Designing a Massive Open Online Course (MOOC) in face-to-face sessions. A blended design to teach practical histology

Teaching histology, through virtual microscopy in educational strategies, undeniably moved towards the digitization and distancing of teaching. The setting up of the Massive Open Online Course (MOOC) entitled "Introduction to Histology: exploring the tissues of the human body" made it possible to exploit the potential to share digital resources with a wider audience while being integrated into the teaching on-campus students. This article described the pedagogical choices prevailing during the design of the MOOC and its combination with face-to-face sessions to achieve specific learning outcomes. The pedagogical alignment of learning outcomes described according to their cognitive levels, with online and face-to-face learning activities and evaluation methods has been demonstrated. The impact of such a blended design into an academic program has been ascertained using perception and performance data. Student satisfaction and engagement as well as motivational cues were identified. The level of performance was maintained in the educational strategy implemented and made it possible to achieve the objectives expected by the teachers. The benefits of integrating a MOOC with classroom-based teaching were highlighted, as well as barriers that could hinder the successful implementation.

[Psychological stressors, resources and well-being of surgeons in Germany : A cross-sectional study]

BACKGROUND

Psychological stress at work is associated with detrimental and health-impairing consequences for employees.

OBJECTIVE

In this study major stress factors and the resource job control at the workplace of surgeons and facets of mental health were examined and compared to benchmark results of a large reference sample.

METHOD

Data were collected by a representative online survey among surgeons throughout Germany who were contacted via the Professional Association of German Surgeons. In total 643 surgeons from different organizations and different disciplines completed the questionnaire that was developed using well-validated instruments.

RESULTS

Time pressure was the most meaningful stress factor for surgeons. Moreover, the results for medical assistants showed adverse stress combinations of high goal uncertainty and low job control as well as high emotional exhaustion and low job satisfaction. In addition, the results indicated that surgeons in single and group practices as well as in outpatient healthcare centers have less stressors and more job resources.

CONCLUSION

The survey results suggest high levels of burnout risk for German surgeons, especially among medical assistants and medical specialists from large hospitals. In order to maintain a high quality in the surgical disciplines, a concerted effort by all players in the healthcare system is necessary.

Clinical Relevance of Tumor Ploidy and Micronucleus Formation for Oral Cavity Cancer

Aims and Background

To study the clinical relevance of tumor ploidy and micronucleus formation as prognostic factors.

Methods and Study Design

Twenty-eight patients with squamous cell carcinoma of the oral cavity were treated with primary radiochemotherapy consisting of irradiation up to 70 Gy in combination with cisplatin. Cell cycle distribution, micronucleus formation and ploidy were evaluated by flow cytometry of biopsies taken before treatment and after irradiation to 10 Gy (5 × 2 Gy). Sexteen out of 28 patients relapsed after a minimum follow-up period of two years.

Results

Flow cytometry of the recurrence biopsy showed hyperpentaploid (5c exceeding) cells in 13/16 (81%) of the relapsed patients. In 7 patients the hyperploid clone was not present in the flow cytometry of the primary tumors. Ploidy could retrospectively be determined also by image cytometry in archival tumor material of the pretreatment specimens. Patients with a level below 100 5c cells per 10,000 cell nuclei were shown to have a significantly better prognosis than patients with more than 100 hyperpentaploid tumor cells. The micronucleus formation was 2-5 times higher in tumors showing a good response to treatment than in carcinomas relapsing within two years.

Conclusions

The 5c-exceeding ratio measured by image cytometry and micronucleus formation proved to be good prognostic parameters for the clinical outcome of patients with locally advanced head and neck carcinomas.

[Heterotopic pancreas in the gallbladder. Diagnosis, therapy, and course of a rare developmental anomaly of the pancreas]

Ectopic pancreas is a rare entity but the second most prevalent pancreatic anomaly. Heterotopic pancreas is defined as the presence of pancreatic tissue without any anatomic or vascular continuity with the main body of the pancreas. Its aetiology is not clearly established. In 1916, Poppi published for the first time evidence of heterotopic pancreas in the gallbladder. A review of the literature up to the present showed only 28 more cases worldwide of ectopic pancreas in the gallbladder. Aberrant pancreas is incidentally discovered in 2% of autopsies and has been estimated to occur once in every 500 upper abdominal explorations. Ninety per cent of ectopic pancreas is found in the stomach, duodenum, and jejunum. Mostly it is asymptomatic and benign. For this reason, therapy is indicated only in patients with symptoms such as pyloric obstruction, bleeding, and malignant transformation. Surgical resection or endoscopic mucosal resection as a newer method are recommended.

Macrophages in human visceral adipose tissue: increased accumulation in obesity and a source of resistin and visfatin

AIMS/HYPOTHESIS

Increased visceral white adipose tissue (WAT) is linked to the risk of developing diabetes.

METHODS/RESULTS

We showed by fluorescence activated cell sorting analysis that human visceral WAT contains macrophages, the proportion of which increased with obesity. Selective isolation of mature adipocytes and macrophages from human visceral WAT by CD14 immunoselection revealed that macrophages expressed higher levels of chemokines (monocyte chemotactic protein 1, macrophage inflammatory protein 1alpha, IL-8) and the adipokines resistin and visfatin than did mature adipocytes, as assessed by real-time PCR analysis. Moreover, resistin and visfatin proteins were found to be released predominantly by visceral WAT macrophages. Macrophage-derived secretory products stimulated phosphorylation of protein kinase B in human hepatocytes.

CONCLUSIONS/INTERPRETATION

Resistin and visfatin might be considered to be proinflammatory markers. The increased macrophage population in obese human visceral WAT might be responsible for the enhanced production of chemokines as well as resistin and visfatin.

Ad�quates Management von Stich- und Schussverletzungen

BACKGROUND

It is difficult to verify the treatment of stab and gunshot wounds with prospective randomized studies. That is why the results of observational studies are so important.

MATERIAL

From 1 January 1989 to 31 December 1998, we saw 74 patients because of stab (64) and gunshot (ten) wounds.

RESULTS

Most of the patients, whose injuries were caused mainly for criminal reasons (criminal 54, autoaggressive 14, accidental 4, unknown 2), came to hospital on weekends. We saw 38 abdominal, 23 thoracic, and 13 mixed injuries. On average, 3.8 h passed between the time of injury and getting first aid. Concerning abdominal injuries, we counted 21 negative intraoperative results. Two of 12 thoracic injuries showed no further damage. The patients stayed in hospital for 13.1 days on average. The morbidity was 28.38%, and mortality was 5.41%.

CONCLUSIONS

Abdominal gunshot wounds need immediate surgical treatment. Concerning stab wounds, obligatory as well as selective surgical methods are both acceptable. Because of valid diagnostic options, thoracic stab wounds allow several ways of treatment.

[Psoas abscess. Etiology and treatment]

Psoas abscess is in general a syndrome with low incidence. In the following, two cases are presented which describe the etiology, diagnosis, and treatment of primary and secondary retroperitoneal manifestations. The article mainly focuses on the different respective surgical procedures. Because of its rareness, an overview of further cases discussed in the literature is provided.

CT-based navigation systems for intraoperative radiotherapy using the afterloading-flab technique

INTRODUCTION

The fact that conventional intraoperative radiotherapy does not give the opportunity to exactly document the radiation volume applied and the dose distribution has been criticized in many ways. We would like to introduce a system for surgical navigation and documentation of flap positioning in intraoperative brachytherapy using the afterloading flap technique.

METHODS

Our system consists of an electromagnetic 3D-digitizer and a PC workstation. Spiral CT scans of the tumor region taken preoperatively are used for navigation and documentation of flap positioning, analogous to the procedure in neuronavigation. Registration is done via an external reference system which is attached to the iliac bone of the patient.

RESULTS

The mean accuracy of digitalization of the 100 spheres in a pelvis model is about 2.6 +/- 0.5 to 3.7 +/- 9.9 mm. The mean navigation accuracy is 2.4 +/- 0.8 to 3.3 +/- 0.8 mm. These figures correspond to the clinical experience of our surgeons.

DISCUSSION

The optimization of flab positioning by CT-guided navigation and the more accurate documentation of the dose volume and distribution in the patient is an important step on the way to improving the quality of individual radiation therapy. We are of the opinion that surgical navigation in the pelvic region should be subject to additional investigation in order to optimize the procedure.

Long-term effects on the intelligence of children treated for acute lymphoblastic leukemia

The purpose of this study was to investigate whether the intelligence quotient (IQ) in children treated for leukemia decreases in the years following whole brain irradiation. Twenty-seven leukemic children were assessed following a mean time lapse between radiotherapy and IQ measurement of 9 years. The IQ test used was the Hamburg Weschsler Intelligence Test for Adults. The IQ results did not differ significantly, p > 0.05, from the IQs of the general population. It was found that age and dose were not predictors of a decrease in IQ. The only predictor was time lapse between irradiation and IQ measurement, which we found to be indicative of an IQ decrease even after 9 years. Time lapse between irradiation is a useful predictor of IQ.

[Intraoperative radiotherapy--progress with a CT-assisted navigation system]

INTRODUCTION

The fact that conventional intraoperative radiotherapy (IORT) does not give the opportunity for exact documentation of the applied radiation volume and dose distribution has been criticised. We would like to introduce a system for surgical navigation and documentation of the flab positioning for intraoperative brachytherapy in afterloading flab technique.

METHODS

Our system consists of an electromagnetic 3D digitizer and a PC workstation. Preoperatively taken spiral CT scans of the tumour region are used for navigation and documentation of the flab positioning, analogous to the procedure in neuronavigation. Registration is done via an external reference system attached to the iliac bone of the patient.

RESULTS

The mean accuracy of digitalization of the 100 spheres in a pelvis model is about 2.6 +/- 0.5-3.7 +/- 0.9 mm. Mean navigation accuracy is 2.4 +/- 0.8-3.3 +/- 0.8 mm. These figures correspond to the clinical experience of our surgeons.

CONCLUSIONS

The optimization of the flab positioning by CT-guided navigation and the more accurate documentation of the dose volume and distribution in the patient is an important step towards improving the quality of individual radiotherapy. We are of the opinion that surgical navigation in the pelvic region should be subject to additional investigation in order to optimize the procedure.

Reconstruction and navigation system for intraoperative brachytherapy using the flab technique for colorectal tumor bed irradiation

PURPOSE

To present the development of a new navigation and reconstruction system based on an electromagnetic free-hand tracker and on CT imaging for treatment planning of intraoperative high-dose-rate brachytherapy (IORT-HDRB) in the sacral region. Our aim is to improve accuracy and to enable individualized treatment planning and dose documentation to be performed for IORT-HDRB using a flab technique.

METHODS AND MATERIALS

The material consists of an electromagnetic 3D tracker system, a PC workstation with Microsoft Windows NT 4.0 operating system, and a recognition program for continuous speech. In addition, we designed an external reference system constructed of titanium and Perspex, which is positioned in the pelvis, and a special digitizer pen for reconstruction of the flab geometry. The flab design incorporates a series of silicon 10-mm-diameter spherical pellets. Measurements were made with a pelvic phantom in order to study the accuracy of the system. The reconstruction results are stored and can be exported via network or floppy to our different treatment planning systems.

RESULTS

Our results for the reconstruction of a flab with six catheters and a total of 100 spherical pellets give mean errors in the range (2.5 +/- 0.6) mm to (3.5 +/- 0.8) mm depending on the positions of the pelvic phantom and transmitter relative to the operation table. These errors are calculated by comparing the reconstruction results of our system with those using a CT-based reconstruction of the flab geometry. For the accuracy of the navigation system for the pelvic phantom, we obtained mean errors in the range (2.2 +/- 0.7) mm to (3. 1 +/- 1.0) mm.

CONCLUSIONS

The new system we have developed enables navigation and reconstruction within the surgical environment with a clinically acceptable level of accuracy. It offers the possibility of individualized treatment planning and effective documentation of the 3D dose distribution in IORT-HDRB using a flab technique.

Introduction of proton pump inhibitors--consequences for surgical treatment of peptic ulcer

BACKGROUND/AIMS

This retrospective study analyzes the influence of different factors on morbidity and mortality after surgical treatment of peptic ulcer.

METHODOLOGY

At the Municipal Hospital of Offenbach, Germany, from 1985-1996, 485 patients underwent surgery.

RESULTS

Of the 485 patients, 70.7% (343) were diagnosed to have duodenal ulcer and 29.2% (142) had suffered from gastric ulcer. During this period, 79.2% (384) of the operations were performed under emergency conditions because of acute complications (56% of these with perforation, 20% with penetration, 24% with ulcer bleeding), whereas the rest was done electively. Two hundred and ninety-one (60%) patients were male, the average age was 59 years and 71.7% (348) of the patients had certain concomitant diseases. We observed complications in 48% of the cases with a total postoperative mortality of 21%.

CONCLUSIONS

Between 1985 and 1996 the total number of ulcer surgeries performed at the Municipal Hospital Offenbach per year has stayed almost constant. However, a definite increase of acute operations in addition to a decrease of elective interventions was noticed. The dissatisfying results of surgical treatment of peptic ulcer after the introduction of proton pump inhibitors seems to be the consequence of the negative selection of patients mentioned above. A connection could be proved between the age and condition of the patient, the type of the surgical intervention (acute or elective) and the morbidity and mortality after the surgery.

[Mechanical duodenal stump suture. Report of experiences: metal staples versus resorbable staples]

The main observation criterion of the present retrospective study is the insufficiency rate after machine closing of the duodenal stump (TA-clip seam device, Auto-Suture), as a consequence of gastrectomy, resection of the stomach with Billroth II respective Roux-Y reconstruction, depending on the used type of clip. Between January 1, 1985 and October 2, 1989 the closing of the duodenal stump was routinely carried out with metal clips (n = 253) in the City Hospital Offenbach. Between October 3, 1989 and December 31, 1991 polysorb staples (n = 96) were exclusively used. The patient collectives were comparable regarding age, sex, health status, basic diseases, accompanying diseases and surgical methods. Closing of the duodenal stump by polysorb staples demonstrated with 13.5% more dehiscent seams than with metal clips (4.7%). As a result of the present study, we cannot recommend the use of polysorb clips for the closing of the duodenal stump.

[Colorectal carcinoma. Which factors are decisive for development of postoperative complications?]

This retrospective study analyses the prognostic effect of different factors on morbidity and lethality based on selected, primarily resecting colon carcinoma operations (n = 222). In all, 12.2% of our operations were performed under emergency conditions. The total complication rate was 31.5%, the lethality rate 7.7%. The left hemicolectomy cases showed the highest morbidity (48.4%), the rectum amputation the highest lethality (11.8%). Tumour staging tumour differentiation and the sex of the patient showed no significant influence on the postoperative morbidity and lethality. However, a correlation was proved between the age of the patient, tumour localisation, co-morbidity, duration of operation and the conditions under which the operation was performed (emergency or elective), on the one hand, and morbidity and lethality on the other.