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1.
Artigo em Inglês | MEDLINE | ID: mdl-34327544

RESUMO

PURPOSE: Emergency trauma room treatment follows established algorithms such as ATLS®. Nevertheless, there are injuries that are not immediately recognized here. The aim of this study was to evaluate the residual risk for manifesting life-threatening injuries despite strict adherence to trauma room guidelines, which is different to missed injuries that describe recognizable injuries. METHODS: In a retrospective study, we included 2694 consecutive patients admitted to the emergency trauma room of one single level I trauma center between 2016 and 2019. In accordance with the trauma room algorithm, primary and secondary survey, trauma whole-body CT scan, eFAST, and tertiary survey were performed. Patients who needed emergency surgery during their hospital stay for additional injury found after guidelines-oriented emergency trauma room treatment were analyzed. RESULTS: In seven patients (0.26%; mean age 50.4 years, range 18-90; mean ISS 39.7, range 34-50), a life-threatening injury occurred in the further course: one epidural bleeding (13 h after tertiary survey) and six abdominal hollow organ injuries (range 5.5 h-4 days after tertiary survey). Two patients (0.07% overall) with abdominal injury died. The "number needed to fail" was 385 (95%-CI 0.0010-0.0053). CONCLUSION: Our study reveals a remaining risk for delayed diagnosis of potentially lethal injuries despite accurate emergency trauma room algorithms. In other words, there were missed injuries that could have been identified using this algorithm but were missed due to other reasons. Continuous clinical and instrument-based examinations should, therefore, not be neglected after completion of the tertiary survey. LEVEL OF EVIDENCE: Level II: Development of diagnostic criteria on the basis of consecutive patients (with universally applied reference "gold" standard).

2.
Z Orthop Unfall ; 159(3): 332-335, 2021 06.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-34111895

RESUMO

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.


Assuntos
Educação de Graduação em Medicina , Articulação do Ombro , Estudantes de Medicina , Competência Clínica , Humanos , Exame Físico , Articulação do Ombro/diagnóstico por imagem , Ensino
3.
Int Orthop ; 45(12): 3179-3184, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34100986

RESUMO

PURPOSE: Stability of the dorsal pelvic ring is important for patient mobilisation and can be restored using several surgical procedures after fracture. Placement of percutaneous iliosacral screws is a reliable and minimal-invasive technique to achieve stabilisation of the dorsal pelvic ring by placement of two screws in the first sacral vertebra. Aim of this study was to evaluate 3D CT scans regarding the anatomical possibility to place two 7.3 mm iliosacral screws for fixation of the dorsal pelvic ring. METHODS: 3D CT datasets of 500 consecutive trauma patients with 1000 hemipelves of a mid-european level I trauma centre with or without pelvic injury were evaluated and measured bilaterally in this retrospective study. RESULTS: One thousand hemipelvic datasets of 500 patients (157 females, 343 males) with a mean age of 49.7 years (18 to 95) were included in this study. Only 16 hemipelves (1.6%, 11 in females, 5 in males) in 14 patients (2.8%, 9 females = 5.73%, 5 males = 1.5%) showed too narrow corridors so that 7.3 mm screw placement would not be possible (p = 0.001). In women, too narrow corridors occurred 3.9 times as often as in men. Only two females showed this bilaterally. CONCLUSION: The evaluation of 3D CT scans of the pelvis showed the importance of planning iliosacral screw placement, especially if two 7.3 mm screws are intended to be placed in the first sacral vertebra.

4.
Z Orthop Unfall ; 159(4): 454-457, 2021 Aug.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-34010973

RESUMO

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.


Assuntos
Articulação do Joelho , Humanos
5.
Eur J Trauma Emerg Surg ; 47(1): 233-240, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31385000

RESUMO

PURPOSE: Postoperative quadriceps muscle strength was lowered after tourniquet application during total knee arthroplasty (TKA). Furthermore, tourniquet application results in higher proteolytic activity within vastus medialis cells, without influence on the amount and function of mitochondria. The effects of the commonly utilized intraoperative tourniquet on gene expression within the human skeletal muscle cells are barely examined. The purpose of the present study was to analyze the gene expression within the skeletal muscle cells after tourniquet-induced ischemia to identify differential expressed genes (DEGs) and pathways. METHODS: As part of a randomized, controlled, monocentric trial (Clinical-Trials.gov NCT02475603) 20 patients, scheduled to undergo primary total knee arthroplasty (TKA), were included. Written informed consent was received and the patients were randomly assigned to Group A (TKA with tourniquet) (n = 10) and Group B (TKA without tourniquet) (n = 10). A muscle biopsie of (5 × 5 × 5 mm) 125 mm3 were obtained from the vastus medialis exactly 60 min after performing the surgical approach. After preparation of a muscle homogenate, RNA extraction was performed (RNeasy Plus Universal Mini Kit Qiagen) and RNA integrity (RIN) was determined (Agilent 2100 Bioanalyzer, RNA 6000 Pico Kit). Gene expression profiling was performed using a validated method (GeneChip™ Human Transcriptome Array 2.0; Affymetrix). Statistical analysis (SPSS-Version 24; SAS JMP10 Genomics, Version 6) included the number of significant DEGs (p < 0.05), the number of DEGs with relative difference > 25% and the number of significant pathway (p < 0.05). The serum C-reactive protein (CRP) and the white blood cell (WBC) count were also perioperatively measured. The protocol was approved by our Institutional Ethics Committee (File reference 2012-334N-MA). RESULTS: Tourniquet application resulted in a total of 3555 (13.8%) statistically significant DEGs within vastus medialis cells. 76 DEGs (29 upregulated, 47 downregulated) revealed a relative difference of more than 25%. Statistically significant changes occurred in 59 (25.8%) of 229 analyzed pathways. Furthermore, there was no clinically meaningful difference between the groups with regard to CRP and WBC count. CONCLUSIONS: Tourniquet induced ischemia results in significant changes of the gene expression within cells of vastus medialis including metabolism, genetic information processing and cellular processes. The identified altered expression of genes and pathways might serve as pharmacotherapeutical targets; although further research is needed to clarify the underlying biological processes. CLINICAL RELEVANCE: These findings add further knowledge and should raise the awareness of surgeons about the effects of tourniquet induced ischemia at the gene expression level. Additional high-quality research may be warranted to examine the short and long term clinical significance of the present data. LEVEL OF EVIDENCE: Level I.


Assuntos
Artroplastia do Joelho , Perfilação da Expressão Gênica , Isquemia , Fibras Musculares Esqueléticas , Torniquetes , Idoso , Biomarcadores/sangue , Feminino , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Osteoartrite do Joelho/cirurgia
6.
Z Orthop Unfall ; 159(4): 430-437, 2021 Aug.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-32392597

RESUMO

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.


Assuntos
Lista de Checagem , Procedimentos Ortopédicos , Competência Clínica , Humanos , Ensino , Gravação em Vídeo
7.
J Contemp Brachytherapy ; 12(5): 480-486, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33299437

RESUMO

Purpose: Radiotherapy is the mainstay in the treatment of locally inoperable tumors. Interstitial electronic needle-based kilovoltage brachytherapy (EBT) could be an economic alternative to high-dose-rate (HDR) brachytherapy or permanent seed implantation (PSI). In this work, we evaluated if locally inoperable tumors treated with PSI at our institution may be suitable for EBT. Material and methods: A total of 10 post-interventional computed tomography (CT) scans of patients, who received PSI and simulated stepping-source EBT applied with Intrabeam system and needle applicator were used. EBT treatment planning software with 3-dimensional image and projection of applicator were applied for designing trajectories and establishing dwell positions. Dwell position doses were summarized, and doses covering 90% of the target volume (D90) achieved with stepping-source EBT were compared to those of PSI. Additionally, conformality of dose distributions and total irradiation time were assessed using conformation number (CN) or conformal index (COIN). Results: In all patients, D90 of EBT exceeded the prescribed dose or D90 of PSI on average by 4.7% or 21.3% relative to the prescribed dose, respectively. Mean number of trajectories was 5.0 for EBT and 6.9 for PSI. Average CN/COIN for EBT was 0.69, with a mean irradiation time of 27.8 minutes for standardized dose of 13 Gy. Conclusions: Stepping-source EBT allowed for a conformal treatment of inoperable interstitial tumors with similar D90. Fewer trajectories were required for EBT in majority of cases.

8.
Radiat Oncol ; 15(1): 263, 2020 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-33183307

RESUMO

INTRODUCTION: The spine represents the site which is most frequently affected by bone metastases in patients with systemic cancer. Of all local treatment options, combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provides both, instantaneous stabilization and immediate pain relief. We here report on the long-term outcomes of the largest cohort treated with Kypho-IORT to date. METHODS: Between 2009 and 2019 a total of 104 patients underwent Kypho-IORT to vertebral tumors in the thoracic, lumbar, or sacral spine with transpedicular kyphoplasty and intraoperative irradiation with a needle-shaped electronic brachytherapy source at our center. Patients were treated either on trial, within the prospective Kypho-IORT studies (NCT01280032 and NCT02773966), or, after completion of the study, off trial but compliant with the study protocol. Follow-up and imaging with computed tomography (CT) or magnetic resonance imaging was scheduled after 3 and 6 months and then bi-annually. RESULTS: A total of 143 vertebrae (89 thoracic spine, 53 lumbar spine, and 1 sacral spine) were treated in 104 patients. The median follow-up was 14.5 months (range 0.4-109). Local progression occurred in 10 patients (10 vertebrae) after a median time of 22.3 months (range 1.5-73) resulting in local control rates of 97.1, 95.9, and 94.2% at 6, 12, and 24 months, respectively. Overall survival was 74.6, 61.7, and 50.3% at 6, 12, and 24 months, respectively. A single serious adverse event was reported. CONCLUSION: In addition to immediate pain reduction and stabilization, Kypho-IORT shows excellent long-term local control with minimal side effects.


Assuntos
Cifoplastia/métodos , Neoplasias da Coluna Vertebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Cifoplastia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , Neoplasias da Coluna Vertebral/mortalidade
9.
PLoS One ; 15(6): e0233400, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502213

RESUMO

The teaching of professional roles in medical education is an interdisciplinary concern. However, surgeons require specific standards of professionalism for certain context-based situations. In addition to communication, studies require collaboration, leadership, error-/conflict-management, patient-safety and decision-making as essential competencies for surgeons. Standards for corresponding competencies are defined in special chapters of the German National Competency-based Learning Objectives for Undergraduate Medical Education (NKLM; chapter 8, 10). The current study asks whether these chapters are adequately taught in surgical curricula. Eight German faculties contributed to analysing mapping data considering surgical courses of undergraduate programs. All faculties used the MERlin mapping platform and agreed on procedures for data collection and processing. Sub-competency and objective coverage, as well as the achievement of the competency level were mapped. Overall counts of explicit citations were used for analysis. Collaboration within the medical team is a strongly represented topic. In contrast, interprofessional cooperation, particularly in healthcare sector issues is less represented. Patient safety and dealing with errors and complications is most emphasized for the Manager/Leader, while time management, career planning and leadership are not addressed. Overall, the involvement of surgery in teaching the competencies of the Collaborator and Manager/Leader is currently low. However, there are indications of a curricular development towards explicit teaching of these roles in surgery. Moreover, implicitly taught roles are numerous, which indicates a beginning awareness of professional roles.


Assuntos
Competência Clínica/normas , Educação de Graduação em Medicina/métodos , Ensino/normas , Currículo/tendências , Educação de Graduação em Medicina/tendências , Docentes de Medicina/psicologia , Docentes de Medicina/tendências , Alemanha , Humanos , Liderança , Aprendizagem , Segurança do Paciente , Comportamento Social , Cirurgiões/psicologia
10.
Z Orthop Unfall ; 158(1): 90-103, 2020 Feb.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-31250413

RESUMO

OBJECTIVE: In orthopaedics and trauma surgery scores are frequently used to assess treatment outcomes. The purpose of the review is to create an overview analysing the content of validity studies of frequently utilized scores for upper and lower extremity. METHODS: Commonly used outcome measures to assess clinical outcome of upper (n = 19) and lower (n = 22) extremity were included. For each of the scores a comprehensive search in several databases (Medline, PubMed, google scholar) were performed to identify validation studies. The COSMIN-Checklist (COSMIN: Consensus-based Standards for the selection of health Measurement Instruments) introduced by Mokkink et al. were used to analyse systematically the methodological quality of the validation studies. RESULTS: Validity, objectivity and reliability were not routinely considered and addressed in validation studies. The score related validation studies did not include all defined criteria of the COSMIN-Checklist. Six scores of the upper extremity and four scores of the lower extremity are not adequately validated. The best validated scores of the upper extremity is Oxford Shoulder Score (OSS) and for the lower extremity Hip Disabilities and Osteoarthritis Outcome Score (HOOS) as well as Western Ontario and McMaster Universities Score (WOMAC). CONCLUSION: There is no gold standard for the content-comprehension of validation studies due to the structure of the original study. The more criteria were tested the more informative and significant the outcome measure is. However some scores, such as Neer and Castaing Score, that lack validation are still being successfully used in research and clinical practice. The present review provides an overview of frequently used score in orthopaedics and trauma surgery and their grade of validity.


Assuntos
Extremidade Inferior , Lista de Checagem , Humanos , Ortopedia , Osteoartrite , Reprodutibilidade dos Testes , Extremidade Superior
11.
Z Orthop Unfall ; 158(6): 630-640, 2020 Dec.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-31556080

RESUMO

BACKGROUND: The use of the tourniquet in total knee arthroplasty is still a subject of controversial discussion. Previous studies mainly focus on parameters like blood loss and operation time. The aim of this systematic review is to evaluate the postoperative outcome involving parameters such as pain intensity, analgesic consumption, knee function and complication rate with and without tourniquet use, to find a recommendation for future application in total knee arthroplasty. MATERIAL AND METHODS: This review is based on the PRISMA Checklists. A systematic research was performed in PubMed using the key words "tourniquet", "total knee arthroplasty", "TKA" and "knee endoprosthesis" up to and including January 2018. The initial search revealed 686 Papers which were extracted by the parameters intensity of pain, analgesic consumption, function (range of motion, Hospital for Special Surgery Score, Knee Society Score) and complications (deep vein thrombosis, surgical side infection, pulmonary embolism). The program Review Manager Version 5.3 was used for statistical analysis. A significance level of p < 0,05 was defined. RESULTS: 18 studies were included in this review with 1279 total knee arthroplasties overall (646 with the use of tourniquet and 633 without). The analysis shows a significant lower pain intensity until the fifth postoperative day (p = 0,03) and also after one to three months (p = 0,04) without using the tourniquet. Range of motion is significantly higher in two to three days postoperatively (p < 0,00 001) when the surgery was performed without tourniquet. Knee Society Score shows no difference between the two groups. A deep vein thrombosis appears significantly more often when using a tourniquet (p = 0,04). There was no higher occurrence in pulmonary embolism and surgical side infections. CONCLUSION: The use of a pneumatic tourniquet in total knee arthroplasty affects especially the early postoperative pain and functional recovery.


Assuntos
Artroplastia do Joelho , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica , Humanos , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular , Torniquetes
12.
Z Orthop Unfall ; 158(2): 201-207, 2020 Apr.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-31533168

RESUMO

OBJECTIVE: In Germany, among patients with minor head injury (MHI), the incidence of coexisting alcohol intoxication is indicated up to 50%. The neurological symptoms of patients with MHI may be caused or altered by alcohol intoxication, this could mislead to further, potential harmful, diagnostic steps or to misinterpretation of the symptoms and to non-execution of necessary treatments. In order to decide which patients need further diagnostics by CCT, S100B has been proposed as a potential selection criterion. On the other hand, studies have hypothesized that alcohol intoxication may lead to elevated S100B serum levels. Therefore, the present study aims to investigate the relationship between the blood ethyl alcohol concentration and the S100B serum concentration in an experimental setting in young human adult volunteers. METHODS: In a cohort of 58 healthy volunteers, serum S100B concentration and blood ethyl alcohol concentration were measured before and after liberately drinking alcohol. The study was approved by the local Ethics Committee of the Medical Faculty Mannheim (Ethics Committee II, AZ 2012-272 N-MA). Instantaneous analysis of the samples was carried out using state-of-the art automated measuring systems. (Analyzer Cobas e411, Roche and Analyzer Dimension Vista 1500, Siemens). RESULTS: After drinking, alcohol levels ranged from 0,23 to 1,92 g/l. The S100B value ranged from to 0,021 to 0,115 µg/l after alcohol consumption (S100B standard value < 0,11 µg/l). By calculating the Pearson correlation of empirical correlation after drinking alcohol with r = 0.01181, a correlation between serum S100B concentration and ethyl alcohol concentration is not probable. The S100B concentrations were independent on the alcohol intake in low to medium alcohol levels. CONCLUSION: A relevant alcohol blood concentration (~ 1 g/l), in otherwise healthy volunteers, does not affect the serum concentration of S100B. S100B may be a useful brain injury marker in low to moderate drunken patients.


Assuntos
Intoxicação Alcoólica , Biomarcadores , Lesões Encefálicas , Traumatismos Craniocerebrais , Alemanha , Humanos , Subunidade beta da Proteína Ligante de Cálcio S100
13.
Knee Surg Sports Traumatol Arthrosc ; 28(4): 1045-1054, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31372679

RESUMO

PURPOSE: Tourniquet use during primary total knee arthroplasty (TKA) may negatively impact the early postoperative functional recovery due to molecular effects of ischaemia. The hypothesis of the present study was that primary TKA without a tourniquet positively influences the postoperative muscle strength, functional outcome, patient satisfaction and health status. METHODS: The monocentric, randomized, controlled trial included a total of 99 patients scheduled to undergo primary TKA (ClinicalTrials.gov NCT02475603). The patients were randomly assigned to the tourniquet (n = 50) or non-tourniquet (n = 49) group after receiving a written informed consent. As primary outcome parameter, the functional outcome, patient expectation/satisfaction and the health status were assessed preoperatively, 6 weeks, 6 months postoperatively using Oxford knee score, WOMAC score, Mancuso score, EQ-5D index, EQ-VAS, anxiety score, depression score, hospital anxiety and depression scale, respectively. Additionally, a rope pulley isokinetic system (Moflex, Recotec/Bernina, Switzerland) was applied to quantify the muscle strength preoperatively, 1 week, 6 weeks and 6 months postoperatively. RESULTS: No difference in any of the outcome parameters could be observed between the groups at all time points after TKA (n.s.). Also the isokinetic muscle strength of the knee joint as quantified by concentric/eccentric peak force (N), workload (J), total workload (J) and power (W) did not reveal statistically significant differences between the groups and time points. However, in both groups improved results were found with respect to the functional outcome, patient satisfaction, health status and isokinetic muscle strength up to 6 months postoperatively. CONCLUSIONS: The application of the tourniquet did not affect the isokinetic muscle strength, the functional outcome, the patient satisfaction and the health status following primary TKA. However, with and without tourniquet use, the level of the knee functionality, the patient satisfaction as well as the health status improved significantly. LEVEL OF EVIDENCE: I.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/cirurgia , Força Muscular , Osteoartrite do Joelho/cirurgia , Torniquetes , Idoso , Feminino , Nível de Saúde , Humanos , Cinética , Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Recuperação de Função Fisiológica , Índice de Gravidade de Doença
14.
Z Orthop Unfall ; 158(1): 104-110, 2020 Feb.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-31117145

RESUMO

The correct timing of urgent surgery in the field of orthopedic and trauma surgery is under constant discussion. The authors of this review like to present a scientific based recommendation for the timing of acute care surgery using the TACS-classification for the description of urgency. The timing and priority of the indicated procedure is deduced only from the expected mortality and disability caused by a potential delay. A proposal for a nomenclature is given to be integrated in the clinical practice and to be completed.


Assuntos
Ortopedia
15.
GMS J Med Educ ; 36(6): Doc70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31844642

RESUMO

Objective: Training in the final year (FY) of undergraduate medical training currently does not adequately prepare students for the independent performance of medical professional activities after graduation. The concept of Entrustable Professional Activities (EPA) offers the opportunity for a competency-based FY training with the focus on medical professional activities. Methodology: In regular meetings, the FY sub-working group of the German Medical Faculty Association (MFT), which includes representatives with clinical and didactic expertise of the Associations of Internal Medicine, Surgery and General Medicine, developed a concept for the competecy-orientated, EPA-based, FY model logbook 2.0. The selection of the units of practice was made in a cross-disciplinary, consensus-orientated discussion process based on the question which medical professional activities a young professional has to master in the inpatient or outpatient working environment. Results: For the FY electives internal medicine, surgery and general medicine, a blueprint of a total of 18 comprehensive, partially interdisciplinary EPAs relating to inpatient and outpatient care contexts were developed. Each EPA was operationalised by a short description, supervision levels were attributed, and the process of transparent entrustment was determined. Conclusions: The concept for a new FY model logbook 2.0 focuses on the interdisciplinary core medical professional activities in an inpatient and outpatient care context, in order to facilitate transition from undergraduate training to professional practice, and to help avoid overload, thus increasing patient safety.


Assuntos
Educação Baseada em Competências/métodos , Educação de Graduação em Medicina/métodos , Internato e Residência/organização & administração , Competência Clínica , Alemanha , Humanos
16.
Zentralbl Chir ; 144(6): 573-579, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31842239

RESUMO

Competency-based medical education is needed in order to meet the requirements of medical care currently and in the future. The basis of this are activity-based learning objectives that are merged in competency-based catalogues. A basis for a core curriculum of undergraduate medical training is the National Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM). Already in 2013, for surgery, the competencies which medical students should have achieved after completing the practical year (PJ) in relation to surgical diseases were defined in the special part of the National Catalogue of Learning Objectives in Surgery (NKLC). In the now amended general part of the NKLC, interdisciplinary competencies were defined and consented from all surgical disciplines, that are relevant for all surgical disciplines and that all representatives from the different surgical disciplines should incorporate in their surgical training. The complete NKLC is now available for faculties, teachers and students for trial (available online: https://www.dgch.de/index.php?id=190&L=528). The guiding principle for the entire development process was to make sure that students gain all competencies they need when starting to work as a medical doctor and therefor to increase patient safety.


Assuntos
Educação de Graduação em Medicina , Faculdades de Medicina , Competência Clínica , Currículo , Alemanha , Humanos , Aprendizagem
17.
BMC Cancer ; 19(1): 430, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072314

RESUMO

BACKGROUND: The spine is the most frequent location of bone metastases. Local treatment aims at palliation of pain and, given the increased likelihood of long-term cancer survival, at local control. Kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provided instantaneous pain relief in 70% of patients at the first day after the intervention and resulted in local control rates of > 93% at 1 year in a recently conducted phase I/II trial. To assess its clinical value, we designed a phase III trial which tests Kypho-IORT against the most widespread standard-of-care, external beam radiotherapy (EBRT), in patients with painful vertebral metastases. METHODS: This phase III study includes patients ≥50 years of age with up to 4 vertebral metastases and a pain score of at least 3/10 points on the visual/numeric analogy scale (VAS). Patients randomized into the experimental arm (A) will undergo Kypho-IORT (Kyphoplasty plus IORT with 8 Gy prescribed to 13 mm depth). Patients randomized into the control arm (B) will receive EBRT with either 30 Gy in 10 fractions or 8 Gy as a single dose. The primary end point is pain reduction defined as at least - 3 points on the VAS compared to baseline at day 1. Assuming that 40% of patients in the Kypho-IORT arm and 5% of patients in the control arm will achieve this reduction and 20% will drop out, a total of 54 patients will have to be included to reach a power of 0.817 with a two-sided alpha of 0.05. Secondary endpoints are evaluation of the percentage of patients with a pain reduction of at least 3 points at 2 and 6 weeks, local tumor control, frequency of re-intervention, secondary fractures/sintering, complication rates, skin toxicity/wound healing, progression-free survival (PFS), overall survival (OS) and quality of life. DISCUSSION: This trial will generate level 1 evidence on the clinical value of a one-stop procedure which may provide instantaneous pain relief, long-term control and shortened intervals to further adjuvant (systemic) therapies in patients with spinal metastases. TRIAL REGISTRATION: Registered with ClinicalTrials.gov, number: NCT02773966 (Registration date: 05/16/2016).


Assuntos
Dor do Câncer/terapia , Cuidados Intraoperatórios/métodos , Cifoplastia/métodos , Manejo da Dor/métodos , Neoplasias da Coluna Vertebral/terapia , Dor do Câncer/diagnóstico , Dor do Câncer/etiologia , Ensaios Clínicos Fase III como Assunto , Terapia Combinada/métodos , Fracionamento da Dose de Radiação , Humanos , Pessoa de Meia-Idade , Medição da Dor , Intervalo Livre de Progressão , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Coluna Vertebral/efeitos da radiação , Coluna Vertebral/cirurgia
18.
Zentralbl Chir ; 144(6): 532-535, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31067573

RESUMO

The "Masterplan Medizinstudium 2020" from the German Federal Government should not be underestimated as only one among many announcement. Thus, the Surgical Working Group on Medical Education (CAL) of the German Association of Surgeons (DGCH) comments on the intended measures of the "Masterplan Medizinstudium 2020" and discusses the challenges, consequences and duties arising from the "Masterplan Medizinstudium 2020" for the representatives of the surgical societies and those engaged in surgical undergraduate training.


Assuntos
Educação Médica , Alemanha , Sociedades Médicas
19.
Zentralbl Chir ; 144(6): 543-550, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-30912103

RESUMO

BACKGROUND: The final year is an important time for a medical student as this is when medical knowledge is transformed into medical responsibilities. The field of surgery is firmly anchored in the educational structure as it is mandatory during the practical year of a medical student. The purpose of this paper is to identify factors that influence medical students to choose surgery after the final year of medical school. MATERIALS AND METHODS: An online survey conducted by the AG DGOU 2012 provided complete data sets from a total of 9079 participants. 184 of these had already completed their PJ compulsory sub-internship (tertiary) surgery. These were divided into four groups for analysis: decision to specialise in surgery prior to the PJ compulsory tertiary ("yes, before", JV), during the PJ compulsory ("yes, during", JW), decision against before the PJ compulsory ("no, before", NV) or during the compulsory ("no, during", NW). The total of 38 survey items were summarised for overall assessment, taking into account the decision on subject specialisation. RESULTS: 57.9% of the respondents were positive regarding the overall impression of the surgical internship during their final year. The respondents of the JW group were especially positive, having made the decision to become a surgeon, based on their internship experience during the final year in comparison to the NW group (decision against surgery). We find significant differences in all analysed items: integration into team JW/NW (p ≤ 0.003), acquisition of expertise (p ≤ 0.014), teachers (p ≤ 0.025), quality and structure of teaching (p ≤ 0.043) and overall satisfaction with the required tertial (p ≤ 0.037). CONCLUSION: In comparison to other specialities, in the field of surgery there is the option of recruiting directly within the framework of the compulsory internship. The results reveal unsatisfactory structures from a student perspective. The lack of medical care/support, the insufficient inclusion in therapeutic considerations, the lack of professional knowledge and lack of contact with the teachers are just a few key points that negatively impact the overall outcome of students' satisfaction with the compulsory tertiary education. The results of the present study should serve as motivation and contribute to the restructuring of the compulsory core of the Practical Year, which the Master Plan 2020 will entail.


Assuntos
Educação de Graduação em Medicina , Internato e Residência , Faculdades de Medicina , Estudantes de Medicina , Cirurgiões , Currículo , Humanos , Inquéritos e Questionários
20.
Zentralbl Chir ; 144(6): 580-586, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-30562797

RESUMO

INTRODUCTION: One way to recruit junior physicians in surgery is to optimise the final year. Starting points for this can be gained through a standardised evaluation of the deployments in the final year. In this study, a questionnaire for the evaluation of the training conditions and satisfaction with the deployment in the final year (Ma-FEZ-PJ) underwent a test and item analysis. In addition, initial studies were carried out to analyse the construct validity of the two scales - final year training and individual attitude. A specific example will then be used to show how the Ma-FEZ-PJ can be used to optimise the final year. METHODS: 555 medical students from eight final year cohorts evaluated their deployments in the final year with the Ma-FEZ-PJ. The reliability of the two scales as well as item characteristics were calculated. To validate construct validity, a global satisfaction item was used to verify the convergent validity of the final year training scale, which captures training conditions and satisfaction with the final year, and the divergent validity of the individual attitude scale. Groups of students who voluntarily or involuntarily attended the mandatory subjects in the final year were then compared to show whether the individual attitude scale can differentiate between the two. RESULTS: The reliability of the scale final year training is very good, that of the scale individual attitude is in the acceptable range. The construct validity can be sufficiently confirmed. DISCUSSION: The Ma-FEZ-PJ can be used as a tool to evaluate training conditions and satisfaction with the final year's deployment. Comparisons with other surgical departments, oriented at the scale level and then in detail at the item level, identify deficits in final year training and therefore approaches to optimise it.


Assuntos
Autoavaliação Diagnóstica , Satisfação Pessoal , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
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