[Safety of patient care on an interprofessional training ward in visceral surgery].

Background: Interprofessional training wards (ITW) are increasingly being integrated into teaching and training concepts in visceral surgery clinics.

Objective: How safe is patient care on an ITW in visceral surgery?

Material And Methods: Data collection took place from November 2021 to December 2022. In this nonrandomized prospective evaluation study the frequency and severity of adverse events (AE) in 3 groups of 100 patients each in a tertiary referral center hospital for visceral surgery were investigated.

[Teaching patient safety during undergraduate medical studies].

Background: In the professional public there is agreement that healthcare professionals worldwide should already be prepared for safety in patient care during their education.

Objective: How can the topic of patient safety be successfully integrated into the curricula of healthcare professions?

Material And Methods: Overview of the Marburg curriculum on patient safety during the practical year as well as of other approaches to teaching patient safety described in the literature.

Results: In recent years teaching initiatives on patient safety have significantly increased; however, they are still not comprehensively distributed in German-speaking countries or throughout Europe.

Concept and contents of a voluntary course for medical students' achievement of a basic qualification in patient safety during the practical year of medical studies.

Regarding the urgent need of qualification in the field of patient safety, the respective education and training were completed by a voluntary course for 10-15 students in their practical year (PY) provided in cooperation of the private University Hospital of Marburg and the Medical Faculty of the Philipps-University of Marburg. At the same time, this course was intended to develop important knowledge for implementing improvements of the current PY teaching as well as revising the curriculum of Marburg in the medium term. The PY course on patient safety is offered every six months since 2016 and comprises about 80 lessons.

Defining the optimal animal model for translational research using gene set enrichment analysis.

The mouse is the main model organism used to study the functions of human genes because most biological processes in the mouse are highly conserved in humans. Recent reports that compared identical transcriptomic datasets of human inflammatory diseases with datasets from mouse models using traditional gene-to-gene comparison techniques resulted in contradictory conclusions regarding the relevance of animal models for translational research. To reduce susceptibility to biased interpretation, all genes of interest for the biological question under investigation should be considered.

Ubiquitin-like protein ISG15 (interferon-stimulated gene of 15 kDa) in host defense against heart failure in a mouse model of virus-induced cardiomyopathy.

Background: Common causative agents in the development of inflammatory cardiomyopathy include cardiotropic viruses such as coxsackievirus B3 (CVB3). Here, we investigated the role of the ubiquitin-like modifier interferon-stimulated gene of 15 kDa (ISG15) in the pathogenesis of viral cardiomyopathy.

Methods And Results: In CVB3-infected mice, the absence of protein modification with ISG15 was accompanied by a profound exacerbation of myocarditis and by a significant increase in mortality and heart failure.

Impairment of immunoproteasome function by β5i/LMP7 subunit deficiency results in severe enterovirus myocarditis.

Proteasomes recognize and degrade poly-ubiquitinylated proteins. In infectious disease, cells activated by interferons (IFNs) express three unique catalytic subunits β1i/LMP2, β2i/MECL-1 and β5i/LMP7 forming an alternative proteasome isoform, the immunoproteasome (IP). The in vivo function of IPs in pathogen-induced inflammation is still a matter of controversy.

Antigen-presentation capacity of dendritic cells is impaired in ongoing enterovirus myocarditis.

Coxsackievirus B3 (CVB3)-infection is a frequent cause of acute myocarditis, which may result in chronic myocarditis and virus persistence. Investigation of the initial immune responses to CVB3 may shed light on the mechanisms that contribute to ongoing disease. DCs, as key professional APCs, were investigated in two MHC-matched hosts: while C57BL/6 mice are resistant to chronic CVB3-myocarditis, the A.

Differential interferon responses enhance viral epitope generation by myocardial immunoproteasomes in murine enterovirus myocarditis.

Murine models of coxsackievirus B3 (CVB3)-induced myocarditis mimic the divergent human disease course of cardiotropic viral infection, with host-specific outcomes ranging from complete recovery in resistant mice to chronic disease in susceptible hosts. To identify susceptibility factors that modulate the course of viral myocarditis, we show that type-I interferon (IFN) responses are considerably impaired in acute CVB3-induced myocarditis in susceptible mice, which have been linked to immunoproteasome (IP) formation. Here we report that in concurrence with distinctive type-I IFN kinetics, myocardial IP formation peaked early after infection in resistant mice and was postponed with maximum IP expression concomitant to massive inflammation and predominant type-II IFN responses in susceptible mice.

Endoscopic sphincterotomy before deployment of covered metal stent is associated with greater complication rate: a prospective randomized control trial.

Objective: Endoscopic sphincterotomy (ES) may facilitate insertion of self expandable metal stent (SEMS) and also help avert the development of pancreatitis from stent-related occlusion of the pancreatic duct. On the other hand, ES is also independently associated with pancreatitis, bleeding, and perforation. We evaluated whether ES before SEMS placement was associated with a greater likelihood of stent migration and other complications in patients with malignant obstruction of the distal common bile duct.

Improving pathway compliance and clinician performance by using information technology.

To deliver patient-specific advice at the time and place of a consultation is an important contribution to improving clinician performance. Using computer-based decision support on the basis of clinical pathways is a promising strategy to achieve this goal. Thereby integration of IT applications into the clinical workflow is a core precondition for success.

Improving pathway compliance and clinician performance by using information technology.

To deliver patient-specific advice at the time and place of a consultation, to improve clinician performance and compliance by using computer-based decision support, and to integrate such IT solutions with the clinical workflow are important strategies for the implementation of clinical pathways. User acceptance plays a critical role: additional effort has to be balanced with enough benefit for the users. Experiences from routine use of an online surgical pathway at Marburg University Medical Center show that it is possible to successfully address this issue by seamlessly integrating patient-specific pat documentation tasks which have to be done anyway and by substantially reusing entered data to accelerate routine tasks (e.

Towards responsive IT-infrastructures--assessment of a health information system.

Marburg University Medical Center has been introducing a comprehensive health information system since 1999, using a single-vendor application framework with an integrated generator tool for the development of clinical applications. To find out if this architecture and our participative software engineering approach can be considered a step towards a responsive infrastructure, we compared the situation after the first deployment phase (basically a holistic approach) with the situation after the system was further developed and adapted to the users' needs using the generator tool approach. We collected system statistics and conducted user satisfaction surveys in 2001/02 and 2003 using standardized measurements.

[Selection of a hospital information system--experiences and critical aspects].

Due to typical problems (heterogeneity, lack of clinical functionality, Y2K problems) the board of directors of the university hospital of Marburg decided in 1997 to replace major components of the existing system by commercially available software. The products available on the market were analyzed, and, under participation of different user groups, a comprehensive functional specification was generated. This was the basis for a Europe-wide vendor selection process.

[Overview, analysis and evaluation of the 1995 public health structural law and the federal social care law from the viewpoint of the trauma surgery department of a university clinic. Measures for preparation of a new reimbursement system and documentation requirements].

All doctors in Germany are required to cooperate in the implementation of the health system reform and the new system for reimbursement of the hospitals to limit the negative consequences to the patients. It would be absolutely wrong to leave the medical services of the insurance companies to define the diagnosis-related groups and determine the charges. The revision of the health system is beneficial in that it supports the economical independence of hospital departments.

Surgical wound infections documented after hospital discharge.

Shorter lengths of hospitalization may result in more surgical wound infections being documented after hospital discharge. The current investigation analyzed 1644 surgical procedures performed over a 3-month period, and documented surgical wound infections both before and for 1 month after hospital discharge. Physician and patient questionnaires were used.

[Malignant fibrous histiocytoma of the mandible in a 1 6/12-year-old boy].

A report on malignant fibrous histiocytoma of the mandible in a 1 6/12-year-old boy, a condition rarely seen in children. Because of inoperability radiotherapy was used resulting in complete tumour remission. The clinical course was complicated by a tracheo-oesophageal fistula and aspiration pneumonia.

A comparison of infections in different ICUs within the same hospital.

Infections identified between 1981 and 1983 in a hospital's medical/surgical, pediatric, neonatal, coronary care, and cardiac surgery ICUs were compared. Among 14,360 admissions, 1840 infections occurred in 1360 patients. Total infection rates ranged from 1.

[Monitoring in paediatric surgery (author's translation)].

Monitoring of poor risk cases is of decisive importance in paediatric surgery. The monitoring has to be adapted to the specific situation of the disease in question.