Chirurgische Ausbildung im digitalen Zeitalter – Virtual Reality, Augmented Reality und Robotik im Medizinstudium

The digital transformation of healthcare is changing the medical profession. Augmented/Virtual Reality (AR/VR) and robotics are being increasingly used in different clinical contexts and require supporting education and training, which must begin within the medical school. There is currently a large discrepancy between the high demand and the number of scientifically proven concepts. The aim of this thesis was the conceptual design and structured evaluation of a newly developed learning/teaching concept for the digital transformation of medicine, with a special focus on the influence of surgical teaching.Thirty-five students participated in three courses of the blended learning curriculum "…

Influence of formalin fixation on the biomechanical properties of human diaphyseal bone.

Owing to the lack of fresh human bones, formalin-fixed specimens are frequently used in biomechanical testing. However, formalin fixation is assumed to affect the biomechanical properties of bone. The aim of this study was to compare axial and torsional stiffness and bone mineral density in fresh and embalmed human bones. The subtrochanteric regions of 12 pairs of fresh human femora were randomised into two groups for paired comparison. After bone mineral density measurement, one group was preserved in 4% formalin. After 6 weeks, bone mineral density was remeasured and each specimen underwent axial and torsional loading. The formalin group showed significant higher stiffness values for tors…

Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms

ObjectivesDuring a ‘cannot intubate, cannot oxygenate’ situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient’s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, d…

Two-year results of vertebral body stenting for the treatment of traumatic incomplete burst fractures.

Vertebral body stenting (VBS) was developed to prevent loss of reduction after balloon deflation during kyphoplasty. The aim of this study is the radiological and clinical mid-term evaluation of traumatic incomplete burst fractures treated by vertebral body stenting.This retrospective study included patients with traumatic thoracolumbar incomplete burst fractures treated with VBS between 2009 and 2010. The outcome was evaluated with the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI), the SF-36 Health Survey and radiologically assessed.Eighteen patients with an average age of 74.8 years were treated with VBS. Twelve were female and six were male. Two years after the op…

Symptoms of adjustment disorder and smoking predict long-term functional outcome after ankle and lower leg fracture

Objective To examine the psychological, social, behavioural and injury-related factors impacting functional outcome in patients with ankle or lower limb fracture one year post-operation. Methods In this prospective study 66 patients with ankle or lower leg fracture were recruited and followed up one year post-operation. Possible associations between predictors and functional outcome were explored by regression analyses. Functional outcome was assessed with the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. Results Linear regression models revealed that smoking and elevated symptoms of adjustment disorder were associated with lower functional outcome one year post-operation…

Influence of implant and screw type on local bone strain field: a preliminary study

Principles of Damage Control in the Elderly

A steadily increase of severely injured elderly patients may be expected. Comorbidities are present in the majority of these patients and negatively influence outcome. Blunt trauma is the leading cause of high-energy injuries in the elderly. Motor vehicle accidents, either as driver or as pedestrian hit by a car, and falls from height are the most important mechanisms of polytrauma. The principles of advanced trauma life support (ATLS) should also apply for elderly persons. Underestimation of the severity of injury is a common problem leading to undertriage. A basic rule of primary care is to avoid the lethal triad of hypothermia, coagulopathy and acidosis. Emergent invasive monitoring redu…

Symptome einer Anpassungsstörung nach einer Unfallverletzung: Risiko- und Schutzfaktoren

Symptoms of Adjustment Disorder after an accidental injury: risk and protective factors Objectives: The identification of protective and risk factors for symptoms of adjustment disorder (AD) after an accident injury. Methods: In this prospective long-term study, data from 73 patients with ankle and lower leg fractures were analyzed. Symptoms of AD were assessed at enrollment (T0), 1 month (T1) and 12 months (T2) after injury. In addition, questionnaires regarding adverse childhood experiences, coping strategies and the number of stressors during the last year were obtained. The Structured Clinical Interview for DSM-IV (SCID) was conducted at T1 and T2. Results: 4.1 % of patients met the cri…

Accuracy of a Chatbot (Ada) in the Diagnosis of Mental Disorders: Comparative Case Study With Lay and Expert Users

Background Health apps for the screening and diagnosis of mental disorders have emerged in recent years on various levels (eg, patients, practitioners, and public health system). However, the diagnostic quality of these apps has not been (sufficiently) tested so far. Objective The objective of this pilot study was to investigate the diagnostic quality of a health app for a broad spectrum of mental disorders and its dependency on expert knowledge. Methods Two psychotherapists, two psychology students, and two laypersons each read 20 case vignettes with a broad spectrum of mental disorders. They used a health app (Ada—Your Health Guide) to get a diagnosis by entering the symptoms. Interrater …

Critical single proximal left arterial descending coronary artery stenosis to mimic chronic myocardial ischemia: a new model induced by minimal invasive technology.

<i>Background/Aims:</i> The present report examines a new pig model for progressive induction of high-grade stenosis, for the study of chronic myocardial ischemia and the dynamics of collateral vessel growth. <i>Methods:</i> Thirty-nine Landrace pigs were instrumented with a novel experimental stent (GVD stent) in the left anterior descending coronary artery. Eight animals underwent transthoracic echocardiography at rest and under low-dose dobutamine. Seven animals were examined by nuclear PET and SPECT analysis. Epi-, mid- and endocardial fibrosis and the numbers of arterial vessels were examined by histology. <i>Results:</i> Functional analysis showed a…

The Retrograde Tibial Nail: presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures.

Displaced distal tibia fractures require stable fixation while minimizing secondary damage to the soft tissues by the surgical approach and implants. Antegrade intramedullary nailing has become an alternative to plate osteosynthesis for the treatment of distal metaphyseal fractures over the past two decades. While retrograde intramedullary nailing is a standard procedure in other long bone fractures, only few attempts have been made on retrograde nailing of tibial fractures. The main reasons are difficulties of finding an ideal entry portal and the lack of an ideal implant for retrograde insertion. The Retrograde Tibial Nail (RTN) is a prototype intramedullary implant developed by our group…

Biomechanical evaluation of a new treatment method for distal tibia fractures

Distal tibial fractures are often the result of high-energy impacts combined with excessive soft tissue injury. Treatment options include either open reduction and internal fixation usually as a mi...

Radiological analysis, operative management and functional outcome of open book pelvic lesions: a 13-year cohort study.

Abstract We present the clinical and radiological outcome of a 13-year cohort study of 38 open book pelvic lesions. All patients were treated in one Level I Trauma centre. In the posterior pelvis, sacro-iliac diastasis was seen in 31 patients, sacral fracture in 7. In all patients with sacro-iliac diastasis, the pubic bone was inferiorly displaced on the primary ap pelvic overview on the side of injury. All but one patient was treated with open reduction and internal fixation of the symphysis pubis. Additional stabilization of the posterior pelvis was done in 9 patients. 32 patients were seen after a median follow up of 84 months. Majeed score and SF-36 questionnaire were used. Functional o…

Das Märchen der Digital Natives

Der Zielgruppe heutiger Hochschulbildung werden oft vorschnell weitreichende Kompetenzen im Umgang mit zunehmender Digitalisierung von Arbeitswelt und Alltag zugeschrieben. Das vorliegende Papier betrachtet dies kritisch und versucht sich der Frage zu widmen, wie Hochschulbildung den digitalen Wandel adressieren, begleiten und Studierende so zur beruflichen Kompetenz und aktiven gesellschaftlichen Teilhabe befähigen kann. Dies geschieht unter Einbezug des Curriculum 4.0-Projekts «Medizin im digitalen Zeitalter», einem Lehrkonzept, welches die zunehmende Digitalisierung von Arbeitswelt und Alltag im Bereich der Medizin auf inhaltlicher Ebene adressiert und sich methodisch vor allem auf kolla…

The effect of the pro-inflammatory cytokine tumor necrosis factor-alpha on human joint capsule myofibroblasts.

Introduction Previous studies have shown that the number of myoblastically differentiated fibroblasts known as myofibroblasts (MFs) is significantly increased in stiff joint capsules, indicating their crucial role in the pathogenesis of post-traumatic joint stiffness. Although the mode of MFs' function has been well defined for different diseases associated with tissue fibrosis, the underlying mechanisms of their regulation in the pathogenesis of post-traumatic joint capsule contracture are largely unknown. Methods In this study, we examined the impact of the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α) on cellular functions of human joint capsule MFs. MFs were challenged w…

Dynamic angular three-dimensional measurement of multisegmental thoracolumbar motion in vivo.

Study design Method validation and in vivo motion segment study. Objective To determine in healthy subjects in vivo intervertebral segmental kinematics and coupled motion behavior in all 3 planes simultaneously for 3 segments and to evaluate whether these results differ from those in the normal population according to the literature. Summary of background data Few studies have provided a direct invasive approach to investigate segmental kinematics in vivo. Dynamic recordings of 3-dimensional segmental motion patterns of adjacent segments have rarely been reported. To date, no studies have examined the 3-dimensional segmental movements of the thoracolumbar junction in vivo in detail. Methods…

The anatomy of the proximal radius: implications on fracture implant design.

Background The proximal radius features a complex anatomy. Several studies have been published on the anatomy using different technical approaches; however, most of these studies were conducted with a special focus on parameters relevant to radial prosthetic design. The purpose of our study was to explore the complex geometry of the proximal radius with regard to fracture implant design. Methods Our computed tomography-based measurements of 78 multiplanar reformatted radii allow for exact assessment of its geometry and offer a scientific rationale towards the design of fracture implants. We conducted measurements on the radial head, the radial neck, the radial tuberosity, the radial head-to…

Treatment of distal intraarticular tibial fractures: A biomechanical evaluation of intramedullary nailing vs. angle-stable plate osteosynthesis

In factures of the distal tibia with simple articular extension, the optimal surgical treatment remains debatable. In clinical practice, minimally invasive plate osteosynthesis and intramedullary nailing are both routinely performed. Comparative biomechanical studies of different types of osteosynthesis of intraarticular distal tibial fractures are missing due to the lack of an established model. The goal of this study was first to establish a biomechanical model and second to investigate, which are the biomechanical advantages of angle-stable plate osteosynthesis and intramedullary nailing of distal intraarticular tibial fractures. Seven 4(th) generation biomechanical composite tibiae feat…

Traumatic damage to the cartilage influences outcome of anatomically reduced acetabular fractures: A medium-term retrospective analysis

We reviewed 77 patients with an acetabular fracture, treated operatively through a non-extensile approach after an average time of 45 months. The ilioinguinal approach was chosen in 41, the Kocher-Langenbeck approach in 36 patients. Following the Letournel classification, the most frequent lesions were posterior wall (26%), two-column (22.1%) and anterior column (14.3%) fractures. Subchondral impaction, intra-articular fracture fragments and fracture comminution, called modifiers, could be identified in the preoperative CT-data of 38 patients (49.4%). Patients were operated after an average of 4 days. Average hospital stay was 19 days. Sciatic nerve and peroneal nerve palsy were registered …

Retrograde nailing versus locking plate osteosynthesis of proximal humeral fractures: a biomechanical study

Background In locking plate osteosynthesis of proximal humeral fractures, secondary varus malalignment is a specific complication. Retron nails (Tantum AG, Neumunster, Germany), among others, have been designed to improve medial support of the calcar humeri. The aim of our biomechanical study was to examine whether Retron nails provide increased stiffness for axial loads and adequate stiffness for torsional loads when compared with Philos plates (Synthes AG, Umkirch, Germany). Materials and methods Twenty-two fresh-frozen paired humeri were collected. After potting the specimens, intact bones were exposed to sinusoidal axial (10-120 N) and torsional (±2.5 Nm) loading for 8 cycles to calcula…