Entwicklung und Evaluation des Selbstsicherheitstrainings für Studierende der Medizin. Eine randomisierte kontrollierte Interventionsstudie.

Diese Dissertation evaluiert ein Selbstsicherheitstrainingsprogramm („SST“) für Medizinstudenten an der Philipps Universität in Marburg („UMR“). Neueste Studien haben gezeigt, dass ein Training von Selbstsicherheit und Empathie mittels Videofeedback und Rollenspielen die soziale Intelligenz fördert und es zu einer gesteigerten Sensibilisierung gegenüber Mitmenschen kommt. Das Ergebnis der Studie, welche ein theoretisches Seminar (“TS”), gefolgt von einem SST beinhaltet, wurde zu 3 unterschiedlichen Zeitpunkten untersucht: vor und nach einem TS, sowie nach einem SST. Das SST beinhaltete ein Training in Kleingruppen (12-18) von verschiedenen zielführenden Verhaltensstrategien mittels kooperativem, gehemmtem, gehemmt-aggressivem und aggressivem Verhalten. Ziel war es, die Empathie und die Sensibilität im Umgang mit Patienten zu fördern. Die vorliegende Studie wendete für eine standardisierte videobasierte Verhaltensbeobachtung während eines 8-minütigen Patienten-Simulationsgespräches (als Teil des UMR Lehrplans von 2012-2014) einen Kodierleitfaden an, welcher verbale, nonverbale, zielführende, nicht-zielführende, empathische und pathische Aspekte beinhaltet. 343 Studenten erhielten das SST, einen vorliegenden Fragebogen nach dem TS füllten jedoch nur 225 Teilnehmer aus. Basierend auf diesen standardisierten Fragebögen konnte die Gruppe in 4 Cluster (empathisch, ängstlich, emotional unreif, psychopathisch auffällig) unterteilt werden, auch wenn alle Teilnehmer zuvor das gleiche Training erhielten. Die Analyse zeigte, dass kooperatives Verhalten vor allem unter den empathischen Studierenden signifikant anstieg. Ängstliche und emotional unreife Studierende steigerten im Patienten-Simulationsgespräch sowohl ihr zielführendes (insbesondere nach Durchlaufen der Kombination SST und TS) verbales und nonverbales Verhalten, als auch empathisches Verhalten. Im Kontrast zur Gruppe der empatischen Studierenden, wendeten die Studierenden mit psychopathischen Auffälligkeiten in dem durchgeführten Gespräch insgesamt vermehrt nicht-zielführende Kriterien (P < 0,02) und psychopathische Strategien an. Im Rahmen des Studiums der Humanmedizin half das SST also Empathie zu fördern und Hemmungen zu überwinden. Hieraus folgend können zwei Empfehlungen gegeben werden. Als erstes sollte das SST zur Aufrechterhaltung der Empathie während des gesamten Studiums der Humanmedizin semesterübergreifend regelmäßig durchgeführt werden (einige internationale Studien zeigten ein Abfallen der Empathie während der Studienlaufzeit). Zweitens basiert die Auswahl zur Aufnahme für ein Medizinstudium vorrangig auf Leistungen und Testung des Wissens, obwohl grundsätzlich eine fürsorgliche Rolle im dem Berufsbild tragend ist. Das SST zeigte den geringsten Effekt bei Studierenden mit psychopathischen Auffälligkeiten. Zudem konnte dargelegt werden, dass empathisches Verhalten durch eine strukturierte, halbstandardisierten Verhaltensbeobachtung messbar ist. Dies könnte nun als Kriterium für die Aufnahme eines Medizinstudiums angewendet werden. Ein SST, basierend auf der hier angewendeten Methode scheint nötig zu sein, um junge Ärzte in ihrer emotionalen Kompetenz zu fördern, schwierige zwischenmenschliche Situationen zu meistern, den hohen Ansprüchen gerecht zu werden, sowie der täglichen Belastung im medizinischen Alltag Stand zu halten. Abschließend ist anzunehmen, dass eine hohe emotionale Kompetenz eine höhere Patientenzufriedenheit- und Compliance erwarten lassen. Zudem sind eine gesteigerte persönliche Zufriedenheit, effizienteres Arbeiten im klinischen Alltag, sowie eine verbesserte medizinische Versorgung und auch sinkende Gesundheitskosten zu erwarten. Empathie kann trainiert werden. Als Nebeneffekt können die durch das SST erlernten Skills zur Analyse und Optimierung zwischenmenschlicher Interaktionen genutzt werden. Auch wenn die Methode zeitintensiv ist und Training in Kleingruppen erfordert, so ist sie nötig, um ein hohes Maß an Empathie bei Ärzten zu trainieren und bewirkt als selbstbeschützendes Tool eine Minimierung von Burn-out im ärztlichen Beruf. Die UMR’s SST Methode und der Lehrplan sollten in weiteren Studien durch eine mögliche Analyse der Stimmfrequenz und Analysen emotionaler Gesichtsausdrücke, sowie durch weitere Optimierung des angewandten Trainings zukunftsperspektivisch ergänzt werden

A Common HLA-DPA1 Variant Is Associated with Hepatitis B Virus Infection but Fails to Distinguish Active from Inactive Caucasian Carriers

Background and Aims: Chronic infection with the hepatitis B virus (HBV) is a major health issue worldwide. Recently, single nucleotide polymorphisms (SNPs) within the human leukocyte antigen (HLA)-DP locus were identified to be associated with HBV infection in Asian populations. Most significant associations were observed for the A alleles of HLA-DPA1 rs3077 and HLA-DPB1 rs9277535, which conferred a decreased risk for HBV infection. We assessed the implications of these variants for HBV infection in Caucasians. Methods: Two HLA-DP gene variants (rs3077 and rs9277535) were analyzed for associations with persistent HBV infection and with different clinical outcomes, i.e., inactive HBsAg carrier status versus progressive chronic HBV (CHB) infection in Caucasian patients (n = 201) and HBsAg negative controls (n = 235). Results: The HLA-DPA1 rs3077 C allele was significantly associated with HBV infection (odds ratio, OR = 5.1, 95% confidence interval, CI: 1.9–13.7; p = 0.00093). However, no significant association was seen for rs3077 with progressive CHB infection versus inactive HBsAg carrier status (OR = 2.7, 95% CI: 0.6–11.1; p = 0.31). In contrast, HLA-DPB1 rs9277535 was not associated with HBV infection in Caucasians (OR = 0.8, 95% CI: 0.4–1.9; p = 1). Conclusions: A highly significant association of HLA-DPA1 rs3077 with HBV infection was observed in Caucasians. However, as a differentiation between different clinical courses of HBV infection was not possible, knowledge of the HLA-DPA1 genotype cannot be translated into personalized anti-HBV therapy approaches

High prevalence of anti-HCV antibodies in two metropolitan emergency departments in Germany : a prospective screening analysis of 28,809 patients

Background and Aims: The prevalence of hepatitis C virus (HCV) antibodies in Germany has been estimated to be in the range of 0.4–0.63%. Screening for HCV is recommended in patients with elevated ALT levels or significant risk factors for HCV transmission only. However, 15–30% of patients report no risk factors and ALT levels can be normal in up to 20–30% of patients with chronic HCV infection. The aim of this study was to assess the HCV seroprevalence in patients visiting two tertiary care emergency departments in Berlin and Frankfurt, respectively. Methods: Between May 2008 and March 2010, a total of 28,809 consecutive patients were screened for the presence of anti-HCV antibodies. Anti-HCV positive sera were subsequently tested for HCV-RNA. Results: The overall HCV seroprevalence was 2.6% (95% CI: 2.4–2.8; 2.4% in Berlin and 3.5% in Frankfurt). HCV-RNA was detectable in 68% of anti-HCV positive cases. Thus, the prevalence of chronic HCV infection in the overall study population was 1.6% (95% CI 1.5–1.8). The most commonly reported risk factor was former/current injection drug use (IDU; 31.2%) and those with IDU as the main risk factor were significantly younger than patients without IDU (p<0.001) and the male-to-female ratio was 72% (121 vs. 46 patients; p<0.001). Finally, 18.8% of contacted HCV-RNA positive patients had not been diagnosed previously. Conclusions: The HCV seroprevalence was more than four times higher compared to current estimates and almost one fifth of contacted HCV-RNA positive patients had not been diagnosed previously

Infection with and carriage of Mycoplasma pneumoniae in children

"Atypical" pneumonia was described as a distinct and mild form of community-acquired pneumonia (CAP) already before Mycoplasma pneumoniae had been discovered and recognized as its cause. M. pneumoniae is detected in CAP patients most frequently among school-aged children from 5 to 15 years of age, with a decline after adolescence and tapering off in adulthood. Detection rates by polymerase chain reaction (PCR) or serology in children with CAP admitted to the hospital amount 4-39%. Although the infection is generally mild and self-limiting, patients of every age can develo

Improving mobility performance in wheelchair basketball

Objective: This study aimed to investigate which characteristics of athlete, wheelchair and athlete-wheelchair interface are the best predictors of wheelchair basketball mobility performance. Design: A total of 60 experienced wheelchair basketball players performed a wheelchair mobility performance test to assess their mobility performance. To determine which variables were the best predictors of mobility performance, forward stepwise linear regression analyses were performed on a set of 33 characteristics, including 10 athlete, 19 wheelchair, and 4 athlete-wheelchair interface characteristics. Results: A total of 8 of the characteristics turned out to be significant predictors of wheelchair basketball mobility performance. Classification, experience, maximal isometric force, wheel axis height, and hand rim diameter-which both are interchangeable with each other and wheel diameter-camber angle, and the vertical distance between shoulder and rear wheel axis-which was interchangeable with seat height-were positively associated with mobility performance. The vertical distance between the front seat and the footrest was negatively associated with mobility performance. Conclusion: With this insight, coaches and biomechanical specialists are provided with statistical findings to determine which characteristics they could focus on best to improve mobility performance. Six out of 8 predictors are modifiable and can be optimized to improve mobility performance. These adjustments could be carried out both in training (maximal isometric force) and in wheelchair configurations (eg, camber angle)

Circulating Antibody-Secreting Cell Response During Mycoplasma pneumoniae Childhood Pneumonia

Background. We recently demonstrated that the measurement of Mycoplasma pneumoniae (Mp)-specific immunoglobulin (Ig) M antibody-secreting cells (ASCs) improved diagnosis o

Aufträge zur Vorbereitung für den 2. Klausurtag

Aufträge für Lehrkräfte bis zum nächsten Klausurtag (Evaluation und Vorbereitung)

Surveillance of SARS-CoV-2 in Frankfurt am Main from October to December 2020 Reveals High Viral Diversity Including Spike Mutation N501Y in B.1.1.70 and B.1.1.7.

BACKGROUND: International travel is a major driver of the introduction and spread of SARS-CoV-2. AIM: To investigate SARS-CoV-2 genetic diversity in the region of a major transport hub in Germany, we characterized the viral sequence diversity of the SARS-CoV-2 variants circulating in Frankfurt am Main, the city with the largest airport in Germany, from the end of October to the end of December 2020. METHODS: In total, we recovered 136 SARS-CoV-2 genomes from nasopharyngeal swab samples. We isolated 104 isolates that were grown in cell culture and RNA from the recovered viruses and subjected them to full-genome sequence analysis. In addition, 32 nasopharyngeal swab samples were directly sequenced. RESULTS AND CONCLUSION: We found 28 different lineages of SARS-CoV-2 circulating during the study period, including the variant of concern B.1.1.7 (Δ69/70, N501Y). Six of the lineages had not previously been observed in Germany. We detected the spike protein (S) deletion Δ69/Δ70 in 15% of all sequences, a four base pair (bp) deletion (in 2.9% of sequences) and a single bp deletion (in 0.7% of sequences) in ORF3a, leading to ORF3a truncations. In four sequences (2.9%), an amino acid deletion at position 210 in S was identified. In a single sample (0.7%), both a 9 bp deletion in ORF1ab and a 7 bp deletion in ORF7a were identified. One sequence in lineage B.1.1.70 had an N501Y substitution while lacking the Δ69/70 in S. The high diversity of sequences observed over two months in Frankfurt am Main highlights the persisting need for continuous SARS-CoV-2 surveillance using full-genome sequencing, particularly in cities with international airport connections

Carriage of Mycoplasma pneumoniae in the Upper Respiratory Tract of Symptomatic and Asymptomatic Children: An Observational Study

Background:Mycoplasma pneumoniae is thought to be a common cause of respiratory tract infections (RTIs) in children. The diagnosis of M. pneumoniae RTIs currently relies on serological methods and/or the detection of bacterial DNA in the upper respiratory tract (URT). It is conceivable, however, that these diagnostic methods also yield positive results if M. pneumoniae is carried asymptomatically in the URT. Positive results from these tests may therefore not always be indicative of a symptomatic infection. The existence of asymptomatic carriage of M. pneumoniae has not been established. We hypothesized that asymptomatic carriage in children exists and investigated whether colonization and symptomatic infection could be differentiated by current diagnostic methods.Methods and Findings:This study was conducted at the Erasmus MC-Sophia Children's Hospital and the after-hours General Practitioners Cooperative in Rotterdam, The Netherlands. Asymptomatic children (n = 405) and children with RTI symptoms (n = 321) aged 3 mo to 16 y were enrolled in a cross-sectional study from July 1, 2008, to November 30, 2011. Clinical data, pharyngeal and nasopharyngeal specimens, and serum samples were collected. The primary objective was to differentiate between colonization and symptomatic infection with M. pneumoniae by current diagnostic methods, especially real-time PCR. M. pneumoniae DNA was detected in 21.2% (95% CI 17.2%-25.2%) of the asymptomatic children and in 16.2% (95% CI 12.2%-20.2%) of the symptomatic children (p = 0.11). Neither serology nor quantitative PCR nor culture differentiated asymptomatic carriage from infection. A total of 202 children were tested for the presence of other bacterial and viral pathogens. Two or more pathogens were found in 56% (63/112) of the asymptomatic children and in 55.5% (50/90) of the symptomatic children. Finally, longitudinal sampling showed persistence of M. pneumoniae in the URT for up to 4 mo. Fifteen of the 21 asymptomatic children with M. pneumoniae and 19 of the 22 symptomatic children with M. pneumoniae in this longitudinal follow-up tested negative after 1 mo.Conclusions:Although our study has limitations, such as a single study sit

RNA reference materials with defined viral RNA loads of SARS-CoV-2—A useful tool towards a better PCR assay harmonization

SARS-CoV-2, the cause of COVID-19, requires reliable diagnostic methods to track the circulation of this virus. Following the development of RT-qPCR methods to meet this diagnostic need in January 2020, it became clear from interlaboratory studies that the reported Ct values obtained for the different laboratories showed high variability. Despite this the Ct values were explored as a quantitative cut off to aid clinical decisions based on viral load. Consequently, there was a need to introduce standards to support estimation of SARS-CoV-2 viral load in diagnostic specimens. In a collaborative study, INSTAND established two reference materials (RMs) containing heat-inactivated SARS-CoV-2 with SARS-CoV-2 RNA loads of ~107 copies/mL (RM 1) and ~106 copies/mL (RM 2), respectively. Quantification was performed by RT-qPCR using synthetic SARS-CoV-2 RNA standards and digital PCR. Between November 2020 and February 2021, German laboratories were invited to use the two RMs to anchor their Ct values measured in routine diagnostic specimens, with the Ct values of the two RMs. A total of 305 laboratories in Germany were supplied with RM 1 and RM 2. The laboratories were requested to report their measured Ct values together with details on the PCR method they used to INSTAND. This resultant 1,109 data sets were differentiated by test system and targeted gene region. Our findings demonstrate that an indispensable prerequisite for linking Ct values to SARS-CoV-2 viral loads is that they are treated as being unique to an individual laboratory. For this reason, clinical guidance based on viral loads should not cite Ct values. The RMs described were a suitable tool to determine the specific laboratory Ct for a given viral load. Furthermore, as Ct values can also vary between runs when using the same instrument, such RMs could be used as run controls to ensure reproducibility of the quantitative measurements.Peer Reviewe