[Allergen immunotherapy for rare allergens]. / Allergen-Immuntherapie gegen seltenere Allergene.

Among allergies to aeroallergens, approximately 20% are allotted to the so-called rare allergens. These include ash pollen, weed pollen, storage mites, molds, and animal allergens. The prevalences of allergies to these allergens are lower, but affected patients also suffer considerably from their "rare" allergy. Hence, these allergies should neither be overseen nor completely forgotten in daily practice. Especially mold, mite, and animal allergens often induce asthma, so that the significance of allergen-specific immunotherapy (AIT) should not be neglected in causal therapy. This work summarizes the current state of knowledge on the groups of rare aeroallergens in terms of characteristics, prevalences, and data on AIT. It is based on a systematic literature search performed in the MEDLINE (PubMed®) and Google Scholar databases. AIT preparations for rare allergens are classified as individual formulations and are not subject to the German Therapy Allergen Ordinance. Due to the low case numbers, the levels of evidence for these formulations are not as high as those for dust mites, grass, or birch pollen, but exhibit good efficacy in practical experience.

[Interprofessional evaluation of "soft skills" of students in the practical year]. / Interprofessionelle Evaluation der "Soft Skills" von Studierenden des Praktischen Jahres.

OBJECTIVE: The present study deals with the implementation of a questionnaire with 360° evaluation to assess the performance of students in the practical year (PJ). A special focus is put on the "soft skills" (self-competence, methodological competence, social competence), whose evaluation in medical studies has not yet taken place comprehensively. MATERIAL & METHODS: The study was conducted prospectively with 21 PJ students of the Medical Faculty of the TU Dresden. The assessment was performed by means of a self-designed questionnaire, which was divided into 4 sub-competencies (self-competence, methodological competence, social competence, clinical skills and abilities), which could be assessed by means of a 6-point Likert scale. Four professions were involved in the assessment: Medical Service, Nursing Service, Functional Service, and Administration. RESULTS: On average, the strongest deficits in terms of self-confidence, willingness to perform, and ability to deal with conflict were revealed by students in the PJ. Students showed a very good performance in performing a medical history and basic skills of clinical examination. CONCLUSION: The implementation of 360° feedback is possible and useful for students in the internship year across disciplines and professions. Such personal and interprofessional feedback has not been widely available. The questionnaire represents the first comprehensive measurement tool of soft skills for medical students and provides a good basis for comprehensive feedback.

Digital teaching and assessment of psychomotor skills of the clinical head and neck examination during COVID-19 pandemic.

PURPOSE: During COVID-19, a fully digital course was established for teaching and assessing the psychomotor skills of clinical head and neck examination. Influence of different digital teaching formats was investigated. METHODS: The students (n = 286) received disposable instruments, a manual, and instructional videos for the examination. 221 students additionally received 45 min of interactive teleteaching. After 5 days of practice, all students were required to submit a video of their examination and report their spent practice time. The assessment was carried out using a checklist which was already established in presence teaching. RESULTS: The average score achieved by digital teaching was 86%. Previously published data show that presence teaching achieved 94%. With a teleteaching unit the total score was significantly better than without (87% vs 83%). Teleteaching leads to a significant positive correlation between practice time and total score. Without teleteaching there is a negative correlation. After the same practice time, presence teaching leads to better total scores than digital teaching. CONCLUSION: Digital teaching and assessing of a complex psychomotor skill is possible. Interactive teaching methods increase learning success. Nevertheless, presence teaching seems to be better at teaching these skills. The results can provide a basis for developing hybrid teaching models.

Real-time monitoring of middle ear prosthesis coupling.

INTRODUCTION: In reconstructive middle ear surgery, acoustic quality has received a high level of attention in recent years. Careful intraoperative selection and positioning of passive middle ear prostheses during tympanoplasty with ossiculoplasty is essential to ensure satisfactory sound transmission and postoperative hearing outcome. The reconstruction quality of the ossicular chain (OC) can be evaluated intraoperatively using a surgical assistance system which is based on a real-time monitoring system (RTM system) that acquires the transmission (middle ear transfer function (METF)) with electromagnetic excitation of the OC. In this experimental study, the METF with electromagnetic excitation of the (reconstructed) OC was compared to usual acoustic excitation and the benefit of the RTM system was investigated for the implantation of partial (PORP) and total (TORP) prostheses. METHODS: Laser Doppler vibrometry (LDV) was used to measure the middle ear transfer function (METF) in 18 human temporal bones (TB). The RTM system uses electromagnetic excitation of the OC with a magnet placed on the umbo. Comparatively, measurements with the usual acoustical excitation, using an earphone in the external auditory canal, were performed. The measurements began with the intact OC, followed by real-time monitoring guided OC reconstruction with PORP and TORP. In addition, during the simulation of an intraoperative setting, the influence of the influence of opening (tympanomeatal flap lifted and pushed anteriorly) and closing (tympanomeatal flap folded back) the tympanic membrane on the measurements with the RTM system was determined. RESULTS: Electromagnetic and acoustic excitation of the intact and the reconstructed OC provided comparable METF. The application of the RTM system significantly improved the quality of the OC reconstruction. The METF increased by up to 10 dB over the entire frequency range during implantation of the PORP with positioning control by the RTM system. When using the TORP, the METF could be improved by up to 15 dB. The opening of the tympanomeatal flap did not affect the measurements with the RTM system at the reconstructed OC. CONCLUSION: In this TB study, we demonstrated that the quality of OC reconstruction (improved METF as a benchmark for improved transmission) could be significantly increased by means of a RTM system. Intraoperative studies should now be conducted to investigate to which quantitative extent the intraoperative reconstruction quality can be improved and whether or not this improvement also manifests in an increased (long-term) hearing outcome. This will enable conclusions to be drawn about the contribution of the intraoperative reconstruction quality to the (long-term) hearing outcome in the context of the conglomerate of various factors influencing the postoperative hearing outcome.

Emergency Treatment of Anaphylactic Reactions in Air Rescue Missions: An Eight-Year Analysis of a German Rescue Helicopter Base.

INTRODUCTION: Anaphylactic reactions can lead to a life-threatening situation. In the event of anaphylaxis, rapid and targeted emergency treatment is indicated. STUDY OBJECTIVE: The study sought to determine the emergency therapy administered for anaphylaxis in children and adults. Focus was placed on therapy with adrenaline. In addition, the study aimed to investigate demographic data, triggers, and hospitalization rates of the different severities of anaphylaxis. METHODS: A retrospective analysis of anaphylactic reactions was conducted using data from prehospital emergency missions performed by the Air Rescue Dresden/Germany from 2008 through 2015 using the standardized application protocol EPRO-5.0 (MIND 3) anonymized. Data from 152 adults and 29 children were evaluated, focusing especially on the acute treatment as well as demographic information, triggers, and symptoms of anaphylactic reactions. RESULTS: In total, 152 adults (73 female, 79 male) from 18 to 87 years (mean 50.5 years) and 29 children (9 female, 20 male) from 1 to 16 years (mean 7.5 years) with anaphylactic reactions were analyzed. The most common trigger for severe anaphylactic reactions (Grade II-IV; classification modified according to Ring and Messmer) was food in children (33%) and insect venom in adults (59%). The data show that 19% of adults with Grade II-IV anaphylactic reactions (classification modified according to Ring and Messmer) received adrenaline. Regarding children, the appliance of adrenaline was only administered in seven percent of the cases of Grade II-IV anaphylactic reactions. Adults with Grade II or higher anaphylactic reactions were hospitalized in 92%. Three percent refused hospitalization and five percent were not transferred to hospital. One-hundred percent of the children with Grade II-IV anaphylaxis were hospitalized. CONCLUSIONS: Analysis of data from the Air Rescue Dresden/Germany shows that despite existing recommendations, only 19% of adults with severe anaphylaxis received adrenaline. Among children, only in seven percent was a treatment with adrenaline performed.On the other hand, all patients survived the acute emergency treatment without apparent adverse outcomes. Thus, further studies are needed to determine the proper use of adrenaline in anaphylactic reactions.

Measurement of middle ear transfer function in temporal bones using electromagnetic excitation: Comparison to sound excitation and evaluation of influencing factors.

Hearing a sound produces vibrations of the ossicles in the middle ear, which can be measured in the micrometer to nanometer range. Destruction of middle ear structures results most commonly from chronic inflammatory diseases. In these cases, passive and active middle ear implants are used for reconstruction of the ossicular chain. The positioning of the implants depends primarily on the surgeon's experience. So far, no objective assessment has been conducted to affirm if the chosen positioning is the best in each specific case. We have established a new method, allowing us to measure the middle ear transfer function (METF) intraoperatively. Using the new method, a magnet is placed on the umbo of the malleus handle and is stimulated by a coil positioned underneath the head. The resulting vibration is measured on the stapes footplate using Laser Doppler vibrometry (LDV). Acoustic and electromagnetic excitation show comparable METF in lower frequencies, which differ up to 10 dB in frequencies over 1 kHz. The position of the coil does not play a relevant part in the METF, whereas the location of the magnet on the tympanic membrane highly impacts the METF. This technique demonstrates reproducible results. Electromagnetic excitation is comparable to sound excitation and is suited for measuring the METF. A stable positioning of the magnet on the umbo is essential in order to acquire valid data.

Biomimetic Tympanic Membrane Replacement Made by Melt Electrowriting.

The tympanic membrane (TM) transfers sound waves from the air into mechanical motion for the ossicular chain. This requires a high sensitivity to small dynamic pressure changes and resistance to large quasi-static pressure differences. The TM achieves this by providing a layered structure of about 100µm in thickness, a low flexural stiffness, and a high tensile strength. Chronically infected middle ears require reconstruction of a large area of the TM. However, current clinical treatment can cause a reduction in hearing. With the novel additive manufacturing technique of melt electrowriting (MEW), it is for the first time possible to fabricate highly organized and biodegradable membranes within the dimensions of the TM. Scaffold designs of various fiber composition are analyzed mechanically and acoustically. It can be demonstrated that by customizing fiber orientation, fiber diameter, and number of layers the desired properties of the TM can be met. An applied thin collagen layer seals the micropores of the MEW-printed membrane while keeping the favorable mechanical and acoustical characteristics. The determined properties are beneficial for implantation, closely match those of the human TM, and support the growth of a neo-epithelial layer. This proves the possibilities to create a biomimimetic TM replacement using MEW.