RepoMed (Medizinische Hochschule Hannover)
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Defining Learning Outcomes as a Prerequisite of Implementing a Longitudinal and Transdisciplinary Curriculum with Regard to Digital Competencies at Hannover Medical School
No full textBackground Worldwide educational programs face the challenge how to define and integrate digital competencies in medical education. This article describes the implementation of learning outcomes with respect to digital competencies in the compulsory curriculum at Hannover Medical School (MHH). Methods An interdisciplinary MHH project group was constituted consisting of physicians and experts in medical informatics and in curriculum development. Over the course of 7 work sessions the group compared different international and national frameworks dealing with digital competencies for physicians. By a consensus driven approach the working group drew up a collection of learning outcomes which were regarded relevant to be incorporated in the curriculum at MHH. Results The analysis of different frameworks indicated that data literacy is a central domain within all viewed preexisting catalogs. During the course of the project group analysis, 57 learning outcomes with respect to digital competencies were identified as necessary to be integrated in the compulsory curriculum. They were divided in 5 main categories: "handling of medical data," "the digital infrastructure of the health system," "scope of application: usage in patient care and in the field of preventive medicine," "medico-legal and ethical basics," and "transformation processes in medicine due to digitalization." Conclusions The MHH project group concluded that medical students should be taught digital competencies that enable an understanding of underlying functional principles of digital systems rather than their correct utilization. The presented project indicates that a close interdisciplinary collaboration of physicians and medical informaticians can be a promising approach to incorporate digital competencies in the undergraduate medical curriculum
Centromedian-Parafascicular and Somatosensory Thalamic Deep Brain Stimulation for Treatment of Chronic Neuropathic Pain: A Contemporary Series of 40 Patients.
No full textIntroduction: The treatment of neuropathic and central pain still remains a major challenge. Thalamic deep brain stimulation (DBS) involving various target structures is a therapeutic option which has received increased re-interest. Beneficial results have been reported in several more recent smaller studies, however, there is a lack of prospective studies on larger series providing long term outcomes. Methods: Forty patients with refractory neuropathic and central pain syndromes underwent stereotactic bifocal implantation of DBS electrodes in the centromedian-parafascicular (CM-Pf) and the ventroposterolateral (VPL) or ventroposteromedial (VPM) nucleus contralateral to the side of pain. Electrodes were externalized for test stimulation for several days. Outcome was assessed with five specific VAS pain scores (maximum, minimum, average pain, pain at presentation, allodynia). Results: The mean age at surgery was 53.5 years, and the mean duration of pain was 8.2 years. During test stimulation significant reductions of all five pain scores was achieved with either CM-Pf or VPL/VPM stimulation. Pacemakers were implanted in 33/40 patients for chronic stimulation for whom a mean follow-up of 62.8 months (range 3-180 months) was available. Of these, 18 patients had a follow-up beyond four years. Hardware related complications requiring secondary surgeries occurred in 11/33 patients. The VAS maximum pain score was improved by ≥50% in 8/18, and by ≥30% in 11/18 on long term follow-up beyond four years, and the VAS average pain score by ≥50% in 10/18, and by ≥30% in 16/18. On a group level, changes in pain scores remained statistically significant over time, however, there was no difference when comparing the efficacy of CM-Pf versus VPL/VPM stimulation. The best results were achieved in patients with facial pain, poststroke/central pain (except thalamic pain), or brachial plexus injury, while patients with thalamic lesions had the least benefit. Conclusion: Thalamic DBS is a useful treatment option in selected patients with severe and medically refractory pain
Generation of platelets with enhanced functionality by targeting transgenic proteins to alpha granules in megakaryocytes
No full textVessel Wall Inflammatory Activity as Determined by F-18 Fluorodeoxyglucose PET in Large Vessel Vasculitis Is Attenuated by Immunomodulatory Drugs.
No full textF-18 fluorodeoxyglucose (F-18 FDG) PET/CT plays an increasing role in the diagnostic workup of large vessel vasculitis (LVV); however, information on the relationship between immunosuppressive drugs and vessel wall uptake is limited. In 94 patients with a confirmed diagnosis of LVV, the vessel wall-to-liver ratio (VLR) was assessed in eight vessel segments. Patients were grouped according to intake of immunomodulatory drugs (Group 1, prednisone; Group 2, prednisone + methotrexate; and Group 3, prednisone + others) and compared to treatment-naïve individuals. A total of 54/94 (57.4%) were treated with immunomodulatory drugs (Group 1, 29/49 (53.7%); Group 2, 9/54 (16.7%); Group 3, 11/54 (20.4%); and Group 4, 5/54 (9.3%)), whereas the remainder received no therapy (40/94 (42.6%)). The mean VLR of the arterial segments correlated significantly with the hematopoietic organs (r ≥ 0.22, p ≤ 0.05), c-reactive protein (r ≥ 0.25, p ≤ 0.05), and prednisone dosage (r ≥ -0.4, p ≤ 0.05). Relative to treatment-naïve patients, a significantly lower VLR was recorded in 5/8 (62.5%) of the investigated vessel segments in Group 1 (p ≤ 0.02), in 6/8 of the vessel segments in Group 2 (75.0%, p ≤ 0.006), and in 7/8 of the segments in Group 3 (87.5%, p ≤ 0.05). In LVV, the F-18 FDG uptake in vessel wall as a marker of inflammatory activity was attenuated by immunomodulatory drugs, which provides a foundation for future serial monitoring of treatment efficacy
The p38/MK2 Axis in Monocytes of Fibromyalgia Syndrome Patients: An Explorative Study.
No full textBackground and Objectives: The aetiology and pathomechanism of fibromyalgia syndrome 12 (FMS) as one of chronic pain syndromes still need to be further elucidated. Mitogen-activated protein kinase (MAPK) pathway has been proposed as a novel approach in pain management. Since the major symptom of fibromyalgia syndrome (FMS) patients is pain, it became of interest whether MAPK pathways, such as the stress-activated p38 MAPK/MK2 axis, are activated in FMS patients. Therefore, this study aimed at determining p38 MAPK/MK2 in FMS patients. Materials and Methods: Phosphorylation of MAPK-activated protein kinases 2 (MK2), a direct target of p38 MAPK, was measured in monocytes of FMS and healthy controls (HCs) to monitor the activity of this pathway. Results: The mean level of phosphorylated MK2 was fivefold higher in FMS patients as compared to HCs (p < 0.001). Subgroup analysis revealed that antidepressants did not influence the activity of MK2 in FMS patients. Conclusions: This result indicates that the p38/MK2 pathway could be involved in the pathomechanism of FMS, could act as a clinical marker for FMS, and could be a possible target for pain management in FMS patients
Life stage-specific trends in educational inequalities in health-related quality of life and self-rated health between 2002 and 2016 in Germany: findings from the German Socio-Economic Panel Study (GSOEP).
No full textObjectives While evidence suggests persisting health inequalities, research on whether these trends may vary according to different stages of life has rarely been considered. Against this backdrop, we analysed life stage-specific trends in educational inequalities in health-related quality of life (HRQOL) and poor self-rated health (SRH) for individuals in 'later working life' (50-64 years), 'young seniors' (65-79 years) and persons of 'old age' (80+ years). Methods We used survey data from the German Socio-Economic Panel Study comprising the period from 2002 to 2016. The sample consists of 26 074 respondents (160 888 person-years) aged 50 years and older. Health was assessed using the mental and physical component summary scale (MCS/PCS) of the HRQOL questionnaire (12-Item Short Form Health Survey V.2) and the single item SRH. To estimate educational health inequalities, we calculated the regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII). Time trends in inequalities were assessed by the inclusion of a two-way interaction term between school education and time. Results With increasing age, educational inequalities in PCS and poor SRH decreased whereas they rose in MCS. Over time, health inequalities decreased in men aged 65-79 years (MCSSII=2.76, 95% CI 0.41 to 5.11; MCSRII=1.05, 95% CI 1.01 to 1.10; PCSSII=2.12, 95% CI -0.27to 4.51; PCSRII=1.05, 95% CI 1.00 to 1.11; poor SRHSII=-0.10, 95% CI -0.19 to 0.01; poor SRHRII=0.73, 95% CI 0.48 to 1.13) and among women of that age for MCS (MCSSII=2.82, 95% CI 0.16 to 5.50; MCSRII=1.06, 95% CI 1.01 to 1.12). In contrast, health inequalities widened in the 'later working life' among women (PCSSII=-2.98, 95% CI -4.86 to -1.11; PCSRII=0.94, 95% CI 0.90 to 0.98; poor SRHSII=0.07, 95% CI 0.00 to 0.14) while remained largely stable at old age for both genders. Conclusions We found distinctive patterns of health inequality trends depending on gender and life stage. Our findings suggest to adopt a differentiated view on health inequality trends and to pursue research that explores their underlying determinants
Trends in healthy life expectancy between 2002 and 2018 in Germany - Compression or expansion of health-related quality of life (HRQOL)?
No full textThe question of whether rising life expectancy has led to additional life years spent in good health or poor health is of major public health relevance. We tested the theories of compression or expansion of morbidity for Germany with respect to the mental and physical component summary scales (MCS/PCS) of the health-related quality of life (HRQOL) questionnaire (SF-12). Data of 90,758 women and 81,400 men were obtained from the German Socio-Economic Panel between 2002 and 2018. Linear and logistic regression analyses were applied to estimate temporal changes in MCS and PCS in different life stages. The development of healthy life expectancy (H-LE) expressed by life years without severe functional limitations was calculated by applying the Sullivan method. Overall, a significant increase of MCS and PCS was found in both genders. The rise was mainly due to declining proportions of severe limitations (norm values 60 points did not change substantially. Improvements were most apparent for the 'young seniors' (65-79 years) and at 'old age' (80 years +). In contrast, no improvements in PCS were found for 'later working life' (50-64 years) and decreasing levels were observed for persons of 'middle working age' (30-49 years). During the study period, H-LE at age 50 increased in women/men by 2.93/2.90 years (MCS) and 1.92/2.53 years (PCS), respectively. Our results support the hypothesis of absolute compression of morbidity. However, since consistent improvements were not found for ages below 65 years, it remains open to debate whether the positive health trend will also persist in the future. Our findings suggest that health promotion efforts should be strengthened for people of middle and later working age to support healthy aging
Etablierung eines Schnelltests zum Nachweis von periprothetischen Infektionen mit Hilfe der Leukozyten-Esterase: eine prospektive Studie
No full textClinically Applicable Quantitative Magnetic Resonance Morphologic Measurements of Grey Matter Changes in the Human Brain.
Get PDF(1) Purpose: Quantitative magnetic resonance imaging (qMRI) measurements can be used to sensitively estimate brain morphological alterations and may support clinical diagnosis of neurodegenerative diseases (ND). We aimed to establish a normative reference database for a clinical applicable quantitative MR morphologic measurement on neurodegenerative changes in patients; (2) Methods: Healthy subjects (HCs, n = 120) with an evenly distribution between 21 to 70 years and amyotrophic lateral sclerosis (ALS) patients (n = 11, mean age = 52.45 ± 6.80 years), as an example of ND patients, underwent magnetic resonance imaging (MRI) examinations under routine diagnostic conditions. Regional cortical thickness (rCTh) in 68 regions of interest (ROIs) and subcortical grey matter volume (SGMV) in 14 ROIs were determined from all subjects by using Computational Anatomy Toolbox. Those derived from HCs were analyzed to determine age-related differences and subsequently used as reference to estimate ALS-related alterations; (3) Results: In HCs, the rCTh (in 49/68 regions) and the SGMV (in 9/14 regions) in elderly subjects were less than those in younger subjects and exhibited negative linear correlations to age (p < 0.0007 for rCTh and p < 0.004 for SGMV). In comparison to age- and sex-matched HCs, the ALS patients revealed significant decreases of rCTh in eight ROIs, majorly located in frontal and temporal lobes; (4) Conclusion: The present study proves an overall grey matter decline with normal ageing as reported previously. The provided reference may be used for detection of grey matter alterations in neurodegenerative diseases that are not apparent in standard MR scans, indicating the potential of using qMRI as an add-on diagnostic tool in a clinical setting