Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: a prospective study

Background: As a non-invasive and readily available diagnostic tool, ultrasound is one of the most important imaging techniques in medicine. Ultrasound is usually trained during residency preferable according to German Society of Ultrasound in Medicine (DEGUM) standards. Our curriculum calls for undergraduate training in ultrasound of medical students in their 4th year of undergraduate education. An explorative pilot study evaluated the acceptance of this teaching method, and compared it to other practical activities in medical education at Muenster University. Methods: 240 medical students in their 4th year of undergraduate medical education participated in the training and completed a pre- and post-questionnaire for self-assessment of technical knowledge, self-assurance of the procedure, and motivation in performing ultrasound using a Likert scale. Moreover, students were asked about their interest in pursuing a career in internal medicine. To compare this training to other educational activities a standardized online evaluation tool was used. A direct observation of procedural skills assessment (DOPS) for the first time applied on ultrasound aimed to independently assess the success of our teaching method. Results: There was a significant increase in technical knowledge and self-assurance (p < 0.001) of the students’ self-assessments. The clinical relevance and self-motivation of the teaching were evaluated positively. The students’ DOPS results demonstrated proficiency in the understanding of anatomic structures shown in ultrasonographic images, including terminology, machine settings, and transducer frequencies. Conclusions: Training ultrasound according to certified DEGUM standards was successful and should be offered in undergraduate medical education. The evaluation of the course affirmed the necessity, quality and clinical relevance of the course with a top ranking score of hands-on training courses within the educational activities of the Medical Faculty of Muenster.<br

Critical evaluation of current concepts in exposure assessment

Abstract The exploitation of natural resources and the improper use and disposal of thousands of chemicals have resulted in environmental pollution and a potential threat to human health on a global scale. Increasing public concern about environmental exposure to and consequent ill health from contaminants demands informed answers based on valid risk assessment. By assessing internal exposure to pollutants, human biomonitoring focuses on early markers of potential risks to prevent serious adverse effects. Exposure assessment may provide a rational basis for risk assessment, with knowledge of the adequacy of limit values; it may also uncover long-term changes in body burdens and thus help identify the sources and transfer pathways of environmental pollutants. The techniques of biological exposure assessment should be incorporated into epidemiological studies if suitable specimens are available, such as exhaled air, blood, urine, breast milk, or adipose or keratinous tissue. Special precautions must be taken in sampling, storage, and analysis if the findings are to be interpreted correctly and reliable conclusions drawn.</jats:p

Bindung von Pharmaka an künstliche Plasmaersatzmittel

Die Bindung von Pharmaka an Plasmaproteine ist gut untersucht und die therapeutische Bedeutung dokumentiert. Auch die Bindung von Pharmaka an Dialysemembranen und Infusionssysteme ist beschrieben, während wenig über die Bindung an künstliche Kolloide (Plasma-expander) bekannt ist. Da Plasmaexpander eine breite Anwendung erfahren, sollte das Bindungsverhalten von Pharmaka an diese Makromoleküle mittels der Gleichgewichtsdialyse untersucht werden. Benzodiazepine, β-Blocker, Herzglykoside, Lokalanästhetika, nicht-steroidale Antirheumatika, Glibenclamid, Phenobarbital und Phenprocoumon wurden eingesetzt in einer Konzentration von 1 × 10&lt;sup&gt;––7&lt;/sup&gt; mol/l in Tris-Puffer und die Bindung an 1:5 mit Tris-HCl-Puffer verdünnte handelsübliche Plasmaersatzmittel ermittelt, die als Makromoleküle Hydroxyäthylstärke (HAS), Dextran, Gelatine und Polyvinylpyrrolidon (PVP) enthalten. Die Pharmakonbindung an Plasmaersatzmittel war in alien Fallen geringer als an Plasmaproteine. Die höchste Bindung wurde für Penbutolol mit Oxypolygelatine (43%), Digitoxin und HAS 200 (36%) sowie Phenprocoumon und PVP (43%) gefunden. Die Bindung von Pharmaka an künstliche Kolloide ist in den meisten Fallen gering und ohne klinische Bedeutung. Im Rahmen von Perfusionsexperimenten an isolierten Organen sollte eine mögliche Bindung der untersuchten Pharmaka an künstliche Kolloide jedoch berücksichtigt werden.</jats:p