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Objective: Spinal epidural abscess (SEA) is a severe and life-threatening disease. Although commonly performed, the effect of timing in surgical treatment on patient outcome is still unclear. With this study, we aim to provide evidence for early surgical treatment in patients with SEA.
Methods: Patients treated for SEA in the authors' department between 2007 and 2016 were included for analysis and retrospectively analyzed for basic clinical parameters and outcome. Pre- and postoperative neurological status were assessed using the American Spinal Injury Association Impairment Scale (AIS). The self-reported quality of life (QOL) based on the Short-Form Health Survey 36 (SF-36) was assessed prospectively. Surgery was defined as "early", when performed within 12 hours after admission and "late" when performed thereafter. Conservative therapy was preferred and recommend in patients without neurological deficits and in patients denying surgical intervention.
Results: One hundred and twenty-three patients were included in this study. Forty-nine patients (39.8%) underwent early, 47 patients (38.2%) delayed surgery and 27 (21.9%) conservative therapy. No significant differences were observed regarding mean age, sex, diabetes, prior history of spinal infection, and bony destruction. Patients undergoing early surgery revealed a significant better clinical outcome before discharge than patients undergoing late surgery (p=0.001) and conservative therapy. QOL based on SF-36 were significantly better in the early surgery cohort in two of four physical items (physical functioning and bodily pain) and in one of four psychological items (role limitation) after a mean follow-up period of 58 months. Readmission to the hospital and failure of conservative therapy were observed more often in patients undergoing conservative therapy.
Conclusion: Our data on both clinical outcome and QOL provide evidence for early surgery within 12 hours after admission in patients with SEA.
Background: Lectures remain an important teaching method to present and structure knowledge to many students concurrently. Adequate measures are necessary to maintain the quality of the lectures. The aim of this study was to determine the impact on the lecture quality using written structured feedback and to compare the ratings of surgical lectures between students and surgical peers.
Methods: Prospective analysis of two consecutive surgical lecture series for undergraduate students at Goethe-University Medical School was performed before and after evaluation of the lecturers via independent written feedback from trained undergraduate students and surgeons. The 22-item feedback instrument covered three areas of performance: content, visualization, and delivery. Additional suggestions for improvement were provided from
both students and surgical peers who anonymously attended the lectures. The lecturers, experienced surgeons, as well as the student and peer raters were blinded in terms of the aim and content of the study. Their response to the feedback was collected using a web-based 13-item questionnaire. The Kendall’s-W coefficient was computed to calculate inter-rater reliability (IRR). Differences between ratings before and after feedback were analyzed using Student’s t-test for dependent samples. The Kolmogorov-Smirnov-test was used for independent samples.
Results: A total of 22 lectures from a possible 32 given by 13 lecturers were included and analyzed by at least three surgeons and two students. There were significant improvements in overall score as well as in the details of 9 of the 13 items were found. The average inter-rater reliability was 0.71. There were no differences in the ratings as a function of the rater’s level of expertise (peers vs. students). We found that 13/23 lecturers (56.5%) answered the questionnaire, and 92% strongly agreed that the written feedback was useful. 76.9% of the lecturers revised their lecture based on the written feedback requiring on average 112.5 min (range from 20 to 300 min).
Conclusions: Overall, this study indicates that structured written feedback provided by trained peers and students that is subsequently discussed by the lecturers concerned is a highly effective and efficient method to improve aspects of lecturing. We anticipate that structured written feedback by trained students that is discussed by the lecturers concerned will improve lecturing.
Keywords: Lecture, Feedback, Surgery, Peer-feedback, Evaluation, Undergraduate training