etiology , Humans , Retinal Detachment/classification , Visual AcuityABSTRACT
Loss of earnings, disability and inability to work may be used to assess the same health damage, but these legal terms are defined differently, as they have different objectives. Important practical distinctions between these terms are explained and their inter-relationships are discussed.
Subject(s)
Disability Evaluation , Glaucoma/economics , Insurance, Disability/legislation & jurisprudence , Salaries and Fringe Benefits/economics , Unemployment , Visually Impaired Persons/legislation & jurisprudence , Germany , Glaucoma/diagnosis , Government Regulation , Insurance, Disability/economics , Salaries and Fringe Benefits/legislation & jurisprudence , Terminology as TopicABSTRACT
In General Accident Insurance, loss of sight in one eye is assessed as giving a 25â% reduction in earning capacity. This does not exclude the possibility that a greater reduction in earning capacity can be assessed for this eye. The ophthalmological situation is outlined under which a much greater reduction in earning capacity can be assessed, if there is not misassessment.
Subject(s)
Blindness/economics , Disability Evaluation , Eligibility Determination/economics , Eye Injuries/economics , Income/statistics & numerical data , Insurance, Accident/economics , Blindness/diagnosis , Eligibility Determination/methods , Eye Injuries/diagnosis , Germany , HumansABSTRACT
BACKGROUND: The treatment of multiple injured patients is a highly demanding process concerning the amount and speed of gathered information. Physicians have to evaluate the situation and begin a treatment immediately. There may be influencing variables in the pre-clinical treatment which are correlated to the specialisation of the first treating physician and influencing the outcome of the patient. The aim of this study was to examine the influence of the specialisation of the first treating physician on the pre-clinical treatment and the resulting outcome. PATIENTS AND METHODS: All trauma patients of our department from 2007 to 2010 who fulfilled the following criteria were included into our study: completely recorded DIVI-emergency protocol with declared specialisation of the first treating physician and inclusion into the trauma register of the DGU. This group of patients was divided into three groups according to the specialisation of the first treating physician (anaesthesia, surgery and other) and compared with one another. RESULTS: The study group consisted of 198 patients. 76 were treated by anaesthesiologists, 58 by surgeons, and 64 by physicians of other specialisations. The Injury Severity Score (ISS), the age and the distribution between the sexes showed no significant differences. Surgeons applied significantly less volume pre-clinically (794 ml [anesthesiologists: 1275 ml, others: 1231 ml; p value = 0.036]), the haemoglobin value was higher in the surgeon-treated group. This was also reflected in the applied blood transfusions at admission. The pre-clinical intubation rates (anaesthesiologists 48.7â%, others 37.5â%, surgeons 31â% [p value = 0.11]), the ventilator free days within the first 30 days after admission (anaesthesiologists 21.8, others 21.0, surgeons 25.8), intensive care unit free days within the first 30 days after admission (anaesthesiologists 18.4, others 18.5, surgeons 22.4) as well as the rescue time and case fatality rate showed no significant differences between the different groups. CONCLUSION: Multiply injured patients get a different treatment from the different specialised physicians in the pre-clinical phase. There were differences in the pre-clinical applied volume and haemoglobin value. Rescue time and intubation rate as well as outcome parameters were not statistically different. The case fatality rate in total was not significantly different between the 3 groups.
Subject(s)
Clinical Competence/statistics & numerical data , Multiple Trauma/mortality , Multiple Trauma/therapy , Registries , Specialization/statistics & numerical data , Surgeons/statistics & numerical data , Adult , Female , Germany/epidemiology , Humans , Incidence , Male , Mortality , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
BACKGROUND: Modified vaccinia virus Ankara (MVA)-encoding antigens are considered as safe vaccine candidates for various infectious diseases in humans. Here, we investigated the immune-modulating properties of MVA-encoding ovalbumin (MVA-OVA) on the allergen-specific immune response. METHODS: The immune-modulating properties of MVA-OVA were investigated using GM-CSF-differentiated BMDCs from C57BL/6 mice. OVA expression upon MVA-OVA infection of BMDCs was monitored. Activation and maturation markers on viable MVA-OVA-infected mDCs were analyzed by flow cytometry. Secretion of INF-γ, IL-2, and IL-10 was determined in a co-culture of BMDCs infected with wtMVA or MVA-OVA and OVA-specific OT-I CD8(+) and OT-II CD4(+ ) T cells. BALB/c mice were vaccinated with wtMVA, MVA-OVA, or PBS, sensitized to OVA/alum and challenged with a diet containing chicken egg white. OVA-specific IgE, IgG1, and IgG2a and cytokine secretion from mesenteric lymph node (MLN) cells were analyzed. Body weight, body temperature, food uptake, intestinal inflammation, and health condition of mice were monitored. RESULTS: Infection with wtMVA and MVA-OVA induced comparable activation of mDCs. MVA-OVA-infected BMDCs expressed OVA and induced enhanced IFN-γ and IL-2 secretion from OVA-specific CD8(+ ) T cells in comparison with OVA, wtMVA, or OVA plus wtMVA. Prophylactic vaccination with MVA-OVA significantly repressed OVA-specific IgE, whereas OVA-specific IgG2a was induced. MVA-OVA vaccination suppressed TH 2 cytokine production in MLN cells and prevented the onset of allergic symptoms and inflammation in a mouse model of OVA-induced intestinal allergy. CONCLUSION: Modified vaccinia virus Ankara-ovalbumin (MVA-OVA) vaccination induces a strong OVA-specific TH 1- immune response, likely mediated by the induction of IFN-γ and IgG2a. Finally, MVA-based vaccines need to be evaluated for their therapeutic potential in established allergy models.
