Three different ways of training ultrasound student-tutors yield significant gains in tutee’s scanning-skills

Aim: Many medical universities rely these days on trained student tutors to enable faculty-wide undergraduate ultrasound training. However, there is neither consensus on an optimal method nor any developed and agreed standard in the training of these student tutors. Usually internships and courses are employed which have both a specific set of advantages and disadvantages. We conducted a prospective quasi-randomized study of assess the effects of three types of tutor training on the resulting improvement in scanning skills of their tutees.Methods: Three batches of student tutors were trained by a course only (C-group), by an internship only (I-group) or by a course and an internship (CI-group). The respective gains in ultrasound scanning skills of the tutees were measured prospectively. A total 75 of the 124 5th year medical students (60.5%) who attended the mandatory ultrasound course completed both pre- and post-exams on a voluntary basis. Within a limit of eight minutes and three images, they were asked to depict and label a maximum of 14 anatomical structures. Two blinded raters independently awarded two points for each label with an identifiable structure and one point for each label with a possibly identifiable structure.Results: In all three groups, the tutees improved significantly by more than doubling their pre-score results and comparably (Gains: C-group 9.19±5.73 points, p<.0001, I-group 9.77±4.81 points, p<.0001, CI-group 8.97±5.49 points, p<.0001).Conclusion: Student tutors, who were trained with a course or an internship or a course and an internship could teach scanning skills to 5th year medical students very effectively and with similar success.Ziel: Viele medizinische Universitäten bieten heutzutage mit der Hilfe von ausgebildeten studentischen Tutoren eine fakultätsweite Ultraschall-Grundausbildung an. Es gibt jedoch weder einen Konsens über eine optimale Methode noch einen verbindlichen Standard für die Ausbildung dieser studentischen Tutoren. In der Regel werden zur Ausbildung Praktika und Kurse eingesetzt, die sowohl spezifische Vor- als auch Nachteile aufweisen.Wir führten eine prospektive, quasi-randomisierte Studie durch, um die Auswirkungen von drei Arten von Tutorentraining auf die daraus resultierende Verbesserung der Scanfähigkeiten ihrer Tutees zu bewerten.Methoden: Drei Gruppen studentischer Tutoren wurden nur durch einen Kurs (K-Gruppe), nur durch eine Famulatur (F-Gruppe) oder durch einen Kurs und eine Famulatur (KF-Gruppe) geschult. Die jeweiligen Zuwächse an Scanfähigkeiten der Tutees wurden prospektiv gemessen. 75 der 124 Medizinstudenten im fünften Studienjahr (60,5%), die den curricularen Ultraschallkurs besuchten, haben sowohl den Vor- als auch den Nachtest auf freiwilliger Basis absolviert. Innerhalb von acht Minuten sollten maximal 14 anatomische Strukturen in drei Bildern dargestellt und beschriftet werden. Zwei verblindete Bewerter vergaben unabhängig voneinander zwei Punkte für jede sicher identifizierbare Struktur und einen Punkt für jede möglicherweise identifizierbare Struktur.Ergebnisse: In allen drei Gruppen verbesserten sich die Tutees signifikant, indem sie ihre Ergebnisse von vor dem Unterricht mehr als verdoppelten (Zuwachs: K-Gruppe 9,19±5,73 Punkte, p<0,0001; F-Gruppe 9,77±4,81 Punkte, p<0,0001; KF-Gruppe 8,97±5,49 Punkte, p<0,0001).Fazit: Studentische Tutoren, die mit einem Kurs oder einer Famulatur oder einem Kurs und einer Famulatur geschult wurden, konnten Medizinstudenten im 5. Jahr sehr effektiv und mit vergleichbarem Erfolg Scanfähigkeiten vermitteln

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Progress in colonoscope reprocessing in physician’s offices due to quality assurance

Flexible endoscopes are complex medical devices and difficult to clean and to disinfect. Following case reports on infection transmission in endoscopy the potential risk of infection transmission was critically discussed in the past questioning the appropriateness of reprocessing practices used at that time. In a historical perspective of the last 20 years different phases were characterized, which retrospectively correspond to the plan-do-check-act- phases of a national quality management program to improve endoscope reprocessing in the physician's offices. The HYGEA-Study reveals questionable results in about 50 % of microbiological surveillance cultures of reprocessed endoscopes. Before introducing a national screening program for colon cancer by colonoscopy in 2002 agreement for a quality assurance assessment was achieved with subsequent establishment of a nationwide quality assurance system. Thereby, the reprocessing quality improved considerably and questionable results of microbiological surveillance cultures drops down nationwide to 5 %. In analogy to the quality assurance assessment for colonoscope reprocessing similar quality assurance assessments for all other endoscopic examinations should be established. The private health assurances should support this quality assurance system

Single-center study: evaluation of sonography in Budd-Chiari syndrome.

PURPOSE Budd-Chiari syndrome (BCS) is a rare disease characterized by hepatic venous outflow tract obstruction. The study aimed to evaluate the diagnostic utility of ultrasound in confirming the diagnosis of BCS and to provide an overview of the clinical picture. MATERIALS AND METHOD In this retrospective single-center study, patients with an initial diagnosis of BCS were included. The files were analyzed concerning the ultrasound images and compared to computed tomography (CT) and magnetic resonance imaging (MRI). Main clinical signs of BCS were collected. RESULTS Data of 25 patients were analyzed. Doppler sonography showed the highest sensitivity (78.9%) with the highest specificity 97.4 (%) in confirming the correct diagnosis of BCS. Main imaging signs were obstruction in the hepatic veins (68.0%, 17/25 thrombotic), collaterals (91.7%, 11/12 intrahepatic), inhomogeneous liver parenchyma (7/21), and a hypertrophied lobus caudatus (18/21) (p < 0.01). All imaging signs could be detected with sonography. Hypertrophied lobus caudatus was seen exclusively in BCS. Furthermore, portal hypertension (9/25), liver cirrhosis (9/25), and ascites (19/25) can be diagnosed as non-specific signs of BCS (p < 0.01).The main clinical findings were elevated γ-GT levels in the laboratory (92.0%, 23/25, p < 0.01) and esophageal varices in endoscopy (12/25 p < 0.01). An association with myeloproliferative neoplasia (MPN) was frequently seen (10/25) (p < 0.01). CONCLUSION The present study demonstrates that sonography is an appropriate tool for the diagnosis of BCS and should be used as the first imaging procedure

Reproducibility evaluation of palpation of anatomical landmarks for estimation of the patient location

This study is about estimating the reproducibility of finding palpation points of three different anatomical landmarks in the human body (Xiphoid Process and the 2 Hip Crests) to support a navigated ultrasound application. On 6 test subjects with different body mass index the three palpation points were located five times by two examiners. The deviation from the target position was calculated and correlated to the fat thickness above each palpation point. The reproducibility of the measurements had a mean error of ≈13.5 mm +- 4 mm, which seems to be sufficient for the desired application field