[Innovative teaching and examination methods--taking stock at German medical faculties]. / Einsatz innovativer Lern- und Prüfungsmethoden an den Medizinischen Fakultäten der Bundesrepublik Deutschland--Eine aktuelle Bestandsaufnahme.

BACKGROUND AND OBJECTIVE: Following amendment to the German medical licensing regulations in April 2002, the training and examination of clinical-technical competencies within university medical education has gained in importance. To date, the implementation of new and innovative teaching and assessment methods at medical faculties in the Federal Republic of Germany has not been subject to exhaustive and detailed evaluation. METHODS: Using structured telephone interviews, all 36 medical faculties were questioned concerning their curricula, application of skills laboratory training, standardised patients (SPs), problem-based learning (PBL), computer-based training (CBT), and the implementation of objective structured clinical examinations (OSCE). RESULTS: All 36 faculties (100 %) took part in the survey. 34 faculties (94 %) reported providing training in a skills laboratory and 30 (83 %) faculties reported working with standardised patients. PBL is employed at 33 faculties (92 %) and CBT at 32 (89 %). Practical clinical assessments in the form of OSCEs are conducted at 28 faculties and are currently being installed at two further universities. CONCLUSION: New and innovative teaching and examination methods have been implemented in almost all medical universities in the Federal Republic of Germany. Further studies are needed in order to assess the extent to which individual specialist fields are involved in these developments.

[Gaussian distribution of intelligence in VLBW preterm infants at age 5: very low correlation with very low birth weight]. / Normalverteilung der Intelligenz von VLBW-Frühgeborenen mit 5 Jahren: sehr geringe Korrelation mit sehr geringem Geburtsgewicht.

BACKGROUND: Preterm infants with very low birth weight < 1500 g (VLBW) have a higher risk of developmental disorders. In addition to the common estimation of the mean intelligence values, we studied the distribution of intelligence at preschool age in VLBW infants and the risk factors influencing this distribution. PATIENTS AND METHODS: A prospective cohort study of 277 VLBW infants < 32 weeks born in 1991-1995 and treated according to a standardized regimen in one Perinatal Center was carried out, including measurement of intelligence (Kaufman-Assessment Battery for Children) at age 5. Statistical methods employed were: explorative data analysis, correlation, chi (2)- and t-tests; the tested variables were: small for gestational age (< third percentile), perinatal acidemia (umbilical arterial pH < 7.10), perinatal hypoxia (BE < - 10), hypothermia (< 36 degrees C), hypoglycemia after the first day of life (< 30 mg / dL), bronchopulmonary dysplasia (FiO (2) > 0.21 > or = 36 weeks), intraventricular hemorrhage, ventricular dilation, periventricular leukomalacia, seizures, abnormal acoustic evoked potentials, and hyperexcitability at discharge. RESULTS: The distribution of intelligence in 137 VLBW infants < 32 weeks (60 % follow-up rate) was similar to a symmetrical Gaussian bell curve. The intelligence increased very slightly with birth weight (Pearson correlation: 0.172; p = 0.045) and was significantly lower in children with hypoglycemia after the first day of life (- 13.35; 95 % confidence interval: - 20.08 to - 6.63; p = 0.002), hyperexcitability at discharge (- 16.28; 95 % confidence interval: - 25.26 to - 7.31; p = 0.005), and bronchopulmonary dysplasia (- 7.00; 95 % confidence interval - 11.71 to - 2.29; p = 0.039). CONCLUSIONS: At preschool age, the intelligence of VLBW infants is normally distributed and correlates only slightly with the very low birth weight. Hypoglycemia after the first day of life and bronchopulmonary dysplasia are risk factors for lower intelligence. Hyperexcitability at discharge seemed to represent a promising prognostic factor for a later intelligence reduction.

Does hospital rundown affect long-stay clients?

In order to examine what happens to long-stay clients who remain in hospital, a retrospective analysis of annual surveys between 1984 and 1992 was undertaken. Data were derived from the REHAB scale, which provides measures of patient Total General Behaviour (TGB) and Deviant Behaviour (DB), together with data from the Supplementary Information Questionnaire (SIQ). Results indicate that skills and behaviour, as measured by TGB, do not deteriorate as a function of continuous length of stay or increasing age. However, TGB for certain clients is adversely affected by a reduction in the level of structured activity occurring during major episodes of contraction leading up to closure. In contrast, DB, which is relatively high for this group, fluctuates independently of rundown. The implications for hospital services in transition are discussed.

[Long-term results of stapedectomy and stapedotomy]. / Langzeitresultate nach Stapedektomie und Stapedotomie.

We have followed up 91 patients for 3 or more years after stapes surgery for otosclerosis, 59 by stapedectomy and 32 by stapedotomy. The surgical technique was chosen randomly. Both surgical techniques achieved significant hearing improvement, but in the higher frequencies (3 kHz) the results of stapedotomy are better and more stable than those after stapedectomy. Surgical revision was necessary in 5 patients--1 after stapedotomy, 4 after stapedectomy.