RepoMed (Medizinische Hochschule Hannover)
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Charakterisierung eines kardialen FGF23-Knockouts und Einflüsse im hochdruckinduzierten Hypertrophiemodell
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Digitale Nephropathologie: automatisierte Tubuluserkennung und -klassifizierung mithilfe von Convolutional Neural Networks
Get PDFEffects of the alternative medical curriculum at the Hannover Medical School on length of study and academic success
No full textZielsetzung: Der Modellstudiengang HannibaL (Hannoversche integrierter berufsorientierter und adaptiver Lehrplan) unterscheidet sich hinsichtlich des Studienaufbaus deutlich von anderen Medizinstudiengängen in Deutschland, unter anderem weil die MHH eine Möglichkeit sah, die Studienzeit positiv zu beeinflussen. Deshalb haben wir untersucht, auf welche Weise die Studiendauer im Medizinstudium durch die Studiengangsstruktur beeinflusst wird und ob dies Auswirkungen auf den Bereich Evaluation & Studienerfolg hat. Methodik: Berücksichtigt werden die Daten von über 2.500 Studierenden, die zwischen 2011 und 2021 an der Medizinischen Hochschule Hannover studiert haben. Die Studienzeit messen wir als vergangene Zeit bis zum erfolgreichen Bestehen der jeweiligen Prüfungsabschnitte, Studienerfolg über die dort erzielten Noten. Ergebnisse: Studierende der Vorabquoten (VQ) und der Wartezeit-Quote (WQ) benötigen deutlich mehr Zeit für den Abschluss des 1. Abschnitts als die Abiturbesten (AQ) und über Auswahlverfahren zugelassene Studierende (AdH), da sie häufiger Prüfungen nicht bestehen oder aufschieben. Den 2. Abschnitt des Staatsexamens erreichen jedoch alle Auswahlquoten fast zeitgleich; VQ und WQ gelingt es in HannibaL, Verzögerungen aufzuholen. Wir zeigen, dass dies keinen negativen Einfluss auf den Erfolg hat. Allgemein erreichen VQ und WQ jedoch im gesamten Studium schlechtere Noten als AQ und AdH und brechen ihr Studium zudem öfter ab. Diskussion: Im Regelstudium kann erst mit dem Studium fortgefahren werden, wenn der 1. Abschnitt komplett abgeschlossen ist. Das Aufholen von Verzögerungen aus den ersten beiden Studienjahren wird durch die Integration der beiden Studienabschnitte in HannibaL ermöglicht. Der Studienaufbau kommt also leistungsschwächeren Studierenden entgegen, die Verspätungen früh im Studium aufbauen. Verzögerungen bei AQ und AdH entstehen dagegen im 2. Abschnitt.Objective: The model curriculum HannibaL (Hannoversche integrierter berufsorientierter und adaptiver Lehrplan) differs significantly from other medical study programs in Germany in terms of its structure with which, among other factors, the Hannover Medical School (MHH) saw an opportunity to positively influence the length of study. We investigate how the length of medical study is influenced by the curriculum’s structure and whether this has any impact on academic success. Methods: We use data from over 2,500 students who studied medicine at MHH between 2011 and 2021. We measure study time as the number of years which pass until completion of the respective study phases and academic success as the grades achieved on final exams. Results: Since they more often fail or postpone exams, students admitted based on special quotas (VQ) or a waiting list (WQ) need significantly more time to complete the first study phase (M1) compared to students who were admitted based on a selection process (AdH) or who belong to the “best school graduates” quota (AQ) because they earned the highest scores on the final secondary school exam. Yet, students from all admission groups reach the written state exam (M2) almost simultaneously. In HannibaL, WQ and VQ manage to catch up on delays from M1 with no negative impact on success in M2. In general, however, VQ and WQ achieve lower grades and drop out more often than students from AQ and AdH. Discussion: In the regular curriculum, students can only proceed with their studies once M1 has been entirely completed. HannibaL, on the other hand, allows for the catching up of delays from the first two years of study by integrating both study phases. The curricular structure thus accommodates students with lower academic performance who accumulate delays early on in their studies. By contrast, delays in the AQ and AdH groups arise during the second phase of study (M2)
Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study.
Get PDFIntroduction Migrant healthcare workers played an important role during the COVID-19 pandemic, but data are lacking especially for high-resourced European healthcare systems. This study aims to research migrant healthcare workers through an intersectional health system-related approach, using Germany as a case study. Methods An intersectional research framework was created and a rapid scoping study performed. Secondary analysis of selected items taken from two COVID-19 surveys was undertaken to compare perceptions of national and foreign-born healthcare workers, using descriptive statistics. Results Available research is focused on worst-case pandemic scenarios of Brazil and the United Kingdom, highlighting racialised discrimination and higher risks of migrant healthcare workers. The German data did not reveal significant differences between national-born and foreign-born healthcare workers for items related to health status including SARS-CoV-2 infection and vaccination, and perception of infection risk, protective workplace measures, and government measures, but items related to social participation and work conditions with higher infection risk indicate a higher burden of migrant healthcare workers. Conclusions COVID-19 pandemic policy must include migrant healthcare workers, but simply adding the migration status is not enough. We introduce an intersectional health systems-related approach to understand how pandemic policies create social inequalities and how the protection of migrant healthcare workers may be improved
Impact of steroid withdrawal on subclinical graft injury after liver transplantation: a propensity score-matched cohort analysis
Get PDFSubclinical graft injuries in orthotopic liver transplantation may threaten long-term graft survival and could be the result of chronic under-immunosuppression. It is not known whether steroid withdrawal increases the risk of subclinical immune responses against the graft. This retrospective single-center study aimed to assess the risk of subclinical graft damage after steroid withdrawal within the first nine months after orthotopic liver transplantation in the first three years after transplantation in a prospective cohort of surveillance biopsies using a propensity score matching analysis. Of 355 patients, 109 patients underwent surveillance biopsies between eleven and 36 months after liver transplantation. Thirty-seven patients discontinue steroids within the first nine months and 72 later than nine months after transplantation. The matching led to 28 patients per group. Patients with autoimmune hepatitis, primary biliary cholangitis, and hepatocarcinoma were excluded by the propensity score matching unintentionally. Patients who discontinued steroids had a trend toward lower levels of immunosuppression at the time of surveillance biopsy. Steroid withdrawal in the first nine months was not associated with an increased risk of subclinical T cell-mediated rejection, graft inflammation, or liver graft fibrosis in the matched cohort with patients with a low frequency of autoimmune liver diseases. There were also no differences in the development of metabolic diseases. In conclusion, steroid withdrawal within the first nine months after transplantation, as assessed by surveillance biopsies, does not increase the risk of subclinical graft injuries or fibrosis at least in liver transplant recipient without or a low prevalence of autoimmune liver diseases
Cognitive-behavioral and dietary weight loss intervention in adult kidney transplant recipients with overweight and obesity: results of a pilot RCT study (Adi-KTx)
Get PDFThe obesity epidemic and its health consequences have not spared the population of kidney transplant (KTx) candidates and recipients. In addition, KTx recipients are susceptible to weight gain after transplantation. Overweight and obesity after KTx are strongly associated with adverse outcomes. Therefore, we designed a randomized controlled, mono-center study to specifically test the effectiveness of a primarily cognitive-behavioral approach supplemented by nutritional counseling for weight reduction following KTx as the intervention group (IG) in comparison to a brief self-guided intervention as control group (CG). The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00017226). Fifty-six KTx patients with a BMI from 27 to 40 kg/m2 were included in this study and randomized to the IG or CG. Main outcome was the number of participants achieving a 5% weight loss during the treatment phase. Additionally, participants were assessed 6 and 12 months after the end of the 6-month treatment phase. Participants significantly lost weight without group differences. 32.0% (n = 8) of the patients in the IG and 16.7% (n = 4) of the patients in the CG achieved a weight loss of 5% or more. Weight loss was largely maintained during follow-up. Retention and acceptance rate in the IG was high, with 25 (out of 28) patients completing all 12 sessions and one patient completing 11 sessions. Short-term, cognitive-behaviorally oriented weight loss treatment seems to be feasible and acceptable for patients after KTx who suffer from overweight or obesity. This clinical trial was ongoing at the onset of the COVID-19 pandemic which might have influenced study conduct and results. Clinical Trial Registration: https://clinicaltrials.gov/ DRKS-ID: DRKS00017226
A holistic approach to maximise diagnostic output in trio exome sequencing.
Get PDFIntroduction Rare genetic diseases are a major cause for severe illness in children. Whole exome sequencing (WES) is a powerful tool for identifying genetic causes of rare diseases. For a better and faster assessment of the vast number of variants that are identified in the index patient in WES, parental sequencing can be applied ("trio WES"). Methods We assessed the diagnostic rate of routine trio WES including analysis of copy number variants in 224 pediatric patients during an evaluation period of three years. Results Trio WES provided a diagnosis in 67 (30%) of all 224 analysed children. The turnaround time of trio WES analysis has been reduced significantly from 41 days in 2019 to 23 days in 2021. Copy number variants could be identified to be causative in 10 cases (4.5%), underlying the importance of copy number variant analysis. Variants in three genes which were previously not associated with a clinical condition (GAD1, TMEM222 and ZNFX1) were identified using the matching tool GeneMatcher and were part of the first description of a new syndrome. Discussion Trio WES has proven to have a high diagnostic yield and to shorten the process of identifying the correct diagnosis in paediatric patients. Re-evaluation of all 224 trio WES 1-3 years after initial analysis did not establish new diagnoses. Initiating (trio) WES as a first-tier diagnostics including copy number variant detection should be considered as early as possible, especially for children treated in ICU, if a monogenetic disease is suspected
Postoperative dumping syndrome, health-related quality of life and eating disturbances: results of a longitudinal obesity surgery study
No full textDas Datenfile enthält im spss-Format Daten aus einer Untersuchung mit 220 Personen vor (t0) und 6 Monate nach (t1) Adipositaschirurgie. Ziel der Längsschnittstudie war es, potentielle Zusammenhänge zwischen Dumpingsyndrom nach chirurgischer Adipositasbehandlung und psychosozialen Variablen zu untersuchen. Der Datensatz beinhaltet Angaben zum postoperativen Dumpingsyndrom, die nach erfolgter Operation mit dem Sigstad Dumping Score erfasst wurden. Neben demographischen Angaben, Body Mass Index (BMI) und Nennung des jeweiligen chirurgischen Zentrums beantworteten die Teilnehmer:innen zu beiden Messzeitpunkten standardisierte Fragebögen zur gesundheitsbezogenen Lebensqualität (Health-related Quality of Life, HRQoL: SF-12), essstörungsbezogenen Symptomen (EDE-Q) und suchtartigem Essverhalten (YFAS 2.0). Die Daten wurden zwischen Dezember 2019 und Juni 2022 an den Standorten Hannover (Medizinische Hochschule Hannover, KRH Klinikum Nordstadt, DRK Clementinenhaus Hannover), München (Dr. Lubos Kliniken Bogenhausen), Gräfeling (AMC-WolfartKlinik) und Braunschweig (Herzogin Elisabeth Hospital) erhoben