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Zur ergonomischen Beurteilung von Arbeitsplätzen werden „ergonomic risk assessment tools“ (ERAT) verwendet. Mithilfe dieser kann die körperliche Belastung evaluiert und hinsichtlich eines biomechanischen Überlastungsrisikos bewertet werden. Dazu gehören neben Eigenangaben auch observatorische Methoden, deren Ergebnisse in Punktwerten („Scores“) zusammengefasst werden, wie z. B. die RULAMethode („rapid upper limb assessment“). Durch die technische Weiterentwicklung direkter Messmethoden können inertiale Motion-Capture-Systeme im 21. Jahrhundert präzise und kontinuierliche objektive Daten liefern. In einem neuen Ansatz wurde die observatorische Scoring-Methode RULA modifiziert und auf die digital erhobenen Daten angewendet, was differenzierte ergonomische Betrachtungen ganzer Arbeitsabläufe ermöglicht.
Hintergrund: Die digitale Transformation des Gesundheitssystems verändert den Beruf des Arztes. Data Literacy wird hierbei als eine der führenden Zukunftskompetenzen erachtet, findet jedoch derzeit weder in den implementierten Curricula des Medizinstudiums noch in den aktuell laufenden Reformprozessen (Masterplan Medizinstudium 2020 und Nationaler Kompetenzbasierter Lernzielkatalog) Beachtung.
Ziel: Der Beitrag möchte zum einen die Aspekte beleuchten, die im Begriff der Data Literacy im medizinischen Kontext gebündelt werden. Zum andern wird ein Lehrkonzept vorgestellt, das Data Literacy im Zeichen der digitalen Transformation erstmals im Medizinstudium abbildet.
Material und Methoden: Das Blended-Learning-Curriculum „Medizin im digitalen Zeitalter“ adressiert in 5 Modulen den diversen Transformationsprozess der Medizin von digitaler Kommunikation über Smart Devices und medizinische Apps, Telemedizin, virtuelle/augmentierte und robotische Chirurgie bis hin zu individualisierter Medizin und Big Data. Diese Arbeit stellt Konzept und Erfahrungen der erstmaligen Implementierung des 5. Moduls dar, welches transdisziplinär und integrativ den Aspekt Data Literacy erläutert.
Ergebnisse: Die Evaluation des Kurskonzepts erfolgte sowohl qualitativ als auch quantitativ und demonstriert einen Kompetenzgewinn in den Bereichen Wissen und Fertigkeiten sowie eine differenziertere Haltung nach Kursabschluss.
Schlussfolgerungen: Die curriculare Integration von Data Literacy ist eine transdisziplinäre und longitudinale Aufgabe. Bei der Entwicklung dieser Curricula sollten die hohe Geschwindigkeit des Veränderungsprozesses der digitalen Transformation beachtet und die curriculare Anpassung im Sinne eines Agility by Design bereits bei der Konzeption adressiert werden.
Tuberöse Sklerose („tuberous sclerosis complex“ [TSC]) ist eine seltene genetische Erkrankung, die neben kutanen und viszeralen Organmanifestationen typischerweise bereits in einem sehr frühen Erkrankungsstadium mit einer schweren, meist therapierefraktären Epilepsie einhergeht. Aufgrund seiner direkten Wirkung am durch TSC dysregulierten mTOR-Signalweg sowie der synergistischen Effekte auf andere Organmanifestationen kommt das Rapamycin-Derivat Everolimus (EVE) zunehmend zur Anwendung. Ziel dieses systematischen Reviews ist, die Wirksamkeit, Sicherheit und Verträglichkeit von EVE bei Patienten mit TSC-assoziierter, therapierefraktärer Epilepsie aufzuarbeiten.
Das adaptive Immunsystem CRISPR (engl. „clustered regularly interspaced short palindromic repeats“) revolutioniert die medizinische Grundlagenforschung. Die Einfachheit, Präzision und Vielseitigkeit der CRISPR-Technologie ermöglicht es nicht nur, Gene gezielt aus- oder einzuschalten, sondern auch zu korrigieren. Die Hoffnung richtet sich auf eine CRISPR-vermittelte Gentherapie, um krebsverursachende Mutationen gezielt zu korrigieren und somit Tumorwachstum zu verhindern oder therapieren zu können. Technisch ist dies zeitnah vorstellbar, doch ethische und rechtliche Rahmenbedingungen sollten dringend vorab geklärt werden. Die durch Gene Editing aufgeworfenen ethischen und rechtlichen Fragen werden zwar schon seit vielen Jahren diskutiert; durch die nun eingetretene rapide technische Entwicklung stellen sie sich jedoch in neuer Dringlichkeit. Eine umfassende ethische Bewertung der Erforschung und möglichen Anwendung ist daher geboten, einschließlich Fragen der Wissenschaftsethik und -kultur sowie längerfristiger potenzieller sozialer Konsequenzen der CRISPR-Technologie. Rechtlich unterliegt die Gentherapie den allgemeinen arzneimittelrechtlichen Regelungen, die Keimbahntherapie dagegen ist in Deutschland verboten. Auf Dauer und angesichts der erwartbaren weltweiten Entwicklung ist dieses Verbot jedoch zu hinterfragen. In der vorliegenden Arbeit erläutern die Autoren technische, ethische und rechtliche Aspekte des Gene Editing in der Krebsforschung und -therapie und diskutieren die daraus resultierenden Fragen: „Was kann, soll und darf gemacht werden?“.
Drug resistance is a commonly unavoidable consequence of cancer treatment that results in therapy failure and disease relapse. Intrinsic (pre-existing) or acquired resistance mechanisms can be drug-specific or be applicable to multiple drugs, resulting in multidrug resistance. The presence of drug resistance is, however, tightly coupled to changes in cellular homeostasis, which can lead to resistance-coupled vulnerabilities. Unbiased gene perturbations through RNAi and CRISPR technologies are invaluable tools to establish genotype-to-phenotype relationships at the genome scale. Moreover, their application to cancer cell lines can uncover new vulnerabilities that are associated with resistance mechanisms. Here, we discuss targeted and unbiased RNAi and CRISPR efforts in the discovery of drug resistance mechanisms by focusing on first-in-line chemotherapy and their enforced vulnerabilities, and we present a view forward on which measures should be taken to accelerate their clinical translation.
Background: To test the effect of variant histology relative to urothelial histology on stage at presentation, cancer specific mortality (CSM) and overall mortality (OM) after chemotherapy use, in urethral cancer.
Materials and Methods: Within the Surveillance, Epidemiology and End Results (2004–2016) database, we identified 1,907 primary variant histology urethral cancer patients. Kaplan-Meier plots, Cox regression analyses, cumulative incidence-plots, multivariable competing-risks regression models and propensity score matching for patient and tumor characteristics were used.
Results:Of 1,907 eligible urethral cancer patients, urothelial histology affected 1,009 (52.9%) vs. squamous cell carcinoma (SCC) 455 (23.6%) vs. adenocarcinoma 278 (14.6%) vs. other histology 165 (8.7%) patients. Urothelial histological patients exhibited lower stages at presentation than SCC, adenocarcinoma or other histology patients. In urothelial histology patients, five-year CSM was 23.5% vs. 34.4% in SCC (Hazard Ratio (HR) 1.57) vs. 40.7% in adenocarcinoma (HR 1.69) vs. 43.4% in other histology (HR 1.99, p<0.001). After matching in multivariate competing-risks regression models, variant histology exhibited 1.35-fold higher CSM than urothelial. Finally, in metastatic urethral cancer, lower OM was recorded after chemotherapy in general, including metastatic adenocarcinoma and other variant histology subtypes, except metastatic SCC.
Conclusion: Adenocarcinoma, SCC and other histology subtypes affect fewer patients than urothelial histology. Presence of variant histology results in higher CSM. Finally, chemotherapy for metastatic urethral cancer improves survival in adenocarcinoma and other variant histology subtypes, but not in SCC.
Abstract In the middle of the twentieth century, the from North America sooty bark disease (SBD) of maples was first discovered in England and has spread in the last decades in Central Europe, in particular. The trigger of SBD is the mould fungus Cryptostroma (C.) corticale. The most common infested maple is the sycamore, Acer pseudoplatanus, a common tree in woods and parks. The disease is characterised by peeling of the outer layer of the bark and brownish-black spores under the peeled off bark. These spores can cause maple bark disease (MBD) in humans, a hypersensitivity pneumonitis (HP) with similar symptoms like COPD, allergic asthma, influenza or flu-like infections and interstitial pneumonia. Persons who have intensive respectively occupational contact with infested trees or wood, e.g., woodman, foresters, sawyers or paper mill workers, are at risk in particular. Since C. corticale favours hot summers and host trees weakened by drought, SBD will increasingly spread in the future due to ongoing climate change. Consequently, the risk of developing MBD will increase, too. As with all HPs, e.g., farmer’s lung and pigeon breeder’s disease, the diagnosis of MBD is intricate because it has no clear distinguishing characteristics compared to other interstitial lung diseases. Therefore, the establishment of consistent diagnosis guidelines is required. For correct diagnosis and successful therapy, multidisciplinary expertise including pulmonologists, radiologists, pathologists and occupational physicians is recommended. If MBD is diagnosed in time, the removal of the triggering fungus or the infested maple wood leads to complete recovery in most cases. Chronic HP can lead to lung fibrosis and a total loss of lung function culminating in death. HP and, thus, MBD, is a disease with a very high occupational amount. To avoid contact with spores of C. corticale, persons working on infested wood or trees have to wear personal protective equipment. To protect the public, areas with infested maples have to be cordoned off, and the trees should be removed. This is also for impeding further spreading of the spores.
Background: Cumulative anticholinergic exposure, also known as anticholinergic burden, is associated with a variety of adverse outcomes. However, studies show that anticholinergic effects tend to be underestimated by prescribers, and anticholinergics are the most frequently prescribed potentially inappropriate medication in older patients. The grading systems and drugs included in existing scales to quantify anticholinergic burden differ considerably and do not adequately account for patients’ susceptibility to medications. Furthermore, their ability to link anticholinergic burden with adverse outcomes such as falls is unclear. This study aims to develop a prognostic model that predicts falls in older general practice patients, to assess the performance of several anticholinergic burden scales, and to quantify the added predictive value of anticholinergic symptoms in this context.
Methods: Data from two cluster-randomized controlled trials investigating medication optimization in older general practice patients in Germany will be used. One trial (RIME, n = 1,197) will be used for the model development and the other trial (PRIMUM, n = 502) will be used to externally validate the model. A priori, candidate predictors will be selected based on a literature search, predictor availability, and clinical reasoning. Candidate predictors will include socio-demographics (e.g. age, sex), morbidity (e.g. single conditions), medication (e.g. polypharmacy, anticholinergic burden as defined by scales), and well-being (e.g. quality of life, physical function). A prognostic model including sociodemographic and lifestyle-related factors, as well as variables on morbidity, medication, health status, and well-being, will be developed, whereby the prognostic value of extending the model to include additional patient-reported symptoms will be also assessed. Logistic regression will be used for the binary outcome, which will be defined as “no falls” vs. “≥1 fall” within six months of baseline, as reported in patient interviews. Discussion: As the ability of different anticholinergic burden scales to predict falls in older patients is unclear, this study may provide insights into their relative importance as well as into the overall contribution of anticholinergic symptoms and other patient characteristics. The results may support general practitioners in their clinical decision-making and in prescribing fewer medications with anticholinergic properties.
Simple Summary
Seizures are among the most common symptoms of meningioma patients even after surgery. This study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified version of a score to predict postoperative seizures on an independent cohort. The data underline that there are distinct factors identifying patients with a high risk of postoperative seizures following meningioma surgery which has been already shown before. We could further show that the high proportion of 43% of postoperative seizures occur as late seizures which are more dangerous because they may happen out of hospital. The modified STAMPE2 score could predict postoperative seizures when reaching very high scores but was not generally transferable to our independent cohort.
Abstract
Seizures are among the most common symptoms of meningioma. This retrospective study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified STAMPE2 score. In 556 patients who underwent meningioma surgery, we correlated different risk factors with the occurrence of postoperative seizures. A modified STAMPE2 score was applied. Risk factors for preoperative seizures were edema (p = 0.039) and temporal location (p = 0.038). For postoperative seizures preoperative tumor size (p < 0.001), sensomotory deficit (p = 0.004) and sphenoid wing location (p = 0.032) were independent risk factors. In terms of postoperative status epilepticus; sphenoid wing location (p = 0.022), tumor volume (p = 0.045) and preoperative seizures (p < 0.001) were independent risk factors. Postoperative seizures lead to a KPS deterioration and thus an impaired quality of life (p < 0.001). Late seizures occurred in 43% of patients with postoperative seizures. The small sub-cohort of patients (2.7%) with a STAMPE2 score of more than six points had a significantly increased risk for seizures (p < 0.001, total risk 70%). We concluded that besides distinct risk factors, high scores of the modified STAMPE2 score could estimate the risk of postoperative seizures. However, it seems not transferable to our cohort