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1.
World J Surg ; 47(9): 2296-2303, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37204438

RESUMEN

BACKGROUND: Incidences of pilonidal sinus disease are rising. Guidelines rarely consider children and adolescents and evidence for their treatment is rare. The literature is divided on the choice of the preferable surgical procedure. Therefore, we aimed to assess recurrences and complications following different treatment approaches in our multi-centric cohort. METHODS: We retrospectively assessed all patients treated for pilonidal sinus disease in the paediatric surgical departments of Bonn and Mainz between 01/01/2009 and 31/12/2020. Recurrences were defined according to the German national guidelines. The pre-specified analysis via logistic regression included the operative approach, age, sex, use of methylene blue, and obesity as independent predictors. RESULTS: We included 213 patients, of which 13.6% experienced complications and 16% a recurrence. Median time to recurrence was 5.8 months (95% confidence interval: 4.2-10.3), which was slightly higher in children than adolescents (10.3 months, 95% confidence interval: 5.3-16.2 vs. 5.5 months, 95% confidence interval: 3.7-9.7). None of the investigated procedures, excision and primary closure, excision and open wound treatment, pit picking, and flap procedures had a decisive advantage in terms of complications or recurrence. Of the independent predictors, only obesity was associated to complications (adjusted odds ratio: 2.86, 95% confidence interval: 1.05-7.79, P = 0.04). CONCLUSIONS: We did not find a difference between the investigated procedures, but our analysis is limited by the small sample size in some subgroups. Our data corroborates that recurrences in paediatric pilonidal sinus disease occur early. Factors linked to these differences remain unknown.


Asunto(s)
Seno Pilonidal , Adolescente , Humanos , Niño , Estudios Retrospectivos , Seno Pilonidal/cirugía , Seno Pilonidal/complicaciones , Recurrencia Local de Neoplasia , Obesidad/complicaciones , Recurrencia , Resultado del Tratamiento
2.
Front Cardiovasc Med ; 10: 1068390, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37255709

RESUMEN

A key step in translational cardiovascular research is the use of large animal models to better understand normal and abnormal physiology, to test drugs or interventions, or to perform studies which would be considered unethical in human subjects. Ultrahigh field magnetic resonance imaging (UHF-MRI) at 7 T field strength is becoming increasingly available for imaging of the heart and, when compared to clinically established field strengths, promises better image quality and image information content, more precise functional analysis, potentially new image contrasts, and as all in-vivo imaging techniques, a reduction of the number of animals per study because of the possibility to scan every animal repeatedly. We present here a solution to the dual use problem of whole-body UHF-MRI systems, which are typically installed in clinical environments, to both UHF-MRI in large animals and humans. Moreover, we provide evidence that in such a research infrastructure UHF-MRI, and ideally combined with a standard small-bore UHF-MRI system, can contribute to a variety of spatial scales in translational cardiovascular research: from cardiac organoids, Zebra fish and rodent hearts to large animal models such as pigs and humans. We present pilot data from serial CINE, late gadolinium enhancement, and susceptibility weighted UHF-MRI in a myocardial infarction model over eight weeks. In 14 pigs which were delivered from a breeding facility in a national SARS-CoV-2 hotspot, we found no infection in the incoming pigs. Human scanning using CINE and phase contrast flow measurements provided good image quality of the left and right ventricle. Agreement of functional analysis between CINE and phase contrast MRI was excellent. MRI in arrested hearts or excised vascular tissue for MRI-based histologic imaging, structural imaging of myofiber and vascular smooth muscle cell architecture using high-resolution diffusion tensor imaging, and UHF-MRI for monitoring free radicals as a surrogate for MRI of reactive oxygen species in studies of oxidative stress are demonstrated. We conclude that UHF-MRI has the potential to become an important precision imaging modality in translational cardiovascular research.

3.
BMC Pediatr ; 23(1): 27, 2023 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-36650449

RESUMEN

BACKGROUND: Esophageal atresia (EA) is a rare malformation with a wide range of co-morbidity and associated malformations impairing weight gain and growth. The aim of this study was to calculate specific percentiles for body weight and height for children born with esophageal atresia according to sex from birth to the age of 6 years, accounting for prematurity and presence of congenital heart disease (CHD). METHODS: Data was extracted from an anonymized voluntary national registry for patients born with esophageal atresia between 2001 and 2021, from birth until the age of six years. Missing values were imputed using a multiple imputation approach. In premature infants, chronological age was corrected for gestational week until the age of one year. The impact of sex and additional congenital heart disease on weight gain and growth was analysed using quartile regression models. RESULTS: In total, 1812 examinations of 485 patients were considered and 1232 examinations of 301 patients were finally included. Most data was available for children at birth and during the first year of life. Body weight was imputed for 3.3% and height for 12.5% of examinations. The mean body weight-for-age and length-for-age at birth according to gestational age was lower in EA patients and median body weight developed along the tenth percentile compared to the general population. Median height-for-age was at the 50th percentile during the first months of life, before crossing to lower percentiles before the age of one year. CHD had an additional negative impact on growth and weight gain, especially during the first year of life. CONCLUSIONS: Children with EA had a reduced bodyweight and -height compared to the general population. Therefore, specific percentile curves are helpful to evaluate growth and development. Especially during the first year of life, particular attention is necessary and complications leading to a reduced calorie intake should be treated without delay to promote timely development and growth. Cardiac co-morbidities may further compromise weight gain in these patients, implying that such patients should be under even closer surveillance.


Asunto(s)
Atresia Esofágica , Cardiopatías Congénitas , Recién Nacido , Lactante , Masculino , Femenino , Humanos , Niño , Preescolar , Atresia Esofágica/epidemiología , Recien Nacido Prematuro , Aumento de Peso , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/epidemiología , Sistema de Registros
4.
Front Surg ; 9: 986826, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36171816

RESUMEN

Background: Communication with patients and their relatives as well as with colleagues and students is an essential part of every physician's daily work. An established method for teaching communication skills is using simulated patients (SPs). However, teaching with SPs is often subjectively perceived by medical students as less instructive than teaching with real patients (RPs). Studies that analyze the influence of SPs compared to RPs for acquiring competencies are lacking. The aim of the present study was therefore to investigate the impact of SPs on long-term learning success for communication skills compared to RPs. Material and Methods: Study participants were undergraduate third-year medical students who attended a communication unit and were randomized into three groups. The first group trained the role-play part with a SP (SP-group). The second group trained with a SP but thought that the patient was a RP because the students and the tutors were told that they were a RP by the principal investigator (incognito patient group [IP-group]). The third group and their tutors trained with a RP and were told that the patient was a RP (real patient group [RP-group]). Five to 12 weeks after completing the training, the study participants completed a curricular summative objective standardized clinical examination. Results: There were 146 students who participated in the study. There were no significant differences between the three study groups at the informed consent stations and for those conducting anamnesis interviews. Conclusion: Communication skills training with SPs appears to be equivalent to training with RPs in terms of competency development in communication-based assessments in surgery. Therefore, SPs should be used in these curricula, especially at an early stage, to enable the students to practice adequate communication skills.

5.
PLoS One ; 17(6): e0270689, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35767553

RESUMEN

BACKGROUND: To investigate the effects of B1-shimming and radiofrequency (RF) parallel transmission (pTX) on the visualization and quantification of the degree of stenosis in a coronary artery phantom using 7 Tesla (7 T) magnetic resonance imaging (MRI). METHODS: Stenosis phantoms with different grades of stenosis (0%, 20%, 40%, 60%, 80%, and 100%; 5 mm inner vessel diameter) were produced using 3D printing (clear resin). Phantoms were imaged with four different concentrations of diluted Gd-DOTA representing established arterial concentrations after intravenous injection in humans. Samples were centrally positioned in a thorax phantom of 30 cm diameter filled with a custom-made liquid featuring dielectric properties of muscle tissue. MRI was performed on a 7 T whole-body system. 2D-gradient-echo sequences were acquired with an 8-channel transmit 16-channel receive (8 Tx / 16 Rx) cardiac array prototype coil with and without pTX mode. Measurements were compared to those obtained with identical scan parameters using a commercially available 1 Tx / 16 Rx single transmit coil (sTX). To assess reproducibility, measurements (n = 15) were repeated at different horizontal angles with respect to the B0-field. RESULTS: B1-shimming and pTX markedly improved flip angle homogeneity across the thorax phantom yielding a distinctly increased signal-to-noise ratio (SNR) averaged over a whole slice relative to non-manipulated RF fields. Images without B1-shimming showed shading artifacts due to local B1+-field inhomogeneities, which hampered stenosis quantification in severe cases. In contrast, B1-shimming and pTX provided superior image homogeneity. Compared with a conventional sTX coil higher grade stenoses (60% and 80%) were graded significantly (p<0.01) more precise. Mild to moderate grade stenoses did not show significant differences. Overall, SNR was distinctly higher with B1-shimming and pTX than with the conventional sTX coil (inside the stenosis phantoms 14%, outside the phantoms 32%). Both full and half concentration (10.2 mM and 5.1 mM) of a conventional Gd-DOTA dose for humans were equally suitable for stenosis evaluation in this phantom study. CONCLUSIONS: B1-shimming and pTX at 7 T can distinctly improve image homogeneity and therefore provide considerably more accurate MR image analysis, which is beneficial for imaging of small vessel structures.


Asunto(s)
Vasos Coronarios , Ondas de Radio , Constricción Patológica , Vasos Coronarios/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos , Fantasmas de Imagen , Reproducibilidad de los Resultados
6.
Children (Basel) ; 9(3)2022 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-35327759

RESUMEN

Minimally invasive esophageal atresia (EA) repair is deemed one of the most demanding procedures in pediatric surgery. Open repair is considered the gold standard and learning opportunities for minimally invasive repairs remain scarce. "Telemedical Interdisciplinary Care for Patients with Esophageal Atresia (TIC-PEA)" offers free access to an interdisciplinary network of experts for telemedical consultation (telementoring). The aim of this study was to determine the frequency of minimally invasive surgery (MIS) in TIC-PEA patients compared to the general population. TIC-PEA patients were matched and compared to controls regarding the use of MIS, patient characteristics, and complications. Patients (n = 31) were included at a mean age of 62.8 days (95%-CI: 41.4-84.3, 77% after the primary esophageal repair). The odds-ratio to have MIS was 4.03 (95%-confidence interval: 0.79-20.55) for esophageal anastomosis and 4.60 (95%-confidence interval: 0.87-24.22) for tracheoesophageal fistula-repair in the TIC-PEA group. Telementoring offered the chance to select the ideal candidate for MIS, plan the procedure, and review intraoperative images and videos with the expert. Telementoring as offered is ideal to promote MIS for EA and helps to address the individual learning curve. In order to maximize benefits, patients need to be included prior to the first esophageal procedure.

7.
Eur J Trauma Emerg Surg ; 48(5): 3793-3801, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34331074

RESUMEN

PURPOSE: Every physician must be able to sufficiently master medical emergencies, especially in medical areas where emergencies occur frequently such as in the emergency room or emergency surgery. This contrasts with the observation that medical students and young residents often feel insufficiently prepared to handle medical emergencies. It is therefore necessary to train them in the treatment of emergency patients. The aim of this study is to analyze the influence of the assignment of manikin versus simulated patients during a training for undergraduate medical students on learning outcomes and the perceived realism. METHODS: The study had a prospective cross-over design and took place in a 3-day emergency medicine training for undergraduate medical students. Students completed three teaching units ('chest pain', 'impaired consciousness', 'dyspnea'), either with manikin or simulated patient. Using a questionnaire after each unit, overall impression, didactics, content, the quality of practical exercises, and the learning success were evaluated. The gained competences were measured in a 6-station objective structured clinical examination (OSCE) at the end of training. RESULTS: 126 students participated. Students rated simulated patients as significantly more realistic than manikins regarding the possibility to carry out examination techniques and taking medical history. 54.92% of the students would prefer to train with simulated patients in the future. Regarding the gained competences for 'chest pain' and 'impaired consciousness', students who trained with a manikin scored less in the OSCE station than the simulated patients-group. CONCLUSION: Simulated patients are rated more realistic than manikins and seem to be superior to manikins regarding gained competence.


Asunto(s)
Medicina de Emergencia , Maniquíes , Competencia Clínica , Estudios Cruzados , Urgencias Médicas , Humanos , Dolor , Estudios Prospectivos
8.
PLoS One ; 16(7): e0252797, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34297720

RESUMEN

INTRODUCTION: Cardiac magnetic resonance (CMR) at ultrahigh field (UHF) offers the potential of high resolution and fast image acquisition. Both technical and physiological challenges associated with CMR at 7T require specific hardware and pulse sequences. This study aimed to assess the current status and existing, publicly available technology regarding the potential of a clinical application of 7T CMR. METHODS: Using a 7T MRI scanner and a commercially available radiofrequency coil, a total of 84 CMR examinations on 72 healthy volunteers (32 males, age 19-70 years, weight 50-103 kg) were obtained. Both electrocardiographic and acoustic triggering were employed. The data were analyzed regarding the diagnostic image quality and the influence of patient and hardware dependent factors. 50 complete short axis stacks and 35 four chamber CINE views were used for left ventricular (LV) and right ventricular (RV), mono-planar LV function, and RV fractional area change (FAC). Twenty-seven data sets included aortic flow measurements that were used to calculate stroke volumes. Subjective acceptance was obtained from all volunteers with a standardized questionnaire. RESULTS: Functional analysis showed good functions of LV (mean EF 56%), RV (mean EF 59%) and RV FAC (mean FAC 52%). Flow measurements showed congruent results with both ECG and ACT triggering. No significant influence of experimental parameters on the image quality of the LV was detected. Small fractions of 5.4% of LV and 2.5% of RV segments showed a non-diagnostic image quality. The nominal flip angle significantly influenced the RV image quality. CONCLUSION: The results demonstrate that already now a commercially available 7T MRI system, without major methods developments, allows for a solid morphological and functional analysis similar to the clinically established CMR routine approach. This opens the door towards combing routine CMR in patients with development of advanced 7T technology.


Asunto(s)
Imagen por Resonancia Magnética , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Volumen Sistólico , Función Ventricular Derecha , Adulto Joven
9.
Z Orthop Unfall ; 159(3): 332-335, 2021 06.
Artículo en Inglés, Alemán | MEDLINE | ID: mdl-34111895

RESUMEN

OBJECTIVE: Digitalisation now almost covers all areas of medical student teaching. Teaching videos are a good way to help students learn practical skills. The existing evidence is a recognised aid for the classification of the respective technology. METHOD: This video presents the usual examination techniques of the shoulder joint on a patient with an unstable shoulder. The respective techniques, if available, were backed up with appropriate evidence. CONCLUSION: The examination techniques presented allow students to view them in a standardized manner on a patient. The evidence for the examination techniques can help with the classification of the respective technique.


Asunto(s)
Educación de Pregrado en Medicina , Articulación del Hombro , Estudiantes de Medicina , Competencia Clínica , Humanos , Examen Físico , Articulación del Hombro/diagnóstico por imagen , Enseñanza
10.
Z Orthop Unfall ; 159(4): 454-457, 2021 Aug.
Artículo en Inglés, Alemán | MEDLINE | ID: mdl-34010973

RESUMEN

OBJECTIVE: Digitalisation now almost covers all areas of medical student teaching. Teaching videos are a good way to help students learn practical skills. The existing evidence is a recognised aid for the classification of the respective technology. METHOD: This video presents the usual examination techniques of the knee joint on a patient with an unstable knee. The respective techniques, if available, were backed up with the appropriate evidence. CONCLUSION: The examination techniques presented allow students to view the examination techniques in a standardised manner on a patient. The evidence for the examination techniques can help with the classification of the respective technique. ZIELSETZUNG: Die Digitalisierung erfasst inzwischen alle Bereiche der studentischen Lehre. Um die Studierenden im Erlernen praktischer Fertigkeiten zu unterstützen, sind Lehrvideos eine gute Methode. Für die Einordnung der jeweiligen Technik ist die vorhandene Evidenz eine anerkannte Hilfestellung. METHODE: Das hier vorliegende Video stellt die üblichen Untersuchungstechniken des Kniegelenkes an einer Patientin mit einem instabilen Knie dar. Die jeweiligen Techniken wurden, wenn vorhanden, mit der jeweiligen Evidenz unterlegt. SCHLUSSFOLGERUNG: Die dargestellten Untersuchungstechniken ermöglichen es Studierenden, sich die Untersuchungstechniken standardisiert an einem Patienten anzuschauen. Die eingeblendete Evidenz für die Untersuchungstechniken kann hierbei eine Hilfestellung bei der Einordnung der jeweiligen Technik leisten.


Asunto(s)
Articulación de la Rodilla , Humanos
12.
Neuroimage ; 232: 117910, 2021 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-33647497

RESUMEN

OBJECT: This study evaluates inter-site and intra-site reproducibility at ten different 7 T sites for quantitative brain imaging. MATERIAL AND METHODS: Two subjects - termed the "traveling heads" - were imaged at ten different 7 T sites with a harmonized quantitative brain MR imaging protocol. In conjunction with the system calibration, MP2RAGE, QSM, CEST and multi-parametric mapping/relaxometry were examined. RESULTS: Quantitative measurements with MP2RAGE showed very high reproducibility across sites and subjects, and errors were in concordance with previous results and other field strengths. QSM had high inter-site reproducibility for relevant subcortical volumes. CEST imaging revealed systematic differences between the sites, but reproducibility was comparable to results in the literature. Relaxometry had also very high agreement between sites, but due to the high sensitivity, differences caused by different applications of the B1 calibration of the two RF coil types used were observed. CONCLUSION: Our results show that quantitative brain imaging can be performed with high reproducibility at 7 T and with similar reliability as found at 3 T for multicenter studies of the supratentorial brain.


Asunto(s)
Encéfalo/diagnóstico por imagen , Cabeza/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/normas , Imagen por Resonancia Magnética/normas , Adulto , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Reproducibilidad de los Resultados
13.
Z Orthop Unfall ; 159(4): 430-437, 2021 Aug.
Artículo en Inglés, Alemán | MEDLINE | ID: mdl-32392597

RESUMEN

INTRODUCTION: The focus of medical-didactic research is the improvement of clinical-practical training. One way to support practical skills training in a time- and resource-saving way is to provide instructional videos. Often the freely available instructional videos do not meet didactic or content requirements. Creating your own videos can therefore be a useful alternative for teachers. There are a variety of instructions on the Internet for shooting instruction videos. To date, this does not include any concrete instructions/assistance for the production of medical instructional videos. However, the presentation of medical learning content in particular can contain many hurdles. The aim of this work was to design a checklist for the creation of instructional videos, which can be used as a guide. METHODS: As a first step, a systematic literature search was carried out to identify works that deal with the creation and not the use of medical instructional videos. To date, corresponding publications do not exist. In a workshop, the participants, who already gained experience in creating this type of video, exchanged ideas. These were critically discussed and analyzed. As a result, a checklist was created. In a subsequent multi-step review process, the checklist was reviewed with regard to applicability, comprehensibility, completeness and quality of the items. RESULTS: Four phases in the creation of an instructional video could be differentiated: preliminary reflections, preparation, day of filming, post-production. The checklist is structured accordingly and should be actively processed phase by phase. The checklist is created in such a way that it can be used and edited without reading this text. Particular focus is placed on the patient and his needs. CONCLUSION: The checklist created provides useful help in the creation of medical instructional videos and can for the first time serve as a guide especially for orthopedic and accident surgical instructional videos.


Asunto(s)
Lista de Verificación , Procedimientos Ortopédicos , Competencia Clínica , Humanos , Enseñanza , Grabación en Video
14.
Magn Reson Med ; 85(1): 182-196, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32700791

RESUMEN

PURPOSE: Inhomogeneities of the static magnetic B0 field are a major limiting factor in cardiac MRI at ultrahigh field (≥ 7T), as they result in signal loss and image distortions. Different magnetic susceptibilities of the myocardium and surrounding tissue in combination with cardiac motion lead to strong spatio-temporal B0 -field inhomogeneities, and their homogenization (B0 shimming) is a prerequisite. Limitations of state-of-the-art shimming are described, regional B0 variations are measured, and a methodology for spherical harmonics shimming of the B0 field within the human myocardium is proposed. METHODS: The spatial B0 -field distribution in the heart was analyzed as well as temporal B0 -field variations in the myocardium over the cardiac cycle. Different shim region-of-interest selections were compared, and hardware limitations of spherical harmonics B0 shimming were evaluated by calibration-based B0 -field modeling. The role of third-order spherical harmonics terms was analyzed as well as potential benefits from cardiac phase-specific shimming. RESULTS: The strongest B0 -field inhomogeneities were observed in localized spots within the left-ventricular and right-ventricular myocardium and varied between systolic and diastolic cardiac phases. An anatomy-driven shim region-of-interest selection allowed for improved B0 -field homogeneity compared with a standard shim region-of-interest cuboid. Third-order spherical harmonics terms were demonstrated to be beneficial for shimming of these myocardial B0 -field inhomogeneities. Initial results from the in vivo implementation of a potential shim strategy were obtained. Simulated cardiac phase-specific shimming was performed, and a shim term-by-term analysis revealed periodic variations of required currents. CONCLUSION: Challenges in state-of-the-art B0 shimming of the human heart at 7 T were described. Cardiac phase-specific shimming strategies were found to be superior to vendor-supplied shimming.


Asunto(s)
Corazón , Procesamiento de Imagen Asistido por Computador , Calibración , Corazón/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética
15.
BMC Med Educ ; 20(1): 194, 2020 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-32552805

RESUMEN

BACKGROUND: Teaching complex motor skills at a high level remains a challenge in medical education. Established methods often involve large amounts of teaching time and material. The implementation of standardized videos in those methods might help save resources. In this study, video-based versions of Peyton's '4-step Approach' and Halsted's 'See One, Do One' are compared. We hypothesized that the video-based '4-step Approach' would be more effective in learning procedural skills than the 'See One, Do One Approach'. METHODS: One-hundred-two naïve students were trained to perform a structured facial examination and a Bellocq's tamponade with either Halsted's (n = 57) or Peyton's (n = 45) method within a curricular course. Steps 1 (Halsted) and 1-3 (Peyton) were replaced by standardized teaching videos. The performance was measured directly (T1) and 8 weeks (T2) after the intervention by blinded examiners using structured checklists. An item-analysis was also carried out. RESULTS: At T1, performance scores significantly differed in favor of the video-based '4-step Approach' (p < 0.01) for both skills. No differences were found at T2 (p < 0.362). The item-analysis revealed that Peyton's method was significantly more effective in the complex subparts of both skills. CONCLUSIONS: The modified video-based version of Peyton's '4-step Approach' is the preferred method for teaching especially complex motor skills in a large curricular scale. Furthermore, an effective way to utilize Peyton's method in a group setting could be demonstrated. Further studies have to investigate the long-term learning retention of this method in a formative setting.


Asunto(s)
Competencia Clínica , Curriculum , Educación de Pregrado en Medicina/métodos , Destreza Motora , Procedimientos Quirúrgicos Operativos/educación , Enseñanza , Adulto , Femenino , Humanos , Masculino , Grabación en Video , Adulto Joven
16.
Handchir Mikrochir Plast Chir ; 52(4): 356-360, 2020 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-32120414

RESUMEN

BACKGROUND: There are 230 defined objectives in the national competency-based catalogue of learning goals in surgery (NKLC) for undergraduate surgical education in Germany. These teaching objectives should be met by the students at the end of their undergraduate education, regardless of their career choice afterward. Assessment drives learning, and thus, alignment of the second state examination and the learning objectives of the NKLC seems reasonable. This study analyses the amount of plastic surgery-based learning objectives in the NKLC. Subsequently, we compared these results with the plastic surgery questions of the German second medical licensing examination compiled by the Central German Institute for Medical and Pharmaceutical Examinations (IMPP). METHODS: Plastic surgery teaching objectives in the NKLC were identified by five plastic surgeons. Exam questions from autumn 2009 to autumn 2014 (number of exams = 11) were retrospectively analyzed, and all exam questions addressing plastic surgery-related objectives were evaluated. The analysis included the total number of questions, mean number of questions for each examination, and the number of questions for each learning objective. RESULTS: Thirty-four learning objectives of the NKLC were identified as "plastic surgery-related" (14.8 % of all NKLC learning objectives). One of these was classified as "only covered by plastic surgery". Ninety-six questions (2.8 % of the total number of 3480 questions) addressed plastic surgery related objectives. Per exam, an average of 8.7 ± 4.0 questions (minimum, 4; maximum, 15) addressed plastic surgery-related learning objectives. During the study period, six learning objectives were not tested at all (2.6 % of all NKLC learning objectives). CONCLUSIONS: Questions focusing on plastic surgery-related learning objectives are not frequent in the second medical licensing examination. Presumably, medical students do not prioritize these objectives and might not have sufficient knowledge of the topics at the beginning of their medical career. A better adjustment of the state examinations and the NKLC seems desirable for plastic surgery-related learning objectives.


Asunto(s)
Cirugía Plástica , Competencia Clínica , Curriculum , Alemania , Humanos , Estudios Retrospectivos
17.
Sci Rep ; 10(1): 3117, 2020 02 20.
Artículo en Inglés | MEDLINE | ID: mdl-32080274

RESUMEN

A novel mono-surface antisymmetric 16-element transmit/receive (Tx/Rx) coil array was designed, simulated, constructed, and tested for cardiac magnetic resonance imaging (cMRI) in pigs at 7 T. The cardiac array comprised of a mono-surface 16-loops with two central elements arranged anti-symmetrically and flanked by seven elements on either side. The array was configured for parallel transmit (pTx) mode to have an eight channel transmit and 16-channel receive (8Tx/16Rx) coil array. Electromagnetic (EM) simulations, bench-top measurements, phantom, and MRI experiments with two pig cadavers (68 and 46 kg) were performed. Finally, the coil was used in pilot in-vivo measurements with a 60 kg pig. Flip angle (FA), geometry factor (g-factor), signal-to-noise ratio (SNR) maps, and high-resolution cardiac images were acquired with an in-plane resolution of 0.6 mm × 0.6 mm (in-vivo) and 0.3 mm × 0.3 mm (ex-vivo). The mean g-factor over the heart was 1.26 (R = 6). Static phase [Formula: see text] shimming in a pig body phantom with the optimal phase vectors makes possible to improve the [Formula: see text] homogeneity by factor > 2 and transmit efficiency by factor > 3 compared to zero phases (before RF shimming). Parallel imaging performed in the in-vivo measurements demonstrated well preserved diagnostic quality of the resulting images at acceleration factors up to R = 6. The described hardware design can be adapted for arrays optimized for animals and humans with a larger number of elements (32-64) while maintaining good decoupling for various MRI applications at UHF (e.g., cardiac, head, and spine).


Asunto(s)
Ingeniería Biomédica/instrumentación , Corazón/diagnóstico por imagen , Imagen por Resonancia Magnética/instrumentación , Animales , Cadáver , Radiación Electromagnética , Diseño de Equipo , Imagen por Resonancia Magnética/métodos , Fantasmas de Imagen , Relación Señal-Ruido , Porcinos
18.
GMS Hyg Infect Control ; 14: Doc17, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31815090

RESUMEN

Objective: Hygienic hand disinfection is of major importance regarding nosocomial infections and antibiotic resistance. The six-step technique is the most commonly taught method, but its superiority has not been empirically demonstrated. This study compares two hand disinfection techniques with regard to their total distribution of the disinfectant. Methods: In this comparative effectiveness analysis, medical students were randomized into two groups. Group 1 was instructed in the 6-step technique, group 2 was referred to a self-responsible application. Learning success was measured using fluorescent disinfectant and black light photographs at three time points (directly, few days later, 5-12 weeks later). Photographs were evaluated quantitatively. Results: 198 students were included in the study (Group 1: 6-step technique; n=103, Group 2: self-responsible disinfection; n=95). 186 were followed up at the second measurement, 182 at the third measurement. Directly after training, there were no significant differences between the two groups. At the second measurement, Group 2 outperformed Group 1 for total, dorsal, and palmar areas (p<0.001, p=0.002, p<0.001). At the third measurement, Group 2 was significantly better (p=0.019) for palmar-sided hands. In Group 1, areas of disinfected skin deteriorated significantly between measurement 1 and 2 (p=0.019) and measurement 2 and 3 (p<0.001). Group 2 did not deteriorate between measurement 1 and 2 (p=0.269) but between measurement 2 and 3 (p<0.001). Conclusions: Compared to the established six-step technique, a self-responsible application method results in measurably better distribution of the hand disinfectant.

19.
Handchir Mikrochir Plast Chir ; 51(3): 193-198, 2019 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-31167280

RESUMEN

BACKGROUND: The national competency-based catalogue of learning objectives in surgery (NKLC) for undergraduate surgical education in Germany consists of 230 objectives and defines competence levels for each objective. These levels range from "competence level 1: factual knowledge" to "competence level 3: independent action". The German second state examination is not based on these objectives, although it is known that assessment drives learning. This study analyses the proportion of hand surgery-based learning objectives in the NKLC and compares the results with the hand surgery questions of the German second medical licensing examination compiled by the Central German Institute for Medical and Pharmaceutical Examinations (IMPP). METHODS: Hand surgery teaching objectives in the NKLC were identified by five hand surgeons. All exam questions addressing these objectives were identified in the German second medical licensing examinations held from autumn 2009 through autumn 2014 (n = 11). The analysis included the number of hand surgery questions for each examination, the number of learning objectives and the different levels of competence. RESULTS: Forty-seven learning objectives of the NKLC were identified as "hand surgery-related" (20.4 % of all NKLC learning objectives). Nine of them were classified as learning objectives that were "only covered by hand surgery" (3.9 % of all NKLC learning objectives). Two hundred and twenty questions (6.3 % of the total number of 3480 questions) addressed hand surgery-related objectives. Per exam, an average of 20 ± 8.2 questions (minimum: 9; maximum: 37) addressed a hand surgery-related learning objective. An average of 0.5 ± 0.7 questions per exam were related to objectives that only covered hand surgery (minimum: 0; maximum: 2). During the study period, 16 learning objectives were not tested at all (13.7 % of all NKLC learning objectives). These untested objectives included 5 objectives of competence level 1 (10.6 % of all NKLC learning objectives). Six of the 9 objectives that are only covered by hand surgery were not assessed at all. CONCLUSIONS: The number of hand surgery-based learning objectives in the NKLC appears to be high. However, many of these learning objectives are not addressed in the second medical licensing examination. We recommend better adjustments between the state examinations and the NKLC.


Asunto(s)
Curriculum , Educación de Pregrado en Medicina , Cirugía General , Concesión de Licencias , Competencia Clínica , Cirugía General/educación , Alemania , Objetivos , Mano/cirugía , Humanos
20.
J Surg Educ ; 76(5): 1440-1449, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30956084

RESUMEN

OBJECTIVE: Musculoskeletal diseases and injuries are the most common cause of long-term pain and physical disability. Thus, every medical graduate should be able to perform a structured examination of the musculoskeletal system. Besides the see-one-do-one principle, other teaching methods have been proposed to be effective. The use of teaching associates offers an established, proven pathway for teaching examination skills in urology and gynecology. During the patient experience method, students are examined first, thus giving them an opportunity to feel the examination before performing it themselves. The objective of this study was to compare the efficiency of 3 distinct teaching methods for both knee and shoulder examination. DESIGN: The study took place during obligatory knee and shoulder examination training. Participants received basic training, including a demonstration of the structured examination by a specialist in trauma surgery. Afterward, group 1 examined each other under professional supervision; group 2 students examined the teaching associates, followed by mutual examinations; and group 3 students were each examined by the instructor, followed by mutual examinations. The acquired competence was assessed in 5-minute practical assessments directly after training and again 5 weeks later. SETTING: The study was conducted at the medical faculty of Goethe University, Frankfurt, Germany. PARTICIPANTS: Study participants were third-year undergraduate medical students completing their obligatory 3-week surgical training. RESULTS: One hundred and forty-four students [group 1 (N = 53), group 2 (N = 46), and group 3 (N = 45)] participated in the first measurement, 92 students in the second measurement of the study. Directly after the training, group 2 and group 3 performed significantly better than group 1 regarding overall score (p < 0.001) and all 4 checklist parts (p < 0.001). At the second measurement, group 2 performed significantly better than group 1 regarding shoulder examination (p = 0.003) and significantly better than group 3 (p = 0.025) regarding knee examination. CONCLUSIONS: The use of a teaching associate and the patient perspective can increase students' performance in knee and shoulder examinations.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Examen Físico , Humanos , Rodilla , Examen Físico/normas , Hombro
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