Entwicklung und Kartierung lernerzentrierter, kompetenzbasierter medizinischer Curricula unter Berücksichtigung erforderlicher Ressourcen

Einleitung: Gemeinsames Ziel der hier vorgestellten Arbeiten war die Entwicklung, online-Implementierung und Evaluierung einer international, interprofessionell und interdisziplinär einsetzbaren Curriculumskarte, welche verschiedene Empfehlungen bzgl. der kompetenzbasierten, medizinischen Ausbildung synthetisiert und Widersprüche zwischen diesen auflöst. Gleichzeitig sollten kritische Punkte bei der Entwicklung kompetenzbasierter, lernerzentrierter Curricula identifiziert und Konzepte zur Lösung dieser Probleme erarbeitet und evaluiert werden. Inhaltliche und organisatorische Aspekte der Curriculumsentwicklung und -kartierung sollten dabei gleichberechtigt nebeneinander stehen, damit die ordnungsgemäße Umsetzung der geplanten Curricula weder die Forschung noch die Krankenversorgung beeinträchtigt. Methoden: Auf Basis eines studentischen Needs-Assessments wurde die Curriculumskarte konzipiert und gleichzeitig eine Webplattform („LOOOP“) entwickelt, mit deren Hilfe diese Karte abgebildet werden konnte. Anschließend wurde die Karte schrittweise in LOOOP implementiert und die Auswirkungen auf Unterrichtsqualität und Prüfungsleistungen sowie das Nutzerverhalten evaluiert. Parallel zu dieser Implementierung wurde zur Unterstützung des selbstbestimmten Lernens ein computerbasierter Test zur Messung der medizinischen Entscheidungskompetenz („ASCLIRE“) entwickelt und evaluiert, um den Studierenden ein Feedback zu dieser Schlüsselkompetenz der medizinischen Ausbildung geben zu können. Zur semantischen Navigation durch das Curriculum wurde im Rahmen einer systematischen Literaturrecherche die am besten geeignete Ontologie identifiziert. Im Vorfeld der Einführung des nationalen, kompetenzbasierten Lernzielkatalogs Medizin (NKLM) wurde das studentische Peer-Teaching-Programm der Charité gegen ein nationales Rahmenwerk kartiert und dabei der Prozess der Kartierung analysiert. Zur Sicherstellung der Verfügbarkeit geeigneter Patientinnen und Patienten für den klinischen Unterricht wurde ein Algorithmus entwickelt und evaluiert, der mit Hilfe der im Krankenhausinformationssystem hinterlegten Patientendiagnosen den Unterricht am Krankenbett bestmöglich zwischen geeigneten Kliniken verteilt. Um den Studierenden den optimalen Kompetenzerwerb auf dem Gebiet der klinischer Untersuchungstechniken bei gleichzeitiger Entlastung der Kliniken, Patientinnen und Patienten zu ermöglichen, wurden am Beispiel der Untersuchung der weiblichen Brust verschiedene, patientenferne Unterrichtsmethoden zum Erwerb klinischer Handlungskompetenz verglichen. Ergebnisse und Schlussfolgerungen: Die entwickelte Curriculumskarte bildet alle von verschiedenen Autoren empfohlenen Aspekte ab und setzt diese in Bezug zueinander. Der Einsatz führte zu einer von den Studierenden empfundenen signifikanten Verbesserung der Unterrichtsqualität sowie zu verbesserten Prüfungsleistungen. Der Nutzungsgrad des zugehörigen Webinterfaces LOOOP ist sehr hoch mit Steigerungsraten um 100% pro Jahr. Zwei Dozierendenbefragungen an der Charité und an einer unserer Partneruniversitäten ermittelten bzgl. aller Aspekte der Karte positive Einschätzungen. Der ASCLIRE-Test wurde ebenfalls positiv evaluiert: Die Teststruktur ergab im Strukturgleichungsmodell eine hohe Anpassungsgüte und verschiedene Aspekte der Entscheidungskompetenz wurden als teilweise voneinander unabhängige Parameter identifiziert. Die Medical Subject Headings wurden als die am besten geeignete Ontologie identifiziert und nach Anpassungen an die Bedürfnisse der studentischen Ausbildung an allen internationalen Partner-Fakultäten in LOOOP implementiert. Die exemplarische Kartierung eines studentischen Peer-Teaching Curriculums gegen eine Teilmenge des NKLM zeigte unter anderem eine geringe Interrater-Reliabilität im Rahmen der subjektiven Kartierung, so dass wir begonnen haben, im Sinne des Web 3.0 unterstützende Algorithmen für die Kartierung in LOOOP zu implementieren. Der entwickelte Algorithmus zur Optimierung der Patientenverfügbarkeit konnte ca. 70% der ermittelten Probleme lösen und wurde ebenfalls unterstützend in LOOOP integriert. Am Beispiel schambesetzter Untersuchungen konnten wir zeigen, dass das Erlernen an einer Simulationspatientin zu signifikant besseren Prüfungsergebnissen verglichen mit dem Erlernen am Modell führte

Adhesion molecules in different treatments of acute myocardial infarction

BACKGROUND: Tissue damage after ischemia and reperfusion involves leukocyte endothelial interactions mediated by cell adhesion molecules. This study was designed to determine the time course of soluble adhesion molecules in patients with acute myocardial infarction after attempted reperfusion by thrombolysis with tissue plasminogen activator (tPA) or streptokinase (SK), or percutaneous transluminal coronary angioplasty (PTCA). METHODS: In 3 × 10 randomly selected patients with acute myocardial infarction undergoing thrombolysis with tPA or SK, or treated with PTCA, plasma concentrations of soluble L-selectin, P-selectin, E-selectin, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and platelet endothelial cell adhesion molecule-1 (PECAM-1) were measured by enzyme-linked immunosorbent assay, 30 min and 1, 2, 4, 8, 12 and 24 hours after intervention. RESULTS: After thrombolysis with tPA, soluble L-selectin concentrations were persistently depressed and soluble PECAM-1 concentrations were elevated, compared with controls, SK and PTCA. While soluble VCAM-1 concentrations did not differ within the first hours after interventions between the three groups, soluble VCAM-1 rose by 24 hours after tPA thrombolysis but did not increase after SK and PTCA treatment. Soluble ICAM-1 concentrations were consistently elevated after PTCA compared with controls and thrombolysed patients. Soluble E-selectin was depressed after tPA thrombolysis and PTCA in comparison with controls, while the SK group showed an increase throughout the observation period. Soluble P-selectin was increased after PTCA and SK lysis up to 8 hours after treatment compared with controls, but no significant differences could be found between treatment groups. CONCLUSION: Adhesion molecules mediating leukocyte endothelial interactions are altered subsequent to postischemic reperfusion and by treatment with thrombolytic agents and angioplasty. The clinical relevance of these biological changes remains to be determined

Use of IFNγ/IL10 Ratio for Stratification of Hydrocortisone Therapy in Patients With Septic Shock

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) (n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNγ/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNγ/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNγ and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNγ/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNγ/IL10 may become a suitable theranostic marker for an urging clinical need

Use of IFNγ/IL10 Ratio for Stratification of Hydrocortisone Therapy in Patients With Septic Shock

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) (n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNg/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNg/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNg and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNg/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNg/IL10 may become a suitable theranostic marker for an urging clinical need

Symposium 'methodology in medical education research' organised by the Methodology in Medical Education Research Committee of the German Society of Medical Education May, 25 to 26 2013 at Charité, Berlin

In 2013, the Methodology in Medical Education Research Committee ran a symposium on “Research in Medical Education” as part of its ongoing faculty development activities. The symposium aimed to introduce to participants educational research methods with a specific focus on research in medical education. Thirty-five participants were able to choose from workshops covering qualitative methods, quantitative methods and scientific writing throughout the one and a half days. The symposium’s evaluation showed participant satisfaction with the format as well as suggestions for future improvement. Consequently, the committee will offer the symposium again in a modified form in proximity to the next annual Congress of the German Society of Medical Education

Modular analytical multicomponent analysis in gas sensor aarrays

Abstract: A multi-sensor system is a chemical sensor system which quantitatively and qualitatively records gases with a combination of cross-sensitive gas sensor arrays and pattern recognition software. This paper addresses the issue of data analysis for identification of gases in a gas sensor array. We introduce a software tool for gas sensor array configuration and simulation. It concerns thereby about a modular software package for the acquisition of data of different sensors. A signal evaluation algorithm referred to as matrix method was used specifically for the software tool. This matrix method computes the gas concentrations from the signals of a sensor array. The software tool was used for the simulation of an array of five sensors to determine gas concentration of CH4, NH3, H2, CO and C2H5OH. The results of the present simulated sensor array indicate that the software tool is capable of the following: (a) identify a gas independently of its concentration; (b) estimate the concentration of the gas, even if the system was not previously exposed to this concentration; (c) tell when a gas concentration exceeds a certain value. A gas sensor data base was build for the configuration of the software. With the data base one can create, generate and manage scenarios and source files for the simulation. With the gas sensor dat