Klinikum Neumarkt

Zusammenfassung: Hintergrund: Eine erweiterte und vertiefte Pflege verfolgt durch den Einsatz von Pflegeexpert_innen APN mit einer Clinical Nurse Specialists (CNS) Ausrichtung das Ziel, die Pflegepraxis durch fachliche Führung zu verbessern und patientenzentriert auszurichten. Das Konzept Fallbegleitung wurde am Klinikum Neumarkt als praxisnahes und patientenzentriertes Tätigkeitsfeld für Pflegeexpert_innen APN entwickelt. Zielsetzungen: Im Rahmen der Fallbegleitung wird der Advanced Nursing Process eingeführt, um eine evidenzbasierte Pflege für eine definierte Patientengruppe zu initiieren. Zudem wird ein positiver Einfluss auf die Einstellung der Pflegenden gegenüber dem Pflegeprozess erwartet. Methoden: Es wurde eine Studie im Mixed Method Design mit zwei Datenerhebungszeitpunkten durchgeführt. Neben einer Dokumentenanalyse wurden Pflegende mithilfe der „Position on the Nursing Process“ zur deren Einstellung zum Pflegeprozess befragt. Ergebnisse: Die Dokumentenanalyse zeigt, dass der Pflegeprozess nach Implementierung der Fallbegleitung vollständiger, strukturierter und evidenzbasiert erfolgt. Die Querschnittserhebung verdeutlicht, dass Pflegende nach Implementierung der Fallbegleitung den Nutzen und Wert des Pflegeprozesses deutlicher erkennen. Diskussion: Das Konzept Fallbegleitung ermöglicht die Umsetzung eines erweiterten Pflegeprozesses und beeinflusst die Einstellung der Pflegenden gegenüber dem Pflegeprozess positiv, was die Pflegequalität insgesamt steigert. Schlussfolgerungen: Diese Ergebnisse unterstreichen die Relevanz einer CNS-gesteuerten fachliche Führung.

Background Medical students experience high levels of stress and related mental health problems. Students’ autonomous and controlled motivation and their mental well-being are interconnected. This study aimed to investigate whether an innovative teaching concept based on self-determination theory (SDT) could improve students’ motivation and thereby reduce their stress levels, ultimately providing a healthier framework for learning. Methods In a week-long practical psychiatry course for medical students, a new didactic concept was implemented in half the groups (n = 73) and compared with the preexisting concept (n = 75) as a randomized controlled trial (RCT). To promote the SDT-target factors of perceived autonomy, competence, and relatedness, the methods used included team building, exclusively positive feedback, group discussions, and choice in task distribution. Significant group differences in motivation, stress, performance, and their relationships were analyzed through t-tests, multiple linear regression analyses, mediation analyses, and hierarchical linear modeling (HLM) using questionnaires collected before (t0) and after (t1) the course, and students’ exam results (t2). Results In the innovation group (n = 53), intrinsic motivation/interest (d = 0.41; p = .019) and perceived choice/autonomy (d = 0.33; p = .048) were greater than in the control group (n = 52). While autonomous regulation remained stable, the innovation group showed reduced controlled regulation (d = -0.36; p = .033) and reported significantly lower stress (d = -0.55; p = .003). The observed changes in motivation collectively mediated the stress reduction. However, students in the innovation group achieved lower exam scores, which seemed to result from the absence of critical feedback, but not from the observed differences in motivation or stress. Conclusions This study demonstrated that enhancing intrinsic motivation through SDT-based teaching can effectively reduce stress in medical students. Exclusively strengths-based positive feedback may have hindered exam performance, but optimizing educational concepts to promote motivation and reduce stress will be a valuable step toward improving medical students’ mental well-being.

Background An acute abdomen is a medical emergency that requires early diagnosis and treatment. In pregnancy, this process is significantly more challenging, and radiological findings are sometimes unclear due to the enlarged uterus displacing other structures. Moreover, endometriosis-related complications are rare, and the disease is often undiagnosed. Case presentation We report a case of acute perforation of the cecum and appendix during pregnancy (35 weeks of gestation) caused by a previously unknown, deep infiltrating endometriosis with focal ulceration of the affected bowel wall, which sonographically seemed to be acute appendicitis. Conclusion Despite the relatively low risk, clinicians should be aware of possible endometriosis-associated complications in pregnancy with potentially life-threatening events, even in previously unknown endometriosis. Further studies should evaluate intestinal complications during pregnancy in relation to previous treatment of intestinal endometriosis (conservative vs. surgical).

From a biomechanical point of view, the tibial slope plays a significant role in relation to the loading of the ligament structures in the knee joint. Currently, there are various methods of measurement for the tibial slope, which makes it difficult to compare the measurement results obtained. These differences can be decisive factors for the indication and the extent respectively of the correction of the tibial slope. The aim of this work is to present the differences in results between the measurement methods, and to compare these with the posterior tibial slope (PTS). By means of a comparative analysis, six measurement techniques for the tibial slope were examined. Using six parameters (correlation coefficient, range, deviation of the average slope value, correction coefficient, difference in the corrected measurements, range of the corrected measurements), these results were compared with the PTS. In this prospective study, the PTS was measured in 107 (49 male, 58 female, age 42.6 ± 23.4 years) strictly lateral plain radiological projections of the tibia with the talocrural joint in comparison with the measurement methods according to Han, Brazier, Moore and Harvey, Pietrini and LaPrade and a supratuberosity measurement. The posterior slope was observed at a mean value of 6.9° (± 8.6°). Compared with the PTS, tibial slope values were increased in 55.5 % of all measurements examined and decreased in 42.4 %. In 2 % the values were identical to those of PTS. The deviations observed were significant at up to +2.9° (± 1.7°) and −2.3° (± 1.5°) respectively in comparison with the measured PTS (p < 0.001). 25.9 % of the results showed a slope value more than 2°too high and 17.6 % one less than −2° too low. Thus, in 43 % of the results clinically relevant results that were too high or too low were observed for the tibial slope compared with the PTS (p < 0.001). The correlation analyses showed very high linear connections with PTS (p < 0.001) for all methods, from r2 = 0.88 (in Moore and Harvey) up to r2 = 0.98 (in Han). The ranges varied between 13.90° (Moore and Harvey) and 18.30° (Han). Depending on the measurement method, the slope values obtained should be individually evaluated, in order to draw the correct clinical conclusions. In principle, the radiological assessment of the whole lower leg is essential, so that concomitant pathologies in the area of the entire tibia can be detected. In everyday clinical practice, the measurement according to Han et al., and thus a shorter X‑ray projection, makes it possible to draw optimal conclusions about the PTS. Prospective diagnostic study, Level II.

This white paper documents the consensus opinion of the authors and Artificial Intelligence Surgery editorial board members regarding common requirements needed to implement routine recording of data in the operating room. The statements were agreed upon by all authors and they attempted to outline common barriers that need to be addressed when implementing such recordings.

Simple Summary Certification in oncology aims to establish structural and procedural standards according to evidence-based guidelines. The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. Based on clinical cancer registry data of 47.440 colorectal cancer patients treated between 2009 and 2017, the present study shows that treatment at colorectal cancer centers has been associated with significantly better outcomes. Patients treated at certified facilities had an eleven percent (colon)/nine percent (rectum) lower risk of dying within the first five years after diagnosis. These findings support the shift towards a more structured cancer care system. Abstract (1) Background: The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. This certification program is provided by the German Cancer Society (GCS) and represents one of the largest oncologic certification programs worldwide. Currently, about 50% of colorectal cancer patients in Germany are treated in certified centers. (2) Methods: All analyses are based on population-based clinical cancer registry data of 47.440 colorectal cancer (ICD-10-GM C18/C20) patients treated between 2009 and 2017. The primary outcome was 5-year overall survival (OAS) after treatment at certified cancer centers compared to treatment at other hospitals; the secondary endpoint was recurrence-free survival. Statistical methods included Kaplan–Meier analysis and multivariable Cox regression. (3) Results: Treatment at certified hospitals was associated with significant advantages concerning 5-year overall survival (HR 0.92, 95% CI 0.89, 0.96, adjusted for a broad range of confounders) for colon cancer patients. Concentrating on UICC stage I–III patients, for whom curative treatment is possible, the survival benefit was even larger (colon cancer: HR 0.89, 95% CI 0.84, 0.94; rectum cancer: HR 0.91, 95% CI 0.84, 0.97). (4) Conclusions: These results encourage future efforts for further implementation of the certification program. Patients with colorectal cancer should preferably be directed to certified centers.

In vascular medicine ultrasound is the most important diagnostic tool in the wide-ranging armamentarium of imaging diagnostics after taking medical history and physical examination. As a contemporary stethoscope, it belongs in the hands of a modern oriented medicine and has not only supplemented other, especially radiological sectional imaging methods but also partially replaced them. When it comes to intraoperative use, we like to refer to it as the “surgeon’s extended hand”. A well-founded training is an indispensable prerequisite for maximizing the possibilities of this method, which, like all others has its limits. New standards have been defined by modern practical training concepts. Ultrasound-based diagnoses nowadays have a high degree of reliability, and the widespread acceptance has significantly increased. In this article, this is made clear on the basis of core topics in vascular medicine and the basic principles of ultrasound are introduced with a focus on pretherapeutic diagnostic findings. We want to arouse interest in the method among our young colleagues and demonstrate the added value for their own personal training and development.

The wash out behavior of focal liver lesions in contrast-enhanced ultrasound plays a central role in tumor classification. Besides hepatocellular carcinomas, other hypervascular tumor entities like renal cell carcinomas may also show a very late wash out, possibly caused by portal-venous tumor vessels. There is need to observe long enough in the late phase in order to classify them correctly.